Geriatric medicine curriculum standards
Knowledge guide
LG 26: Rehabilitation of specific conditions as applied to ageing
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will describe the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the indications for, and how to interpret the results of these investigations, procedures, and clinical assessments tools.
Advanced Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
Presentations
- Amputations
- Deconditioning after acute illness
- Decreased exercise tolerance
- Dyspnoea
- Falls and balance disorders
- Functional decline
- Post-chemotherapy
- Postoperative
- Post-stroke
- Rehabilitation prior to surgery or chemotherapy (prehabilitation)
- Speech, language and swallowing disorders
- Trauma
Conditions
- Cardiovascular conditions
- congestive cardiac failure
- ischaemic heart disease
- peripheral vascular disease
- valvular replacement
- Critical illness myopathy
- Delirium
- Dementia
- Multimorbidity
- Musculoskeletal conditions
- amputation
- fractured long-bones, e.g. femur
- inflammatory and degenerative joint disease
- joint replacement, e.g. hip, knee
- other fractures
- Respiratory conditions
- infections, including post-viral
- obstructive lung disease
- restrictive lung disease
- Neurological conditions
- movement disorders
- stroke
- Pain
- acute pain
- chronic pain syndromes, e.g. fibromyalgia
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Acquired brain injury
- Guillain-Barré syndrome
- Post organ / marrow transplantation
- Spinal cord injury
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients* and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Different types of exercise activity, such as aerobic, resistance, balance, and flexibility, and how these may be used to achieve different outcomes
- Impact of pre-existing health conditions and disability on physiological and functional reserve
- Pathophysiology of physical deconditioning
- Physiology of fitness and conditioning - body systems that contribute to fitness and strength
- Underlying trajectories of disease and the impact on rehabilitation response
Examinations
- Cognitive assessment
- Comprehensive geriatric assessment
- Formal assessment of premorbid functional status
- Hearing and vision tests
- Mental state examination and screening for depression
- Physical examination
- Rehabilitation outcome measurement tools
- functional assessment tools, e.g. Barthel, functional independence measure (FIM), Katz ADL, Lawton-Brody ADL
- mobility assessment tools, e.g. timed up and go, 6-minute walk test, short physical performance battery
Investigations
- Targeted investigations based on patient’s presentation, such as echocardiogram and respiratory function tests in a patient with breathlessness
Medical aspects of rehabilitation
- Delirium prevention and management
- Identifying and optimising management of multimorbid conditions with complex competing needs, to facilitate rehabilitation participation
- Managing intercurrent illness to minimise impact on function
- Neuroplasticity
- Prescribing and/or de-prescribing where appropriate
Principles of rehabilitation
- Adapting function to environment, e.g. mobility and environmental aids, role of orthotics and prosthetics
- Advocacy for rehabilitation needs of the older person
- Benchmarking of clinical rehabilitation outcomes using Australasian data sources
- Collaborative practice within the multidisciplinary team, including case management and team leadership
- Recognise the specialist expertise of rehabilitation medicine physicians
- Identifying individual and systemic barriers to improved activity and participation
- Identifying the most appropriate environment and setting for ongoing rehabilitation, e.g. inpatient, outpatient, home-based, residential aged care
- Measuring progress through
- optimising, restoring, and maintaining function
- patient-centred goal setting and prioritisation
- role of members of the multidisciplinary team
- World Health Organization International Classification of Functioning, Disability and Health (ICF / ICD) framework
Psychosocial aspects of rehabilitation
- Assessing fitness to drive
- Assisting patients and their family or carers to adapt to the consequences of disability
- Managing expectations of family or carers
- Patient’s mood and motivation, and its impact on rehabilitation participation
- Role of family or carers as rehabilitation support partners
- Role of psychological support
Specific rehabilitation interventions
- Understand indications, contraindications, and benefits of:
- exercise programs
- hydrotherapy
- musculoskeletal joint injections, e.g. intraarticular corticosteroid injection, Botox injection