AFRM eBulletin – 4 May 2018

Malnutrition continues to be “The Skeleton in the Hospital Closet” in 2018

The acknowledgement of malnutrition as one of “…the most serious nutritional problems of our time” was made by Dr Butterworth Jr in 1974 in his seminal article, “The skeleton in the hospital closet”. Forty years later, malnutrition is still a major international and Australian healthcare problem, which continues to be under-recognised, under-diagnosed and therefore under-treated.  

NSW Health Policy Directive for Nutrition Care
Since 2011, NSW Local Health Districts, Specialty Health Networks and other public health organisations have had a Nutrition Care Policy Directive Framework for the strategic and coordinated approach to nutrition care for admitted patients, including weight and height assessment, from admission to transfer of care.

The NSW Nutrition Care Policy is designed to specifically address protein-energy malnutrition. It is important to keep in mind that malnutrition can be present in patients who are a normal weight, overweight or obese, not just those that are underweight. Many patients are malnourished on admission, or are at risk of becoming malnourished during their admission.

Prevalence of malnutrition
Malnutrition is estimated to effect 20 to 50 per cent patients in the acute care setting, 30 to 50 per cent of patients in the rehabilitation setting, 40 to 70 per cent in the residential aged care setting and 10 to 30 per cent in the community setting. The prevalence of malnutrition increases by at least twofold in the elderly and those with chronic disease.

Causes of malnutrition
The cause of malnutrition is multifactorial. It develops due to a chronic shortfall between nutritional intake that does not meet nutritional needs as a result of:

  • decreased oral intake
  • increased nutritional requirements associated with a disease state
  • impaired ability to absorb or utilise nutrients
  • or from a combination of these factors. It can occur over a period of weeks or months.

Consequences of malnutrition
If not addressed, the nutritional status of patients may worsen during admission with a wide range of adverse outcomes for the patient and the healthcare system. For the patient, these include impaired immune function, delayed wound healing, increased risk of pressure injuries and higher rates of mortality at 12 months. Studies have shown an increase in about 20 per cent of hospitalisation costs from malnutrition, related to the increased number of unplanned admissions, length of stay and readmission rates.

Linked to Activity Based Funding (ABF) via Diagnosis Related Group (DRG)
Identification of malnutrition in Australian hospitalised patients is linked to case-mix funding via the DRG. Since 2008, malnutrition has been recognised as a complication for coding.  Case-mix reimbursement for malnutrition can only occur if: 1) malnutrition risk is identified, 2) malnutrition is diagnosed, 3) the word ‘malnutrition’ and an associated action plan is documented in the medical record by a dietitian, and 4) malnutrition is recognised and coded by the clinical coder.  Reimbursement potential for malnutrition has been calculated in Australian public hospitals with varying results.  A study by Rowell & Jackson in 2011 estimated that malnutrition added AUD $1,745 per admission.

Identification and diagnosis of malnutrition
Nutrition Screening describes the process of identifying patients with characteristics commonly associated with nutrition problems who may require comprehensive nutrition assessment and may benefit from nutrition intervention.  Nutrition assessment is a comprehensive approach to gathering relevant data in order to diagnose nutritional status.  The NSW Health Policy Directive for Nutrition Care states that: 1) it is mandatory to screen all patients for malnutrition using a validated tool within 24 hours of admission and then weekly during the patient’s episode of care; and that patients whose score is ‘at risk’ should be referred to a dietitian for a full nutrition assessment; and 2) it is mandatory to have a dietitian conduct a nutrition assessment and diagnose malnutrition using a validated tool for all patients whose score is ‘at risk’ on nutrition screening.

Incorporating nutrition screening in your clinical practice
Although nutrition screening is mandatory, the literature has shown that there are several barriers to the successful implementation of nutrition screening, including insufficient time, staff, education and training.  By incorporating the following two questions in patient assessments, “Have you lost weight recently without trying?” and “Have you been eating poorly because of a decreased appetite?” and referring the patients that answer “yes” or “unsure” to the dietitian, medical teams are actively initiating essential nutrition care.

Paula Carroll
Senior Clinical Dietitian – Department of Nutrition and Dietetics
Prince of Wales & Community Health Services SESLHD

A message from your President

Your present Faculty Council will hand over to a new membership in just over a week’s time.

