Rhaïa August 2018

Guest editor – Associate Professor Michael Pollack

I am honoured to be invited to provide some editorial comment in this edition of RHAIA. In my opinion, RHAIA has always been a strong representation of the trends and philosophies of our Faculty. This edition is no exception, with the original articles demonstrating how rehabilitation medicine looks to the future, as well as learning from its past. Indeed, all of the articles in this edition provide us with quite clear pointers for directions in our immediate future, as well as hints of what the horizon may look like. 

The article by Dr Louis Baggio presents us with a Rehabilitation Model of Care that explores the opportunities that exist in Rehabilitation Outreach. This model, currently working with its hub at Wagga Wagga Base Hospital, highlights a number of important points for all of us. The first of these, highlighted by Dr Baggio himself, is that this model helps move the patients closer to home as quickly as possible.  Other points include the fact that this outline highlights the value of emphasising outreach as a valuable and available model of care that all of us should be considering.The funding model being used in the spoke hospitals in this model is also of significant interest. For me however, one of the most important points raised is that this model demonstrates important foundations for delivering the expanding role of technology in the process of Rehabilitation, especially as it is one step closer to being able to utilise these technologies in delivering rehabilitation directly in the home of our patients to facilitate patients/clinician interactions, patient monitoring, and other potential opportunities.

The article by Dr Ben Chen, looking at acute inreach rehabilitation looks at what might be considered by many as the other end of the rehabilitation spectrum from outreach. Dr Chen’s thoughtful article comments nicely on the strength and limitations of the ‘traditional’ inpatient rehabilitation model. Dr Chen shows us that by throwing away complacency with the traditional model, and re-distributing some of the funds from the inpatient unit to an inreach service there has been benefit for the patient journey, the patient outcomes, the outcomes and benchmarks of the acute inpatient hospital, as well as helping rehabilitation medicine and rehabilitation services to be better recognised and more integrated into health systems generally. Surely, there will be increasing demand for this type of rehabilitation model as more pressure is placed on acute hospitals (and the health dollar generally) in coming years.

Professor Farey Kahn and Professor Mary Galea present us with a tantalising taste of what assistive and robotic devices can do to enhance the outcomes for our neurological patients in particular. In this rapidly expanding field, with a growing evidence base, the Professors highlight that this technology can, and should be used not only for improved exercise and therapeutic process, but also for how it modifies the human to environment interface, and the interactions at and beyond this interface.  The Professors however raise the big question of why is the uptake of this technology so slow here in Australia and New Zealand.

Finally, Dr Jim Lavranos takes us on a journey to navigate the future of prosthetic technology. Dr Lavranos reminds us of the drivers for technological advances in prosthetics, and explores all of the opportunities for evolution and expansion for improved prosthetic design, manufacture, fit, and function. His explorations remind us of the increasing potential role of technicians, engineers, and designers in our rehabilitation world, and potentially within our rehabilitation teams. Having however opened the door to expose the view of what is being achieved in this area, he leaves us with a strong note of caution and highlights that ‘gimmickry and spin’ can entice us down a road that is fraught with risks, and challenges.  I think that such a warning is relevant not only in the field of prosthetics, but across a broader context as the temptations to move away from evidence, and grasp the somewhat less substantial (but often more inviting) fantasies of ‘Tomorrow-land’ become ever more difficult to resist.

The trends in rehabilitation of evolving models of care and increasing use of technology are well exemplified in these articles, together with appropriate flags of caution in whatever we may choose to embrace.  I commend to you this edition of RHAIA.  There is a lot to learn from each of these articles.

An innovative, integrated model of care for community rehabilitation services – the Murrumbidgee Local Health District Outreach Rehabilitation Service

By Dr Louis Baggio – Consultant Physician in Rehabilitation Medicine and Director of Rehabilitation Services at Wagga Wagga Base Hospital. 

The document Rehabilitation Medicine Physicians delivering integrated care in the community outlines examples of how rehabilitation physicians are involved in providing integrated care. I would like to further expand on one of the examples outlined: the Murrumbidgee Local Health District Outreach Rehabilitation Service as an innovative integrated hub and spoke model of care.

