Conditions
- Burns
- Cancer:
- cancer-related pain
- chemotherapy-induced peripheral neuropathy
- chemotherapy-related fatigue
- cognitive dysfunction
- decreased exercise tolerance
- functional decline
- global and specific deficits due to primary or secondary brain tumours and treatment
- physical effects of other solid tumours and haematological malignancies and their treatment
- psychological distress
- sarcopenia
- Lymphoedema:
- Steroid myopathy
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
- Graft versus host disease
- Radiation fibrosis
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
Burns
- Burn depth
- The rule of nines to assess total body surface area
- Types and complications of burns
Lymphoedema
- Anatomy and physiology of the lymphatic system
- Degree of impairment of lymphatic system and presence of complications, e.g. cellulitis, obesity, dependency
- Epidemiology of lymphoedema in Australia and Aotearoa New Zealand:
- aetiology
- community cost
- incidence and prevalence
- mortality and morbidity
- Pathophysiology of primary, secondary, and infective lymphoedema and associated disorders such as lipoedema, phlebolymphoedema, and dependent lymphoedema
- Stages of lymphoedema; lymphoedema grading
Investigations
- Burn Specific Health Scale (BSHS)
- Cognitive assessment
- Formal assessment of the patient’s premorbid functional status
- Full physical examination
- Functional assessment tools, e.g. Barthel Index (BI), functional independence measure (FIM), Eastern Cooperative Oncology Group (ECOG) Performance Status, Karnofsky Performance Status (KPS)
- Physical examination
Examinations
- Imaging
- Lymphoscintogram
- Vascular investigations
Important specific issues related to burns
Scar management and burn therapy
- Activities of daily living (ADLs) participation
- Ambulation
- Compression garments – bandaging, pressure garments
- Deconditioning and impaired physical condition
- Exercise
- Factors affecting outcome after burns
- Heterotopic ossification
- Joint care and protection
- Massage
- Oedema management
- Orofacial contracture management
- Pain management:
- acute and sub-acute pain
- long-term pain management:
- bone pain
- malignant pain
- neurogenic pain
- palliative care
- postoperative
- tumour resection
- wide local excision (WLE) after acute burns, during dressing changes
- Psychosocial component of patient care, and the importance of counselling and relaxation methods
- Range of movement to end of range
- Silicone and scar softening products
- Skin care
- Splinting and positioning
- Swallowing and communication impacts
- Sexuality and fertility, including pregnancy management post-burns, risk to foetus from medications
Important specific issues related to cancer
- Preventative rehabilitation (prehabilitation)
- Restorative rehabilitation
- Supportive rehabilitation
- Palliative rehabilitation
Treatment of cancer pain
- Other therapies and physical modalities
- Treatment choices
- Types of medication
Important specific issues related to lymphoedema
Dietary and nutritional advice based on assessment
- Associated medical disorders
- Body weight and fat
- Medication
Elements of patient care for lymphoedema
- Compliance with previous recommendations
- Patient care coordination
- Progression of lymphoedema and disability
- Suitable facilities for care
Individual and group education
- Benefits of exercise and lifestyle changes
- Importance of risk factor management
- Lymphoedema
- Patient’s specific disability
Medical and surgical management of lymphatic diseases
- Contraindications
- Indications
- Phase I and phase II lymphoedema management following the diagnosis of primary or secondary lymphoedema
- Patient’s participation in self-management, including:
- compliance in compression garment use
- self and carer massage exercise
- Prescription of exercise
- Rehabilitation evaluation that identifies aetiology, degree of impairment of lymphatic system and presence of complications, e.g. cellulitis, obesity, dependency
- Side effects of drugs
Organise therapy program
- Education
- Elevation
- Exercise
- Exercise in compression
- Management of concomitant medication condition, including pain and discomfort
- Manual lymphatic drainage (decongestive lymphatic therapy)
- Multilayer bandaging
- Prescription of compression hosiery or garments
- Psychosocial support
- Skin care
Patient support
- Compliance with previous recommendations
- Progression of lymphoedema and disability
- Psychological support
Psychosocial issues
- Anxiety and depression following post-cancer lymphoedema
- Current life stresses, including financial and marital issues
- Response of family to patient’s illness and disability
- Vocational assessment as required, including evaluation of physical and psychosocial demands of work
Rehabilitation emphasises four elements of patient care
- Detection and management of significant psychosocial dysfunction contributing to or arising from lymphoedema or primary cause of secondary lymphoedema, such as breast cancer or melanoma
- Education of patient and family with regards to management, risk factor modification, lifestyle change, and exercise
- Medical assessment and monitoring of risk factors, especially cellulitis
- Self-management in maintenance phase
Risk factors for lymphoedema