At the outset of this post, I wish to express my sincere thanks to each member of the current Faculty Council, for good humour and clear thinking, as we have worked together over the last two years. Your Council has considered a broad range of issues, from policy matters, through educational development and training environments, to matters around explaining our identity, functions and AFRM Council - 9 March 2018 -2scope of practice as rehabilitation medicine specialists. Faculty Council has been very ably informed and supported by our Policy & Advocacy Committee, chaired by Tim Geraghty and our Education Committee, chaired by Greg Bowring, and all the constituent groups of Fellows that meet and work to underpin the work of those two committees. In particular, Steve deGraaff has been continuingly involved with various Faculty committees and working groups for 19 years now, and words cannot sufficiently express the debt of gratitude that we all owe him for such consistent endeavour.

Despite some changes during the last 12 months, the College administrative team supporting our Faculty has provided excellent continuity in all the Faculty’s activities, under the guidance of Lisa Penlington, with oversight of all Division, Faculty, Chapter and regional business. Pip Warnes, the Manager of Faculties in the College’s business structure, went off with Ava’s arrival on maternity leave, and her position has been very ably filled by Wynne Bell, who will complete her time with us on 18 May 18. We wish her well in her new consulting work outside the College. Stacey Barabash has remained a stalwart Faculty Executive Officer all year, and I am not sure how the Faculty Executive group (consisting of Tim, Greg, myself and Steve deGraaff) would have managed to maintain completely consistent direction without her input. Whilst Tim and Greg will acknowledge other College staff members’ work in their own settings, I wish to record my sincere thanks to all College administrative staff for all their hard work, often unseen to Fellows, throughout this last year.

As well as the regular transition to new memberships of Council and Committees at this time, the new College Board will take office following the RACP Annual General Meeting in Sydney on Monday, 14 May at RACP Congress at the Sydney Convention Centre. I encourage Fellows to attend that meeting, if possible. Fellows will be very well aware that the new arrangements for a smaller College Board come into force at this time. As no AFRM Fellow has been elected to the College Board, our incoming Faculty President Tim Geraghty will become our Faculty’s representative on College Council.

Because the Auckland RMSANZ / AOCPRM combined meeting is being held much later in the year than usual, the Annual Members’ Meeting of the AFRM will be held on the Saturday afternoon of the ‘Snapshots’ meeting in Melbourne on 16 June, and I encourage as many Fellows as possible to register (email for this meeting, in amongst all else that comes our way in the midst of winter. For NSW members, there will be an annual meeting in Thredbo in the last weekend in July, which is advertised elsewhere in this eBulletin.

And that’s all from me, folks – thank you and good-bye.

Associate Professor Andrew Cole
President, Faculty of Rehabilitation Medicine

RACP Congress 2018 

RACP Congress 2018 program includes engaging sessions, workshops, demonstrations, exhibits, video presentations and social functions for all Divisions, Faculties and Chapters.

The Australasian Faculty of Rehabilitation Medicine (AFRM) presentation at Congress takes place in a shared session on the Wednesday. Come and listen to the George Burniston Oration being presented by Associate Professor Michael Pollack who will be talking shifting definitions of health and illness and answering the questions;

  • What are the factors that lead to disruption in the health system? 
  • What aspects of health have been disrupted? 
  • How has this impacted the health systems?
  • What is the role of rehabilitation medicine in the evolving picture of health care?

We look forward to seeing you at RACP Congress 2018 at the International Convention Centre Sydney from 14 ​to 16 May 2018, confirm your attendance at Congress and affiliated social functions via

Trainees’ Day 2018

RACP Trainees’ Day and Trainees Dinner is an opportunity for Basic and Advanced Trainees to network and discuss professional critical topics and training pathways. We are pleased to advise that due to the generous contribution from our sponsors Trainees' Day is now AUD $50. Trainees ​who have already registered will receive a refund equivalent to the difference in ticket price. We would like to thank our sponsors: Westpac, Avant Mutual, Novartis, Professional Transcription Solutions and the NSW Government for making this reduced price possible.