This model of care is the first of its kind in NSW. The Outreach service provides both inpatient and ambulatory care. The Wagga Wagga Base Hospital (WWBH) is the hub with Temora, Tumut and Narrandera district hospitals being the outreach spokes. Inpatient medical supervision is provided by the patient’s usual general practitioner or a general practitioner with VMO rights in the outreach hospital and nursing care is provided by existing nursing staff. The rehabilitation program is provided by a team that consists of a rehabilitation physician, coordinator, physiotherapist and occupational therapist based at the WWRRH hub and a full-time allied health assistant at each of the outreach hospitals. The hub physiotherapist and occupational therapist and allied health assistants are newly funded positions.

Typically, most outreach inpatients have been initially admitted to WWBH acutely. Some are acute inpatients in the peripheral hospitals being referred by their GP. The acute inpatients are referred by their admitting team or identified by the rehabilitation coordinator. Once stable, they are reviewed by a rehabilitation physician to determine goals. The hub team see the person and document the program to be implemented by the spoke team. The GP is contacted directly to accept transfer of care. Documentation is electronic as all sites in the MLHD have access to eMR (electronic medical records). The person is entered into the transport portal and once a bed is available then transfer occurs. Admission FIM, impairment codes and adjunct data are collected prior to transfer.

The physiotherapist and occupational therapist visit each site weekly to monitor progress and change therapeutic interventions as required. Telehealth with videoconferencing (PEXIP platform via standard desktop and laptop computers) is utilised for day-to-day allied health assistant supervision, weekly multidisciplinary team case conference meetings, patient education/therapy and rehabilitation medicine physician-patient consultations. The rehabilitation medicine physician liaises with the general practitioner at the commencement of an inpatient program and during the program as required.

Discharge data for funding (Synpatix) and AROC outcomes are collected by the spoke team. FIM training and accreditation has been implemented. Another innovation for NSW Health is these inpatients in the spoke sites are subacute activity base funded as compared to block funding for the acute inpatients in these district hospitals.

The outreach team also provides an ambulatory (both outpatient and home based) service to people living in or near Tumut, Narrandera and Temora. People can be referred directly from the community or a continuum of care can be provided to the outreach inpatients once discharged. 

Currently, the physiotherapist employed locally at Temora visits West Wyalong (one hour northwest of Temora) weekly to provide therapy. Shortly, we will be undertaking a three month trial of the Temora Allied Health Assistant attending West Wyalong weekly to provide follow up interventions for people discharged from Wagga Wagga or Temora requiring further rehabilitation.

In summary, the true benefit of this service is the provision of rehabilitation programs closer to home for people living in rural communities with less complex needs utilising the combined expertise of existing local services, general practitioners and the specialist outreach rehabilitation team. This service model is the first of its kind and exemplifies the role of rehabilitation medicine physicians in the delivery of integrated care for people living in rural and regional communities.

Acute Inreach Rehabilitation – meeting the challenges today and ahead

By Dr Ben Chen

“Every referral is a vote of confidence” was the sagely advice of Dr Stephen Buckley that left an indelible impression on the mind of one young rehabilitation physician after an ASM some years ago.

Indeed, each referral is not just a vote of confidence, but carries a weight of expectation – expectations from our colleagues, from the health system, and from patients and their families, of what a rehabilitation physician could do, or sometimes should do, for them.

In a health system straining to care for ever older, sicker, frailer and more complex patients, the ability to meet, or at least manage, expectations from multiple fronts has become a core skillset for a rehabilitation physician, and a major challenge for the rehabilitation system of care that he / she is part of.  

The traditional model of inpatient rehabilitation has several strengths that have served it well over the years. However, the same strengths are also becoming its Achilles heel in a health system that’s increasingly focused on responsiveness, throughput and cost-effectiveness.

