Rhaïa July 2017

Editorial – Dr Chris Poulos

The rehabilitation physician and the community

This edition of Rhaϊa focuses on rehabilitation in the community. 

Some of the accounts of our colleagues refer to rehabilitation in the community as being that which occurs in people’s homes (including the rehabilitation medical consultation), but I think we need to view rehabilitation in the community as a much broader concept. Let me suggest that it is all rehabilitation that occurs outside of the inpatient setting. This would include private consulting rooms, outpatient services (but not just ‘post-discharge’ patient reviews), rehabilitation day hospital programs, community centres, and, of course within people’s homes (including aged care facilities, which are also homes for some).

My own practice since I left the New South Wales hospital system after 28 years (22 years as a staff specialist in rehabilitation medicine) has been entirely community focused. I moved into a combined clinical and academic (research and teaching) position with the University of New South Wales and HammondCare in 2011. Our AFRM President Associate Professor Andrew Cole and I set up the Centre for Positive Ageing (CPA) at Hammondville, near Liverpool. The Centre hosts teaching, research and clinical services. The clinical services provided out of the CPA started out as just me and a half-time exercise physiologist in 2012, and has since developed into a specialist and general medical practice with four part-time General Practitioners, and now has a full allied health team and an onsite dental practice providing oral health services specifically for older people.

Oh, and did I mention professional artists? We employ a number of artists and have been offering an Arts on Prescription program for community dwelling older people who have a range of challenges to their health and wellbeing (physical, mental and social). This program uses participatory arts in a variety of ways (visual arts, movement and music) to help improve wellbeing (let’s call it little ‘r’ rehabilitation – or reablement, or enablement – but more on that later).

The CPA is funded by a range of means, both public and private, including internal support from HammondCare.

My clinical focus is older people (but with people of any adult age referred). I don’t usually see people in their homes, except for occasional nursing home visits, which I do in person and by telehealth, but I have done a lot of home visits in the past when working for the community rehabilitation and aged care service at St George Hospital. Personally, I find the clinic a better venue to assess patients (medically and for reasons of efficiency), but of course our allied health team does home visits. I would encourage all rehabilitation medicine trainees to do home visits in the course of their training.

My practice is rehabilitation in the community. But it can also be called ‘restorative care’ or ‘reablement’ (you need to understand the nuances of government programs to know why). What ties the terminology together is the main purpose – i.e., maximising functional ability, participation and quality of life for people with disabling conditions. The clinical management hierarchy that I follow is the same in the community as in hospital rehabilitation, being to optimise medical management first, then look at allied health and other therapeutic rehabilitation interventions, assistive technologies and environmental modification, and support services and living arrangements.

Looking at the contributions that follow, a number of themes emerge:

Dr Kirrily Holton points out that our patients live their lives in the community, not in hospital, so focusing a rehabilitation program on where people live is more contextually appropriate. This is reinforced by Professor Hugh Dickson, who tells us that the ability to perform an assessment in a patient’s environment should be part of the skillset of all rehabilitation medicine physicians. Even though we may not work in the community, our focus should still be on the community, says Dr Stuart Browne, as therapy goals should be directed to where patients live. I totally agree with each.

A number of our contributors allude to the fact that, as rehabilitation physicians, we are dealing with greater medical complexity in our patients. This makes for a much more challenging encounter with patients outside of hospitals, and is especially apparent in community settings where subspecialists are not on tap. This extends to the availability of investigations. It’s not just a case of filling in the form and everything just happens. For Dr Saul Geffen, community work is both challenging and interesting, because many patients are not fully diagnosed. For me that was the case in my St George Hospital community team days and is the same today. It is very satisfying, for example, when you are able to identify polymyalgia rheumatica and it responds so well to treatment.

Pointing to the future we should heed the words of Associate Professor Stephen Wilson, who notes that, with pressure on public hospitals, and private hospital rehabilitation already at saturation, “where are the jobs for our new Fellows” coming from? He calls for us to explore, with government and health funds, innovative alternatives to inpatient care. I couldn’t agree more. To build further on the theme of the future I think that we, as a professional group, should be embracing the demographic changes happening before us. People are living longer and the fastest growing age groups are those over 65 years. This is a triumph of public health, education and medicine. 