Trainees Day is on Sunday, 13 May 2018, just prior to RACP Congress 2018. Trainees will meet at the RACP Office Sydney to discuss the following topics:

  • The global refugee crisis: its our responsibility
  • Australian refugees: stand up and be counted
  • How can we advocate for a brighter future?
  • Professional skills workshop: a powerhouse of presidential knowledge
  • Cognitive bias
  • Coaching and mentoring.

The Trainees' Day Dinner will be held over looking Sydney's Darling Harbour. Confirm your attendance during the Congress registration process. 

Date: Sunday, 13 May 2018 
Time: 6pm to 10pm 
Venue: Blackbird Café, 201 Sussex Street, Cockle Bay Wharf, Darling Harbour, Sydney 
Cost: $59 per person

Register and view the program on the Congress website

We look forward to seeing you in Sydney. 

Communiqué to AFRM Trainees – AFRM Fellowship Written Examinations

In anticipation of the upcoming 2018 AFRM Fellowship Written examination, the Faculty Assessment Committee would like to provide some insight into the nature of the Modified Essay Question (MEQ) component. ​We would like to take this opportunity to provide consistent information about the assessment process and reassure trainees who are sitting the 2018 examination. 

A Communique to all AFRM trainees has been prepared in regard to the MEQs. It also includes links to resources that will help candidates and supervisors prepare for the 2018 examination.

Congress session on increasing Aboriginal and Torres Strait Islander peoples access to medical specialists

The Aboriginal and Torres Strait Islander Health Committee (ATSIHC) will be discussing the Medical Specialist Access Framework. The Framework is a guide for health stakeholders to increase Aboriginal and Torres Strait Islander peoples access to medical specialists. The session is on Monday, 14 May 3.30pm to 5pm in room C2.2 and C2.3, and will include Dr Tamara Mackean, Professor Noel Hayman, Dr Catherine Yelland, Professor Donald Campbell and Dr Simon Quilty discussing their experiences in Aboriginal and Torres Strait Islander health. This is an opportunity for Fellows to consider their practice and care for Aboriginal and Torres Strait Islander people. 
Register for RACP Congress 2018 on the website.

Congress session on the RACP Indigenous Child Health statement 

An RACP Working Group is developing a statement on Indigenous Child Health in Australia and New Zealand. This is an opportunity for Fellows to participate in a session with the Working Group chair Dr Danny de Lore and Dr Niroshini Kennedy to discuss the content of the draft statement and provide important input on the direction and key messages of the statement.  Fellows are encouraged to attend to ​contribute to the development of a robust and impactful statement. The session is on Tuesday, 15 May 11.15am to 12.15pm, Cockle Bay Room 2.

Register for RACP Congress 2018 on the website

Wagga Orthotics Weekend (WOW) attracts over 50 doctors to Wagga Wagga

Wagga Wagga hosted the inaugural Wagga Orthotics Weekend (WOW) for rehabilitation trainees and physicians on 24 to 25 March 2018. The weekend was an overwhelming success with 54 participants travelling from all over Australia and New Zealand to attend. 

Five rehabilitation physicians and two orthotists provided an interactive lecture series focusing on the practical and clinical components of gait analysis, lower limb orthotic prescription, spinal orthotics, upper limb orthotics and footwear at the University of Notre Dame Riverina campus. An eleven-station patient based OSCE (Objective Structured Clinical Examination) was conducted at St Joseph’s Rehabilitation Unit, Calvary Riverina Hospital which showcased the diversity and complexity of rehabilitation patients’ needs in a regional area. 

WOW participants also enjoyed the Wagga Wagga Food and Wine Festival on the Saturday night, sampling local wine, beers, cheese and produce. 

The response from the trainees and rehabilitation physicians has been extremely positive and we are planning to run the WOW weekend biannually. The WOW weekend highlighted the interest from trainees to travel to regional Australia to attend high quality educational updates.

The event attracted positive interest from the media, including:

I would encourage all rehab trainees and those rehab physicians wanting to refresh and update their skills in Orthotic prescription and management to consider attending the next WOW weekend in 2020.

Dr Rachael McQueen 
Rehabilitation Physician, Wagga Wagga Base Hospital

Apply for funding opportunity

Applications are now open for the AFRM Education Development Grant and the AFRM Research Establishment Fellowship.