Characteristics of Traditional Inpatient Rehabilitation Unit

Characteristic

Strength

Limitation

Stable patient cohort

Ability to focus on provision of rehabilitation and functional improvement

  • Increasingly, this cohort is managed in the community (eg joint replacements)
  • Unable to address the functional need of patients being treated for acute illness
  • Contributes to perception that rehabilitation is of secondary importance

Weekly case conference

Stable predictable routine that allows comprehensive assessment and goal planning

  • Relatively low throughput
  • Relatively inefficient in meeting the need of those who require short rehabilitation

Defined infrastructure, staffing and geographic location

Well controlled environment conducive to rehabilitation in terms of therapy and routine.

  • Costly in terms of set up and maintenance
  • Unit capability limited by infrastructure, staffing and location (eg stand-alone units) and may not meet the need of potential rehabilitation candidates
  • Fixed number of beds which can be too many, or too few

It is against this background, and in the context of an organisational restructure, that the Rehabilitation Service at Gold Coast Health launched the Rehabilitation Response Team, a team that combined the traditional function of rehabilitation assessment with the ability to provide a small number (10) of Acute Inreach Rehabilitation packages in a co-management arrangement with the acute teams. Early results are viewable in this Powerpoint document.

Following its successful implementation at Gold Coast University Hospital in March 2016, the inreach model was rolled out in Robina Hospital in July 2017. From 2015 to 2018, the rehabilitation service has been able to reduce its bed-base from 82 inpatient beds located over three campuses in 2015, to 52 inpatient beds and a combined total of 16 inreach packages across two campuses currently. At the same time, the service has continued to manage similar number of referrals and inpatient admissions.

 

2015

2016

2017

Total number of rehabilitation referrals

 

2,122

 

2,127

 

2,137

Total number of inpatient admissions

1,083

1,078

945

Total number of RRT admissions

 

335

503

The Rehabilitation Response Team is particularly useful in helping to manage spikes of referrals common in winter months. Prior to the commencement of the Rehabilitation Response Team, a patient referred to rehabilitation during peak season could potentially remain in the acute ward for several days, resulting in further functional deterioration and requiring longer time in rehabilitation. The RRT has been able to intervene early and often discharges the referred patients from acute wards, avoiding an inpatient rehabilitation admission altogether.

An acute inreach model of rehabilitation such as Rehabilitation Response Team in Gold Coast Health is proving to be a viable complement to the traditional model of inpatient rehabilitation, offering greater degree of responsiveness to demands, comparable if not superior functional outcomes, extending rehabilitation to patient cohorts previously not reached by the traditional model, and meeting the expectations of the referring services and the broader health system.

Acknowledgements:

  • hard working team members of Rehabilitation Response Team
  • district executives – for listening and supporting the initiative
  • colleagues who make the referrals to us – thank you for your vote of confidence
  • the inreach team in St. Vincent’s Hospital, Sydney – for guidance and advice on setting up the service

Assistive and robotic devices

By Professors Fary Khan and Mary Galea

Technological advances have led to the development of assistive and robotic devices that have potential to enhance physical rehabilitation, and task-specific practice. In therapeutic settings these devices can tap into ‘Neuroplastic’ processes, which can aid recovery following neurological insults (stroke, MS etc.). Neuroplasticity is the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganising its structure, function and connections. The brain is a self-organising system that adapts to its specific environment throughout life, in the absence of external pressures. Understanding adaptive behaviour in response to nervous system injury requires an understanding of the interaction and continuous feedback between the nervous system, the body and environment.

Post-injury experience is a potent modulator of recovery of function. Laboratory studies show that placing animals in stimulating environments (that expose animals to complex perceptual and spatial stimuli) can optimise functional recovery from various forms of brain damage. Such environmental enrichment may increase the synthesis of neurotrophic factors, which in turn facilitate synaptic plasticity. Beneficial effects of exercise also include cognitive enhancement, delayed disease onset, enhanced cellular plasticity and associated molecular processes. Outside of therapy sessions, patients undergoing rehabilitation spend most of their time inactive and alone. The rehabilitation environment can be conducive to their recovery provided that task-specific training and repetitive exercise are provided for motor weakness following injury (stroke, MS, etc). Skill acquisition and transfer of skills to other activities can be more effectively achieved with the incorporation of context-relevant task-specific meaningful activities compared to rote exercise or passive modalities, using robotic technology, as the timing, the dose of therapy and opportunities to practice are critical factors.

