Rehabilitation medicine curriculum standards (adult)
Knowledge guides
LG 20: Rehabilitation of other specific conditions
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.
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:
- benign
- malignant
- 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
- Cellulitis
- Obesity