The AFRM Education Development Grant provides up to $10,000 funding to support rehabilitation medicine knowledge advancement. It can be used to gain new technical expertise, undertake training or play an active role at conferences or scientific meetings. Applications close on Monday, 28 May 2018.

The RACP AFRM Research Establishment Fellowship provides up to $50,000 funding to further rehabilitation medicine research. Applications close on Monday, 25 June 2018.

For full details about these and other research funding opportunities visit the RACP Foundation website

Neuroimaging Education Weekend and NSW AFRM Branch Meeting 27 to 29 July 2018, an invitation to all who are interested in neurorehabilitation 

The Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) has re-established the Neurorehabilitation Special Interest Group (SIG) formally under AFRM RACP. The group held its inaugural meeting on 20 September 2017 with the election of Liz Thompson as Chair and Steven Faux as Secretary. We are a diverse group of trainees, Fellows, allied health practitioners, scientists, and non-rehab doctors with a special interest in the field of neurorehabilitation. The group has 55 members and will host at least three events this year. 

The Neurorehabilitation SIG invites all members who are interested in neurorehabilitation to join their next event – Neuroimaging Education Weekend and NSW AFRM Branch meeting. The details of the event are:
Date: 27 to 29 July 2018 
Location: Thredbo Alpine Hotel, Thredbo, NSW
For more information please visit the event webpage.

Other upcoming events include:

  • Practitioners involved in spasticity management of adolescents/transition population dinner will be co-hosted by Ipsen and held on Thursday, 5 July 2018.
  • Annual meeting RMSANZ ASM, RMSANZ Snapshots weekend, 15 to 17 June 2018 in Melbourne.

The Neurorehabilitation SIG welcomes new members to the SIG. The aims of the group are:

  • To collate, disseminate and champion information, resources and educational opportunities specific to the area of Neurorehabilitation. Such as the fields of: stroke, traumatic brain injury, neurodegenerative conditions, multiple sclerosis, and neurological diseases of the peripheral and central nervous systems.
  • To recognise, disseminate and represent at an executive leadership level knowledge regarding neurorehabilitation principles and standards, such as liaison and representation on the National Stroke Foundation executive.
  • To facilitate the development of sub-specialist NeuroRehab interest groups such as in the field of Acquired Brain Injury secondary to Cancer, with the aim of promoting development of a Cancer SIG.
  • Other sub-speciality groups of the future may include the development of a sub-specialist interest group for ‘Transition’ and ‘Intellectual/Developmental Disabilities’.
  • Placing a bid to host the World Congress in Neurorehabilitation (2022).

For anyone interested in joining the group or attending one of the events, please contact 
Annalise Papadakis via email at

Dr Liz Thompson
Chair, Neurorehab SIG

2018 AFRM Annual Training Meeting – A great success 

The 2018 Australasian Faculty of Rehabilitation Medicine (AFRM) Annual Training Meeting was held 21 to 22 April in Sydney. The event attracted almost 80 participants across Australia and New Zealand.

Thank you to the many individuals who contributed to the success of the event. A special thank you to the speakers who shared their time and expertise during the event, and the 2018 AFRM ATM Program Committee for their commitment. 

For participants who attended, don’t forget to complete the feedback survey. Your feedback is important so that we can improve on future ATMs and events. The presentation slides are available on the AFRM Training Resources page. The audio recordings will be available once editing is complete. Please note presentation slides and audio are edited at the request of the presenter/s.

Regional Committee elections

Following a recent call for nominations, elections are being held for elected positions on ​a number of RACP Committees.

Detailed election information, voting instructions, forms, candidate information, Committee Member Position Descriptions and Committee By-Laws can be found on the RACP website. Voting closes at 5pm AEST on Friday, 25 May 2018. 

Expressions of Interest for RACP Councils and Committees

Expressions of Interest are being sought for a number of appointed positions.  Available positions are listed on the RACP website along with position descriptions, By-laws for each Council or Committee and the forms you will need to complete the process.

New Evolve Recommendations to Improve Child Neurology Care

As part of the Evolve initiative, the Australia and New Zealand Child Neurology Society and the RACP have released a new series of recommendations to help avoid unnecessary tests, treatments and procedures carried out in child neurology clinical practice. 