The type of assistance provided by robotic devices can be described as active (providing active motion assistance), passive (may resist movement, e.g. for tremor suppression), haptic (provide tactile feedback to the user), and coaching (able to track movement and provide feedback related to performance, e.g. in a computer game).

There are a range of affordable robotic devices in rehabilitation settings. For example, upper limb devices include those that focus separately on shoulder, elbow, wrist/forearm or hand movements, and some that assist with movement of multiple joints. The input control signals used comprise dynamic signals (force/torque), kinematic signals (position, orientation, velocity, acceleration) or a trigger signal such as a threshold value of muscle contraction detected using surface EMG. Actuators include DC or AC motors, hydraulic or pneumatic systems, braking systems, and functional electrical stimulation. Most are stationary systems, however some involve wearable orthoses.

Exoskeleton-based designs, such as the Armeo Power (Hocoma), enable independent and concurrent control of a number of joints. Such systems may require significant set up time because the lengths of particular segments of the device to fit the patient’s arm and the control algorithms are complex. Walking training controlled by exoskeleton-based devices (e.g. Lokomat, Hocoma) is controlled by algorithms which move the knees and hips during the phases of gait. Wearable exoskeleton-based devices such as the ReWalk (ReWalk Robotics) enable spinal cord-injured patients to stand and walk in the community. Other devices are so-called end-effector-based devices, e.g. the InMotion ARM robot; while these are attached to the most distal part of the patient’s limb, movement of this part will alter the position of the other limb segments as part of a mechanical chain. Some devices combine different approaches. End-effector devices for walking have the patient’s feet positioned on footplates, with trajectories that simulate the stance and swing phases of walking (e.g. Haptic Walker prototype).

Devices used for training utilise computer games which are motivating and encourage repetitive task-specific training. Increasingly, virtual reality is being incorporated to simulate real-world conditions. Devices such as the C-Mill (Motek) train gait adaptability by using visual cues on the treadmill belt to simulate obstacles or puddles that patients need to adjust their gait pattern to avoid. The CAREN (Computer Assisted Rehabilitation Environment, Motek) combines a mobile platform with virtual reality that enables challenges to visual, auditory, vestibular and tactile systems for assessment and rehabilitation of balance and gait.   

Despite the availability of many robotic devices commercially or/and in development, clinical uptake in rehabilitation settings has been low. There is evidence for clinical efficacy of upper limb devices suggesting improved arm/ hand strength and function.  Further, evaluation of trials of electromechanical gait show that rates of independent walking were higher after training using end-effector devices compared with exoskeleton-based devices. Given the aging population, greater life expectancy, increased and changing demands for health services in the Australian Healthcare system; robotic devices offer opportunity to improve efficiency and rehabilitation service delivery in hospital and community.

Navigating the future of prosthetic technology

By Dr Jim Lavranos – Manager and Senior Clinican at Caulfield Hospital Prosthetics Department, is passionate about technology and innovation in the field and is involved in numerous design related projects with Melbourne and Monash University.

The past few decades have seen an extraordinary leap in our understanding, development and utilisation of technology. This boom has benefitted the prosthetic industry greatly. Some of the factors that have allowed this to happen include war with both its technological funding and causalities, increased global interest and investment in technology, start-ups and of course the expectation of amputees. More than ever in history research and development within the field has skyrocketed leading to a product rich market that continues to build upon itself.

The main areas of the prosthetics industry that have been vehemently targeted for improvement include manufacturing processes and materials, prosthetic fixation, control and sensory feedback, mechanical components and cosmetic finishes. Ambitious as it may be, a replication or even enhancement of the functional capacities of the physiological limb with a prosthetic substitute is still the ultimate goal. Although current advancements have launched traditional device design into a new era, this dream is still yet to be achieved. Needless to say, amputees are now more confident, comfortable, safe and in control than ever before.