The growing numbers of older people are also leading to a greater prevalence of disability.  A recent report from the Australian Institute of Health and Welfare estimates that men who were aged 65 years in 2015 could expect to live 9.2 years without disability, 7 years with some level of disability, and 3.4 years with a severe or profound activity limitation. For women the numbers are 10 years without disability, 6.7 years with some limitations, and 5.6 years with a severe or profound limitation. Over the past decade, for those who reach 65 years, there has been a trend towards delivering relatively more years free of disability than with disability (going from around 43 to 47 per cent for men, and 42 to 45 per cent for women). While this lends some weight to the ‘compression of morbidity’ theory, there is still a long way to go.

So where to from here? The three take-home messages for me are these: 

  • We should be working to embrace new models of rehabilitation care that emphasise management in the community where it can be effectively, and cost effectively done, as an alternative to inpatient care.
  • We need to become more comfortable understanding and managing medical complexity in our patients if we are to embrace community roles.
  • There is enormous potential for our profession in adapting the rehabilitation model of care to older people living in the community, with disability associated with age-related conditions.

The future of community rehab

Associate Professor Stephen Wilson

The formation of the Australian College of Rehabilitation Medicine 1980 was a very fortunate event for me. It transformed my career from a General Practitioner (GP) interested in musculoskeletal/sports medicine to become a rehabilitation physician. As a GP I had rarely treated patients in hospital and my early rehabilitation career nurtured an interest in community rehabilitation and non-admitted health care.

The community roles that I have filled have included clinical input to Home Based Rehabilitation (1996), Hospital in the Home (1999), day admission rehabilitation (2003) and outpatient rehabilitation in city and rural areas. There are currently strong cost saving drivers for these types of non-admitted care although health outcomes and quality of life may be as good or better at home. Telehealth has also opened new opportunities for connecting multiple disciplines for outreach. A good example is for management of spinal cord injury (SCI) and rural support.

There is increasing competition for management of health conditions in hospital beds from all speciality sectors. Public hospital appointments are becoming rarer and many private hospitals are closed shops, in metropolitan Sydney at least. Where are the jobs for our new Fellows? Fortunately rehabilitation manages disability and there is an abundant need for our services in the community.

It is not difficult to set up specialist consulting rooms, although currently difficult to deliver without therapy. The challenge is to establish a funded multidisciplinary team to deliver our successful programs in the community environment. A successful hybrid model is day rehabilitation programs. However, we need to go further with our funding models and break free from hospital funding.

I believe our professional group has a place in assisting our specialty in negotiating with government and health funds for better non-admitted alternatives for treatment. The formation of the National Disability Insurance Scheme (NDIS) has been an incredible breakthrough with a separation of disability from healthcare for younger people. The next great challenge is to decrease the burden on hospitals for management of aged related disability. This should grow as the frontier for community rehabilitation.

It takes a community to help traumatic brain injury patients

Dr Stuart Browne

I have been a rehabilitation physician since 2000 and have worked in the Brain Injury Rehabilitation Service at Royal Rehab since 2003. Our service provides inpatient and community-based rehabilitation programs for working-age clients who have experienced a severe traumatic brain injury (TBI). I work in our Brain Injury Community Rehabilitation Team, a group of multidisciplinary health professionals dedicated to supporting clients to achieve their goals. With my colleagues, I also provide brain injury rehabilitation consultation clinics at several Sydney and regional hospitals. The clients attending these clinics have usually experienced less severe injuries and have not required inpatient rehabilitation admissions.

The majority of clients my team members see are men under 50, many of whom are employed and with family responsibilities. Impairments affect cognition, behaviour, and physical function, and depending on the initial injury severity, may cause lifelong activity limitations. Although all health conditions have the potential to impact a client’s role within their family, this is a prominent feature of TBI, contributing to significant participation restriction. Large parts of my consultations are therefore directed at key roles in a client’s life: returning to work and study, re-engaging with family and friends, and improving well-being. Not surprisingly, given the common causes of TBI, there is also frequent interaction with insurers and legal representatives.  