Read more on the Evolve website

Slow-release opioid statement

Mounting evidence highlights the inappropriate use of slow-release opioids for the treatment of acute pain. The Australian and New Zealand College of Anaesthetists (ANZCA) and its Faculty of Pain Medicine have released a statement which is designed to inform and recommend action.

Recommendations in the statement align with the approved indications for slow-release opioids listed by domestic and international regulatory authorities.

Cochrane Rehabilitation eNewsletter Issue 7 is now available 

The Cochrane Rehabilitation eNewsletter (April 2018) is now available for members.
Cochrane Rehabilitation serves as a bridge between Cochrane and the Rehabilitation community and its stakeholders.

The Newsletter contains an update on the Cochrane Rehabilitation activities, Cochrane Systematic Reviews and blogshots of rehabilitation interest.

Biologicals Regulatory Framework proposed changes to start on 1 July 2018

The TGA have published guidance on the upcoming changes to the regulation of autologous human cells and tissues (HCT) products. This is to assist you in interpretation of new requirements that are likely to come in to effect from 1 July 2018 (subject to Government approval).
As a result of the changes some autologous HCT products will be subject to increased regulation by the TGA from 1 July 2018. These changes will improve patient protection from providers of unproven therapies, ensure patients have access to safe and effective new therapies, and support a patient-prescriber relationship to access appropriate treatments.
The increase in regulatory oversight from 1 July will include a prohibition on advertising autologous HCT products to patients, and a requirement to report adverse events. Transition arrangements will be included for the other regulatory requirements, with the intention for the provisions to balance the need for increased oversight of this sector, while allowing sufficient time for providers to bring their operations in line with the new requirements. These provisions will allow continuing supply until June 2019.
The guidance also includes an explanation of key terms, new definitions for classifications of biologicals, minimal manipulation, homologous use and regulatory pathways for supply of autologous HCT products. Examples have been used throughout the guidance document to clarify how the definitions operate in practice.
We encourage you to familiarise yourself with this guidance ahead of regulatory changes in July 2018. 
If you have questions or feedback please contact the TGA directly at

Adverse ​Events Reporting Survey

Analysis of adverse event reports is an important way that the Therapeutic Goods Administration (TGA) monitors the safety of medicines and vaccines used in Australia.

Health professionals play an important role in ensuring the safe use of medicines particularly by reporting adverse events they see in clinical practice for new medicines. 

The TGA are undertaking an online survey to seek information about health professionals’ experiences and attitudes towards key issues related to medicines and their use, particularly related to identifying, managing and reporting adverse events. Your responses will help the TGA improve the way they collect and use adverse event reports.

The survey is available ​online and is estimated to take about 10 minutes to complete.

Note: All responses are anonymous and this survey does not collect any personally identifying information.

Career opportunities

Specialist Rehabilitation Physician, Masada Private Hospital, St Kilda East, Melbourne
Locum Rehabilitation Physician - 0.4EFT, Royal Talbot Rehabilitation Centre, Kew Melbourne

The Queensland RMO Campaign will open on Wednesday 6th June 2018. All applications for Rehabilitation Registrar Positions and Hospitals must be lodged through the Queensland Health on-line application system (RMO Campaign).

Trainee events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

Go to the events list at any time to see what events are coming up.

AFRM ​training resources

Bi-National Training Program (BNTP) 

Important note: If you join the session late, the videoconference room will indicate that it is locked and will not allow you to connect. Please ensure that you turn your webcam off before you join the session. Due to the nature of the recordings if you connect to the videoconference with your webcam on you will appear on the screen. 

To join the videoconference on the day, follow this link to the Zoom Software.

Please note this is the URL embedded in the above link: 

The meeting ID: 389 913 1497 

Email the RACP events team at or call +61 2 8247 6240 to arrange equipment testing. Ensure you do this as soon as possible to avoid any last-minute disruptions.

Go to the events list at any time to see what events are coming up.

NSW Saturday Lecture Series
Go to the events list at any time to see what events are coming up.

​AFRM contact details 

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315

AFRM Education and Training inquiries:
Name: Kathleen Walker, Education Officer
Phone: +61 2 8076 6350

AFRM Oral Examination inquiries:
Name: Irene Atsiaris, Examination Coordinator 
Phone: +61 2 9256 5422

AFRM training site accreditation inquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
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