General Rehabilitation Medicine

The purpose of outlining scope of general rehabilitation medicine practice is to established parameters for rehabilitation medicine physicians who hold Fellowship of the AFRM.

The AFRM's focus on interdisciplinary training and teamwork makes the rehabilitation medicine physician the best qualified specialist to lead teams of allied health staff, nurses and other medical practitioners (specialists or general practitioners) in providing coordinated, patient-focused, individualised programs of goal-directed rehabilitative care.

General Rehabilitation Medicine is a:

• Principal Medical Specialty in Australia and a Vocational Scope of Practice in New Zealand
• diverse specialty whose members are trained to facilitate the best possible recovery of function over the full range of common and uncommon medical and surgical conditions seen in contemporary practice
• practice that's collaborative and involves input from a diverse range of health care professionals focused on optimizing the health and well-being of those with short-term or long-term disability

General Rehabilitation Medicine physicians:

• use knowledge and skills – developed through the AFRM training program, equivalent overseas or post-fellowship training – to manage all patient types with medical, musculoskeletal, neurological and neuromuscular disorders with an emphasis on maximising functional ability and quality of life
• practice, diagnose and treat patients from adolescence and young adulthood through to the very elderly
• can manage children in certain circumstances but generally don't provide a full range of rehabilitation services to children – see Paediatric Rehabilitation Rehabilitation Scope of Practice
• treat patients affected by function limiting and/or painful conditions involving the central, peripheral and autonomic nervous systems, the cardiopulmonary system and the musculoskeletal system as well as those who experience disability due to illness or injury affecting other body systems
• hold a unique blend of education, training and experience which makes the rehabilitation medicine physician an ideal treating or consulting physician for patients who have impaired function due to debility and deconditioning, including older patients and those with reduced function as a result of chronic diseases or other complex health conditions
• are experts in the assessment, treatment and management of people with permanent disability as a result of injury or illness
• are well placed to manage patients with occupational or sports-related musculoskeletal or neuromuscular injuries
• use appropriate laboratory and imaging studies, but they are also trained in the clinical interpretation of other diagnostic studies that evaluate musculoskeletal and neuromuscular systems such as CT, bone scan, MRI, and musculoskeletal ultrasound
• are specially trained in the use of therapeutic exercise, orthotics, prosthetics and other rehabilitation equipment and modalities and can prescribe these precisely to meet the patient’s specific needs
• may engage in the delivery of health services through new models of care and modalities like in-reach rehabilitation, early supported discharge, rehabilitation in the home and other community rehabilitation and integrated care models, reablement and restorative models of care, ambulatory care services as well as virtually via telerehabilitation
• possess a holistic approach, experience in integrated care with primary care physicians and training in leading interdisciplinary teams
• are skilled in secondary and tertiary prevention for ambulatory patients in the community e.g. in ambulatory care services and interdisciplinary falls prevention services, as well as for patients who have stroke, neurological or musculoskeletal conditions, osteoporotic fractures or fragility, to prevent relapse or recurrence of injury or to improve function or quality of life

Rehabilitation Medicine physicians who have completed Rehabilitation Medicine specialty training have adequate training in the following areas:

1. Inpatient and outpatient musculoskeletal and neurological assessment, diagnosis and rehabilitation.
2. Acute and persistent pain management.
3. Injury prevention, conditioning, fitness and wellness.
4. Non-surgical spine medicine and rehabilitation.
5. Rehabilitation management of sports and sports injuries.
6. Rehabilitation management of occupational injuries and vocational rehabilitation.
7. Therapeutic and diagnostic injection techniques, such as trigger point, soft tissue and joint injections.
8. Assessments of function, disability and impairment.
9. Prosthetic and orthotic prescription.
10. Mobility aid, wheelchair and seating prescription.
11. Rehabilitation management of patients with (upper and lower) limb amputations or limb deficiency.
12. Rehabilitation management of patients with acquired brain injury.
13. Rehabilitation management of patients with spinal cord impairment through injury or disease.
14. Management of spasticity, dystonia and hypertonia.
15. Rehabilitation management of rheumatological and other joint diseases and arthroplasty (pre- and post-surgery) and post-fracture rehabilitative care.
16. Tissue disorders such as burns, ulcers, lymphoedema and wound care.
17. Rehabilitation management of older people, including the management of frailty and geriatric syndromes.
18. Rehabilitation management of pulmonary and cardiac conditions.
19. Rehabilitation management of oncological conditions (pre- and post-treatment, and recovery).
20. Rehabilitation of patients who are debilitated or deconditioned as a result of multi-system disease, prolonged immobilisation or prolonged hospitalisation.
21. Rehabilitation and coordination of care and management of individuals with developmental and intellectual disorders such as cerebral palsy, spina bifida and other congenital disorders.
22. Long term management of the person with disability, in liaison with the individual, their family and their general practitioner and other healthcare providers.
23. Chronic diseases management, particularly in secondary and tertiary prevention, to prevent relapse or recurrence of conditions, and improve function and quality of patients, e.g. falls prevention, osteoporotic re-fracture prevention.
24. Leadership and clinical and administrative management of rehabilitation medicine services and other related clinical services.

In addition, some rehabilitation physicians can demonstrate qualifications and expertise that qualifies them to practice in other areas:

1. Interventional diagnostic and therapeutic spinal and peripheral pain management procedures utilising x-ray and ultrasound guidance
2. Interventional techniques for spasticity management
3. Electrodiagnostic medicine
4. Manual medicine techniques
5. Assessment of capacity and of permanent impairment, preparation of medical and medico-legal reports and provision of expert medical opinion in rehabilitation medicine

Scope of Practice — General Rehabilitation Medicine (PDF)

Paediatric Rehabilitation Medicine

The purpose of outlining scope of Paediatric Rehabilitation Medicine practice is to established parameters for Rehabilitation Medicine physicians who hold Fellowship of the AFRM and provide rehabilitation services to children and young people aged 0 to 18 years.

Paediatric Rehabilitation Medicine:

• involves the interdisciplinary care of children with acquired and congenital disabilities with an emphasis on maximising functional independence
• includes the provision of comprehensive rehabilitation services to children and young people with disability due to injury or disease
• aims to enable the highest possible level of physical, mental and social functioning
• treats inpatients, non-inpatients and in the community with congenital or acquired neurological, musculoskeletal and genetic conditions resulting in functional impairments for which rehabilitation is assessed to be beneficial in reducing the effects of disability
• requires the coordinated efforts of an interdisciplinary team

The core competencies in Rehabilitation Medicine include but are not limited to:

• patient medical and rehabilitation evaluation
• patient medical and rehabilitation management
• patient and family education and support
• administration and leadership
• prevention
• continuing medical education
• clinical research
• quality management

Paediatric Rehabilitation Medicine physicians:

• on occasion provide rehabilitation services to adults who have experienced congenital or paediatric onset conditions. Reference to the Scope of Practice for Adult Rehabilitation Medicine.
• interests and expertises are not exclusive to holders of Fellowship of the AFRM
• completion of training enables them to provide leadership to interdisciplinary teams in the provision of coordinated, patient and family-centred and goal-directed rehabilitation programs
• recognise their own abilities and limits in the context of the rehabilitation team, provide advocacy for their patients and their families and defend their rights in society
• are expected to continue to develop their competencies to ensure a high level of patient care throughout their practice
• attitudes and behaviours for professional practice include:
  • patient focus
  • professional role
  • maintenance of professional standards
  • interdisciplinary management
  • patient advocacy

The AFRM affirms that all physicians who have completed Paediatric Rehabilitation Medicine specialty training have adequate training in the following areas:

1. Inpatient and outpatient medical and rehabilitation management of children and young people with musculoskeletal or neurological conditions requiring rehabilitation.
2. Assessment of body structure and function impairments, activity limitations and participation restrictions, and evaluation of the potential for rehabilitation.
3. Communication with other health practitioners including other health disciplines in the formulation and execution of rehabilitation plans.
4. Promotion of prevention and/or early identification and management of conditions that may result in worsening/progressive disability.
5. Rehabilitation assessment and management of children and young people with cerebral palsy.
6. Management of hypertonia and hyperkinesia, including provision of interventions such as botulinum toxin A injections, phenol nerve blocks, management of intrathecal baclofen pumps and the selection of children and young people for selective dorsal rhizotomy or deep brain stimulation.
7. Rehabilitation assessment and management of children and young people with acquired brain injury.
8. Rehabilitation assessment and management of children and young people with congenital and acquired limb deficiencies.
9. Assessment for and prescription of assistive equipment including orthotics, prosthetics, mobility aids and communication devices.
10. Rehabilitation assessment and management of children and young people with neural tube defects.
11. Provision of information and support at antenatal counseling sessions in regard to likely outcomes for children born with neural tube defects or congenital limb deficiencies.
12. Rehabilitation assessment and management of children and young people with spinal cord injury or disease.
13. Assessment of skin care and management of wounds.
14. Rehabilitation assessment and management of children and young people with neuromuscular conditions.
15. Rehabilitation assessment and management of children and young people with musculoskeletal conditions.
16. Rehabilitation assessment and management of children and young people with developmental/genetic/chromosomal syndromes resulting in physical disabilities.
17. Provision of appropriate services to enable effective and timely transition to adult services for young adults with complex and chronic disabilities.

The scope of practice has been written with reference to:

1. Australasian Faculty of Rehabilitation Medicine (AFRM) Rehabilitation Physician Scope of Practice Adult Rehabilitation Medicine (November 2017).
2. The Royal Australasian College of Physicians (RACP). Physician Readiness for Expert Practice Training Program (PREP). Paediatric Rehabilitation Medicine Advanced Training Curriculum (December 2013).
3. RACP Advanced Training in Rehabilitation Medicine. 2015 Program Requirements Handbook. AFRM (2016).
4. RACP Advanced Training in Paediatric Rehabilitation Medicine. 2016 Program Requirements Handbook. AFRM, Paediatrics and Child Health Division (2016).

Scope of Practice — Paediatric Rehabilitation Medicine (PDF)

Bi-National Training Program (BNTP)

The AFRM conducts the BNTP on the last Wednesday of every month from February to November. These training lectures are broadcast across Australia and Aotearoa New Zealand. 

Note: These sessions are not intended to prepare trainees for the AFRM Fellowship Examinations.

Upcoming BNTP lecture information can be found on the RACP events list.

Join the BNTP

Lectures are currently online attendance only and pre-registration is required. After registering, a webinar link will be emailed to you. To register, view the lecture you wish to register for on the RACP events list.

Recordings and presentation slides

Recordings and presentation slides that AFRM have permission to publish, are uploaded to the AFRM training resources page following each lecture. Trainees will require their MIN and password to access this material.

NSW Lecture Series – Wednesday sessions

The AFRM conducts the NSW Lecture Series on the last Wednesday of every month from February to November. All AFRM trainees are welcome to join the lectures.

Upcoming NSW Lecture Series information can be found on the RACP events list.

Join the NSW Lecture Series

Lectures are currently online attendance only and pre-registration is required. After registering, a webinar link will be emailed to you. To register, view the lecture you wish to register for on the RACP events list.

Recordings and presentation slides

Recordings and presentation slides that AFRM have permission to publish, are uploaded to the AFRM Training resources page following each lecture. Trainees will require their MIN and password to access this material.

AFRM Trainees' Webinar series

On AFRM resources, you will find out more about the AFRM Trainees' Webinar series, formerly known as the AFRM Annual Training Meeting, including a video archive.

This is an annual event where trainees can learn exam preparation tips, the transition from trainee to Consultant and brush up their knowledge on other key rehabilitation medicine topics included in the curriculum.