The level of participation achievement is probably the best indicator of successful rehabilitation, and is the major focus for a rehabilitation clinician working in the community. Importantly, I don’t think the location of practice should define whether a clinician is, or is not, community-based. Instead, it should be where in the International Classification of Functioning, Disability and Health (ICF) model the therapy goals are being directed. In this way, it is likely that all rehabilitation physicians perform at least some part of their role in the community. Even clinicians working in specialised areas within acute settings are likely to be participation-focused in their outpatient clinics. Indeed, while I consider myself a community-orientated clinician, I am based at Royal Rehab and generally see all of my clients in hospital clinics.  

Is it necessary to have community rehabilitation teams? For TBI rehabilitation, absolutely.  My colleagues are an experienced group of professionals able to provide therapy in various locations, wherever is most appropriate to assist with goal achievement. Often this is the home or workplace, but attending a hospital clinic might be more relevant if the goals include community access and organisational function. Similarly, a recreational facility or café are venues where communication, social skills, and other abilities can be improved. Distinguishing between performance and capacity is important when cognitive impairment is present, so assessing a client in the most suitable environment is critical. However, this is not always straightforward. There are more variables in play that affect the frequency of therapy sessions, service efficiency, compliance, etc. In addition, evidence is limited for specific therapies and the best model of service delivery. These challenges should not detract from the importance of community rehabilitation.

To finish, recovery from TBI can progress for years, so it is common that our team remain involved well beyond the early post-hospital rehabilitation phase. This means we get to know our clients really well; we watch their successes and failures and truly follow them on their recovery ‘journeys’. This can be an emotional and rewarding experience for all involved, including the clinicians. Royal Rehab inducts six former clients into our ‘Wall of Fame’ each year; people who have experienced widely varying challenges and outcomes. The audience at each ceremony includes current and past clients, families, clinicians, even politicians. It is a testament to the resilience of the clients and families involved, that despite there not being a dry eye in the audience, the focus is always on ability and participation. It surely represents the aim of community rehabilitation. 

From general practice to community rehabilitation

Dr Saul Geffen

As a rehabilitation physician, I spend 50 per cent of my professional life working in community rehabilitation. The community work initially began with General Practice, before moving to study at the College of Sports Physicians. Whilst I had a great time working as a team doctor for the South Sydney Rabbitohs and doing many boxing and kickboxing events; most sports physicians have to spend a considerable amount of time assisting orthopaedic surgeons in theatre, which I found ultimately unsatisfying. In the early 90’s I was fortunate enough to meet a wonderful Fellow, Dr Vernon Hill, who in about five minutes summed up my self-serving and directionless career so far and told me to go and train to be a rehabilitation physician in Sydney. This turned out to be one of the best decisions I have made for myself in my life.
 
During my rotations in Sydney, I was fortunate to come under the spell of kindred spirit, Dr Stephen Wilson, who was not only interested in sports medicine and disability sport, but had also been in General Practice and had an unconventional view of the world. Two fulfilling years followed and Steve still remains my most significant career influence. Steve was energetic, holistic and had a flexible way of approaching rehabilitation issues. He was a strong advocate for research and always put patient needs as the first priority.
 
Over the next seventeen years a mix of hospital and community work developed. The community role involves treating chronic pain, disability, spasticity and I run a weekly sports medicine clinic out of my rooms. 
 
I find the community work interesting but challenging. In the community you don’t have the benefit of lots of resources around you and often make judgement calls. Community work can be challenging because many patients are not diagnosed. They have had incomplete examinations and investigations; there are also time pressures because the waiting room quickly fills up if you run overtime.

My previous experience in general practice and sports medicine certainly helps in this regard. General practice teaches you to be holistic and clarify which of the multiple health issues are the most significant to work on. General Practitioners and Sports Physicians often see patients without a diagnosis having been made and they both work in the community sector as small business owner operators.

To increase the community role that rehabilitation physicians play, trainees should be exposed to experienced physicians’ outpatient clinics and community based clinics. Community work is both needed and rewarding. There is a dire need for community patients to have access to specialist doctors who not only understand disability and can treat them pharmacologically, physically and psychologically; but can manage a team that can provide functional improvements and practical help.

This may in fact reduce or head off hospital admission for problems that rightly should be managed in the community. I challenge my peers to ask their patients "where would you prefer to receive treatment?” Many will say from home.

The future is bright. With the new National Disability Insurance Scheme (NDIS), we may have access to more funds to enable us to serve and help people with disability living in the community.