The question remains however as to how we sift through the available information to distinguish between practical facts and hopeful fictions. Everything from customisable 3D printed prostheses to ‘mind controlled’ components have been touted as the next revolution in prosthetic management. The truth is most of these technologies are still in their infancy, or sometimes, just drawing board concepts. Rather than a paradigm shift, the industry seems to actually be faced with the phenomenon of technological fusion. That is, one of which the usefully applicable elements from alleged developments are combined with the proven practices of the past.

This technological tight rope of what already exists and what is new and exciting must be walked with great trepidation. After all, the industry wants to neither stifle itself by perpetually committing to ancient techniques and technologies nor drown itself in the risky depths of futuristic predictions. Technologies like 3D scanning and printing for example have been deemed the successor to existent manual techniques of assessment and manufacturing. At a glance that seems reasonable, but further investigation reveals weaknesses that must be addressed before the system is embraced wholeheartedly. Concepts and designs that work in one industry are not always ready to be immediately transplanted into another.

On another level, interface and component based enhancements that have impacted positively on aspects of prosthetic fixation, control, function and feedback, flood the market at manic speeds and are riddled with gimmickry and spin. This makes staying on the cusp and practicing safely an arduous challenge. To separate the hype and advertising from the truth therefore is a necessary and slow process that requires anecdotal evidence and experience.  Essentially, one must continue practicing what has been proven to work whilst at the same time experimenting with new developments in appropriate settings. Rome wasn’t built in a day as they say, especially when there are standards that need to be complied with.

All in all, there are some great innovations across many of the areas of the prosthetics industry. What impact these might have is an open ended question with the chances being that there will be no all-encompassing revolution but just another technology on the market to consider. Faster, smarter and more intuitive developments are of course everyone’s dream in the field, and in time, things will change in that direction. For now however, prudence and patience rather than unbridled enthusiasm are the key.

President's report

Professor Tim Geraghty
President, AFRM

Breadth and Depth of Rehabilitation Medicine

The theme of this edition of Rhaia is the breadth and depth of rehabilitation medicine and in it we are highlighting both some newer models of care in rehabilitation medicine and areas of technological advancement which are likely to impact on our clinical practice in the future. The Faculty and College have been undertaking significant work related to this theme over the past two years and I would draw your attention to the recently reviewed and updated scope of practice documents in both Adult and Paediatric Rehabilitation Medicine. These documents are succinct and easy for people to read and understand and should be useful documents to use, for example, as appendices when you are submitting business cases for rehabilitation medicine service enhancements or similar.

Over the past few years, we have also been looking for opportunities to highlight the need for improved rehabilitation services in the community and the importance of rehabilitation medicine physician involvement in these services. The resulting paper Rehabilitation medicine physicians delivering integrated care in the community: Early Supported Discharge programs in stroke rehabilitation: an example of integrated care was published in March this year. The paper forms part of this broader integrated care work being undertaken by the College and had the overarching aim of highlighting the crucial contributions specialist physicians can make to the delivery of integrated care, often in community-based settings, through partnerships and collaborations across the health system and beyond. It focused specifically on rehabilitation medicine physicians and uses Early Supported Discharge for stroke rehabilitation as a detailed example of the contribution that can make to the delivery of high quality integrated care in the community. It also highlights a some other community / ambulatory rehabilitation services in Australia and New Zealand in which rehabilitation medicine physicians are integral.

Standards for the provision of Inpatient Adult Rehabilitation Medicine Services in Public and Private Hospitals 2011

A small working party is currently reviewing and updating this document which we hope will be ready for publication in the next two to three months

AFRM Council Planning Day

Council will hold its annual planning day on Thursday, 9 August and we will provide you with some more detail plans over the next two years once they are further developed.

Faculty Education Committee (FEC) Report –August 2018

Dr Greg Bowring
Chair, Faculty Education Committee

The AFRM Faculty Education Committee (FEC) had their last meeting on 23 March 2018. The next meeting date is being finalised for a date in July or early August.

