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