Letting a patient's life guide rehabilitation

Professor Hugh Dickson

My interest in out-of-hospital care began when I visited aged care facilities in the early 1980’s as a rehabilitation and geriatrics registrar in Canberra. I also conducted assessments of patients in their homes in Sydney as a rehabilitation medicine registrar attached to the Eastern Suburbs Community Rehabilitation Team. 

After completing my training, I continued to assess patients in their homes, or in aged care facilities, at the request of solicitors for medico-legal reports, and more occasionally to assess suitability for an inpatient rehabilitation program. Currently, I perform one to two home or aged care facility visits per week either as part of the Hospital in the Home service at Liverpool Hospital or the High Risk Foot Clinic and Wound Clinic’s outreach services. I completed a PhD in Community Medicine in 1999. 

The logistical challenges of transporting some patients to private rooms or a hospital clinic can be profound; there may be risks for the patient in the process of travel such as pressure injuries from immobilisation for long periods in a fixed position. The option of a visit to the patient avoids these problems. The ability to perform an assessment in a patient’s environment should be part of the skill set of all Rehabilitation Medicine physicians, given the high levels of disability of many of our patients.

A home visit allows assessment of the patient’s environment, family, social and physical supports, and the need for allied health intervention. The view of the patient is more holistic than in the clinic setting, and allows the patient to maintain their dignity – often removed in a hospital clinic.

Rehabilitation at home – Helping patients flourish

Dr Kirrily Holton 

Margaret* is a confident and accomplished woman in her early 70s. She was cruelly affected by a non-traumatic acquired brain injury with cognitive impairment, and was transferred to inpatient rehabilitation. There, she declined to engage in assessment or therapy, and became increasingly despondent. With the blessing of her very supportive partner, the decision was made to discharge her home with the Repatriation General Hospital Rehabilitation in the Home service. Once home in her comfort zone, she flourished, we saw her forthright personality shine, and she made leaps in her recovery; functionally, neurologically, and emotionally.

I have been a consultant rehabilitation physician for almost four years, working in Southern Adelaide Local Health Network. Through my training, I was fortunate to be involved in ambulatory rehabilitation on a number of occasions, often as a welcome side-effect of being part-time after maternity leave. This is when my interest in home rehabilitation was piqued, and I was desperate to get out there with the therapists to meet the patients in their own homes – unfortunately time limited me.

When I was offered the opportunity, many years later, to implement an increased medical presence in this excellent service, I jumped at the chance. I now oversee the care of a large and diverse group of patients, alongside a very experienced team of therapists and nurses. With my registrar, we use a combination of home visits and cutting-edge telehealth to see as many patients as we can, and to help guide their rehabilitation. In the process, I have met many patients like Margaret* who have welcomed us into their homes.

There are, alas, challenges once outside the controlled environment of a ward or outpatient clinic. Integration and coordination of medical care with the patient’s General Practitioner is paramount. Blood tests and scans are no longer available at the click of a button, and need to be thought through carefully. We are seeing an increasingly medically complex case load; this is a good thing as patients are avoiding prolonged hospital stays, but careful monitoring and risk management is mandatory. Hours can be spent in the car on home visits, and the technology of telehealth is not the answer for all patients.

Our patients are now in their own homes and, quite rightly, have the ability to live how they wish, even if that makes us uncomfortable. Sometimes, we do not succeed, and our patients need to return to acute care, or supported accommodation. 

Fortunately, as rehabilitation physicians, we are able to meet these challenges.

In an increasingly stretched health system, we need to be innovative, and we need to help our patients remain safely at home. An increase in ambulatory rehabilitation, including home programs can help to achieve this. We talk about the importance of context-specific therapy, and this is the ultimate example. We need to be involved in the community – where our patients live – with all its ambiguity and seeming-chaos, and learn how to flourish – this will benefit the profession, and most importantly our patients.

(*Patient name and identifying features changed)

President's report

Associate Professor Andrew Cole
President, AFRM

The last month has been very busy with Faculty and College activities, and I am very grateful to Dr Chris Poulos and other Faculty colleagues for putting together such a high-quality edition of Rhaïa, that concentrates on research activities in the Faculty.

Your Faculty Council has made developing rehabilitation research one of the main priority activities of the present two-year strategic plan, inviting Professor Michael Pollack to chair and coordinate the Faculty’s Research Committee. This group is to be commended on the extraordinary progress they have made in less than a year since commencing, as you will see from the contents of this issue of Rhaïa.