New Committee or Sub-Committee Members

The FEC currently has one vacancy for the Lead in Physician Education.

The Faculty Paediatric Training & Assessment Committee (FPTAC) in Rehabilitation Medicine has a few members who will be reaching their maximum terms in 2018.

Training Program Development and Implementation

Examination preparation

In 2017, the pass rate in the MEQ paper was disappointingly low. The paper was subjected to an unprecedented level of scrutiny in the days and weeks following to ensure its fairness and consistency with previous standards. This included three separate reviews by experts from the Faculty (not involved in the paper’s development) and experts from the College’s Education Directorate. This is in addition to an extremely thorough process of question development which has been established with validated processes under the guidance of educational experts within the College and carried out by the relevant exam committee each year. I would thus like to reassure all Fellows that the MEQ exam was and remains a fair assessment. It does not have arbitrary percentiles used to set pass marks – these are set following a well validated standard setting process which allows all candidates to pass if they reach the standard.

Following the exam, the above mentioned reviews, and in response to candidates and supervisors’ concerns, the College’s Training Support Unit has provided the following resources to trainees planning on sitting the Fellowship Written Examinations:

Updates from Committees

  • Training (FTC & FPTAC)

    As of July 2018, there are 219 adult trainees and nine paediatric trainees of the AFRM.

  • Accreditation (ASC)

    There are currently 124 Accredited Training Sites for Advanced Training in Rehabilitation Medicine (General and Paediatric combined). 

  • Assessment (FAC)

The following exams are in 2018:

  • AFRM Written Assessment Module 1 – 24 April and 9 October 2018.
  • AFRM Clinical Assessment Module 2 – 24 June 2018
  • AFRM Fellowship Written Examination (Adult) – 29 May 2018.
  • AFRM Fellowship Clinical Examination (Adult) – 11 August 2018.
  • AFRM Fellowship Written Examination (Paeds) – 29 May 2018.
  • AFRM Fellowship Clinical Examination (Paeds) – 25 August 2018.

I will be vacating this position in the near future as I take on the President-elect role. The work of the Education domain remains a large multifaceted area of the Faculty’s work, and relies on the efforts of a great many people – the many Faculty Fellows and many staff members of the College, our trainees and the Fellows involved in this work.

Faculty Policy and Advocacy Committee (FPAC) Report – August 2018

Professor Tim Geraghty
Chair, Faculty Policy and Advocacy Committee 

It has been another busy year for FPAC and I would like to thank all members for their significant contributions and commitment to the effective running of the Committee.

FPAC Work Updates

  1. Integrated Care Working Party and Rehabilitation Medicine Integrated Care document

    The Rehabilitation Medicine and Integrated Care paper titled Rehabilitation medicine physicians delivering integrated care in the community: Early Supported Discharge programs in stroke rehabilitation: an example of integrated care was completed earlier this year and is now published on the website. The aim of the paper was to highlight rehabilitation medicine physicians' skills and expertise in working in ambulatory rehabilitation settings and with GPs and other primary health care providers in an integrated manner. I would like to thank the FPAC sub-group who worked on this paper (Andrew Cole, Tai-Tak Wan, Louis Baggio and Cynthia Bennett) and all FPAC members for their assistance with this task.

  2. Review of the Rehabilitation Medicine Inpatient Standards document

    The review of this document is progressing with the working group including myself, Pesi Katrak, John Estell, Angela Wills, Maria Paul, and Cynthia Bennett, continuing to meet via teleconference on a regular basis. The review should be completed in the next few months. 

  3. Australian Commission on Safety and Quality in Health Care (ACSQHC) OA of the Knee Clinical Care Standard and ACSQHC Hip Fracture Standards

    In November 2017, Associate Professor Andrew Cole (Faculty President at the time) and I met with the Australian Commission for Safety and Quality in Health Care (the Commission). This meeting was also attended by Associate Professor Mark Lane (College President-elect at the time), Linda Smith (College CEO at the time) and Patrick Tobin (Director, Policy & Advocacy). One of the aims of this meeting was to discuss the College’s endorsement of the Commission’s Osteoarthritis of the Knee Clinical Care Standard and Hip Fracture Clinical Care Standard in more detail. The College had previously advised it was unable to endorse the documents in their current form due to concerns raised by AFRM regarding the lack of recognition of rehabilitation medicine. Following this meeting, the Commission agreed to make a number of revisions requested by the College and AFRM. A revised version of the Osteoarthritis of the Knee Clinical Care Standard has now been endorsed by the AFRM and RACP, and the Hip Fracture Standard is pending.

  4. Review of existing Rehabilitation-related policies and position statements on RACP website

    FPAC noted that the existing AFRM policy and advocacy documents were, in some cases, not easily found in the College website policy and advocacy library. All AFRM policy documents are now directly accessible from the AFRM Policy and Advocacy page

    FPAC has recently developed a process to identify current documents that are due for review with the RACP Landmines and Cluster Munitions Policy re-published in September 2017 and available online. Thanks go to Steven Faux for his time and expertise in reviewing this document. Other policies currently under or due for review include the use of stem cells in cerebral palsy and patients with multi-resistant organisms in rehabilitation units. It is planned that appropriate SIGs and other Fellows with an interest or expertise will be asked to assist the review process. 

    I encourage you to browse the list of current Faculty position statements and policies, familiarise yourself with what is available and use them as appropriate in your own policy and advocacy activities.

  5. Rehabilitation Medicine Scope of Practice document

    As part of the process of reviewing the current AFRM policies, it was noted that the Rehabilitation Scope of Practice document was not available on the College website. This prompted a review of the existing scope of practice document which is now complete and it has also been used to inform the process occurring in NSW Health which is also producing a Scope of Practice for Rehabilitation Medicine Physicians in NSW public hospitals.

  6. Evolve

    Evolve is an initiative led by physicians and the College to drive high-value, high-quality care in Australia and New Zealand. Evolve identifies a specialty's Top 5 clinical practices that, in particular circumstances, may be overused, provide little or no benefit or cause unnecessary harm. Evolve recommendations aim to ensure every patient receives the test, treatment or procedure that they need. Evolve is a founding member of Choosing Wisely in Australia and New Zealand.  The Evolve Rehabilitation Medicine list is now finalised and published. I encourage you to review the list.   

  7. The AFRM Special Interest Groups Reinvigoration Project

    This project has also continued throughout the year with available SIG chairs and I meeting via teleconference on a three monthly basis to consider ways of re-invigorating the SIGs.  

    Activities have included: developing meeting documentation templates, assisting SIGs to develop a Statement of Purpose and Induction Packs for new members, commencing a review on SIG information on the website and looking at ways to raise the profile of the SIGs including asking them to contribute brief stories to the AFRM eBulletin.

    Neurorehabilitation SIG, Musculoskeletal, Pain and Occupational Rehabilitation SIG, and Prosthetics and Orthotics SIG have now transferred across to governance under RMSANZ.

  8. Communication with RMSANZ
    FPAC has established a communication process with RMSANZ to ensure that consultation documents and other issues that come to FPAC are also appropriately referred on the RMSANZ for review and input.

Other matters

The AFRM PAC has also contributed its expertise to the following recent College matters:

  • College submission to the National Public Consultation on the Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer – October 2017
  • College 2018-19 pre-budget submission – January 2018. This pre-budget submission highlights key areas where specialists believe new initiatives or sustained investment are needed, including for integrated care, end-of-life care, Aboriginal and Torres Strait Islander health, obesity prevention and treatment, expansion of telehealth items, and drug and alcohol services.
  • College endorsement of the Clinical Oncology Society of Australia (COSA)’s Position statement on Exercise in Cancer Care – February 2018
  • College submission to the Joint Standing Committee’s review into the market readiness for the National Disability Insurance Scheme (NDIS) – February 2018
  • College submission to the Medical Board of Australia on the revised Sexual Boundaries in the Doctor Patient Relationship 2018 – March 2018
  • College submission to the Inquiry into the accessibility and quality of mental health services in rural and remote Australia – May 2018.
Finally, I would particularly like to thank Claire Celia and Jason Soon, RACP Senior Policy Officers supporting FPAC and also Stacey Barabash, Wynne Bell and Lisa Penlington from the Faculties Office.  Without their assistance much of the work of FPAC over the past 12 months would never have happened.

Mind Special Interest Group (SIG) update

Dr Jane Malone
Chair, Mind SIG 

Barbara Hannon attended RACP Congress 2018 in Sydney and reported the theme of the RACP Congress was wide and varied. It covered climate change, disruption in healthcare and included Michael Pollack who gave an excellent overview of the Shifting definitions of both health and illness, and the Role of Rehabilitation in the George Burniston Oration. He provided a historical overview and outlined the current and likely future relevance of rehabilitation medicine.

Barbara’s other highlights, and themes which were topical and had relevance from perspective of the Mind SIG, included:

Barbara also an attended an excellent workshop on Having challenging conversations. Please see the RACP website for further information on these topics.

We’ve held two teleconferences this year. The first was on ‘Mindfulness – Theory and Practice’ and the second ‘Perspectives from Norman Doidge’. Our third teleconference is on Wednesday, 15 August at 5pm. Mind SIG Secretary Dr Jo Braid will be presenting on ‘The Brain Gut Connection’. Please join us if you can. Otherwise we look forward to catching up at the Mind SIG AGM in New Zealand in November.

* The material covered in the above is available on the RACP website under Fellows resources.

Paediatric Rehabilitation Special Interest Group (SIG) update

Dr Simon Paget
Chair, Paediatric Rehabilitation SIG

The Paediatric Rehabilitation SIG (PRSIG) met up at the Australasian Academy of Cerebral Palsy and Developmental Medicine Conference in Auckland, New Zealand in March of this year.

The conference presented a great opportunity for paediatric rehabilitation specialists to meet and discuss new and breaking research in the fields of cerebral palsy and related fields with other colleagues from clinical and research settings. PRSIG members were well represented in the conference schedule, with many having an opportunity to present their research in free papers sections. 

This was our first meeting of 2018, and was an opportunity to discuss working towards agreed practice for dosing for botulinum toxin A injections in children. Forming a working party to review and revise the position statement on the use of stem cells as a therapy for cerebral palsy that was published in November 2016, was also discussed.

As always, the paediatric rehabilitation SIG is keen to attract new members and provide an effective forum to discuss matters with colleagues. Please do not hesitate to contact me if you would like more information. Our next planned meeting will be during the International Spinal Cord Society Conference in Sydney in September 2018.

Rural, Remote and Isolated Rehabilitation Special Interest Group (SIG) update

Dr Louis Baggio
Chair, Rural, Remote and Isolated Rehabilitation SIG

The Rural, Remote and Isolated SIG have completed a training weekend for Rehabilitation Registrars, Physicians and Physios ‘The Wagga Orthotic Weekend (WOW)’ was held on 24 and 25 March. The event was very well received, with 50 trainees in attendance including trainees from Perth, New Zealand and Western Australia. The Rural, Remote and Isolated SIG will continue running this event every two years.

The SIG continues to recruit membership, but has had difficulties with wider membership joining teleconference. A meeting between the FPAC and the chair of the Education committee is planned to discuss options to promote the filling of vacant trainee posts in non-metropolitan sties. Options to consider are mandatory non-metropolitan training and training networks.

 

Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) update 

Dr Lee Laycock
President, RMSANZ

Collaborative efforts between the RMSANZ and AFRM have been enhanced recently, with the decision to reinstate regular teleconferences between Executive Members of both organisations. Speaking last week via teleconference to Tim Geraghty and Andrew Cole we agreed starting from October, I will join bi-monthly teleconferences. These communications can only serve to boost an already strong relationship and to enhance the complementarity of the Society and the Faculty.

I was invited to the AFRM Planning Day on 9 August and attended this event.

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