The Faculty has a significant role in supporting good access to the data resources of the Australasian Rehabilitation Outcomes Centre (AROC), both for trainees’ projects and for research done by our Fellows. This helps our registrars receive training in research methods and identifying real outcomes; it also boosts the evidence basis for the rehabilitation work we do, which becomes ever more important, as medical and hospital systems become increasingly complex and costly.

At the same time, Faculty Fellows have been very involved in Policy and Advocacy work in relation to the emerging National Disability Insurance Scheme (NDIS), and in developing a guide to this scheme, for the use of physicians.

This work came to fruition at the time of the recent RACP Congress in Melbourne: a rehabilitation plenary oration was delivered onto the Congress big screen, from Sydney, by Mr John Walsh AM, about the social developments of the last 40 years that have brought about the introduction of the NDIS. A very lively (and well-subscribed) seminar session followed, with multiple speakers dealing with personal experiences as consumers, providers and assessors of the scheme.  

The RACP President, Dr Catherine Yelland, concluded the seminar by launching the RACP NDIS Guides for Physicians and Paediatricians for the use of physicians who might be involved with individuals in need of the scheme’s support networks.

Finally, during the Congress period, this year’s Australian Commonwealth Budget was released. The Federal government committed to full funding of the NDIS, perhaps the most significant social reform this country has seen in the decades since the introduction of Medicare. It was an historic week, not least for doctors that specialise in the management of problems with daily living functions, and promoting independent participation of people in the general life of the community.

Of course, we live in times of robust political discussion. The squabbles about exactly who would pay for how much, and how the enabling legislation might precisely be constructed, started immediately – but the point is, the NDIS will be fully introduced in all jurisdictions in Australia.

Given the wide scope of environments for the operation of the NDIS, there would seem to be equally wide scope for all sorts of qualitative and descriptive research of its implementation.


Faculty Policy and Advocacy Committee (FPAC) Report – April 2017

Professor Tim Geraghty
Chair, Faculty Policy and Advocacy Committee

The Faculty PAC has continued to be busy throughout the end of 2016 and early 2017.

Committee Members

My Committee colleagues are:

  • Dr Louis Baggio (Rural and Remote representative)
  • Dr Cynthia Bennett (New Zealand)
  • Associate Professor Andrew Cole
  • Dr Luca D'Orsogna (Western Australlia)
  • Dr Harry Eemon
  • Dr Monika Hasnat (Paediatric representative)
  • Dr Julia McLeod (Queensland)
  • Dr Maria Paul (South Australia)
  • Dr Elisabeth Sherry (Victoria/Tasmania)
  • Dr Tai-Tak Wan (New South Wales).

Feedback from FPAC 

The FPAC is currently working on the following issues:

1. Evolve

Work has continued on the draft rehabilitation medicine item list for the Evolve initiative and once the preliminary list has been agreed, Faculty members will be asked to complete a survey to confirm the top ​five initiatives.

2. Policy Review

FPAC, with the assistance of a range of other Fellows, is reviewing a number of existing policy documents that are old and require updating. These include policies on landmines and the AFRM Inpatients Standards document.

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

A number of FPAC members recently finalised the draft policy paper on the role of rehabilitation medicine physicians in integrated care in the community. This work forms part of the broader College work on integrated care being led by the College’s Integrated Care Working Party.

The draft paper focuses specifically on the contributions rehabilitation medicine physicians make to deliver high quality integrated care in the community using Early Supported Discharge for stroke rehabilitation as a detailed example. The final draft is now awaiting review by the College Policy & Advocacy Committee before going out for further consultation.

4. Rehabilitation Medicine and Community Rehabilitation Service  

FPAC envisages scoping a broader project on the role of rehabilitation medicine physicians in community settings once the policy paper on the role of the rehabilitation medicine physicians in integrated care is complete. To inform this stream of work and to better understand the current involvement of rehabilitation medicine physicians and trainees in community rehabilitation services, the Faculty has also developed an online survey aimed at its members. This survey will be managed through the Faculty office.

5. Inherent Requirements for Studying Medicine in Australia and New Zealand document

With the assistance of Dr Harry Eemon, discussions and work are occurring on Inherent Requirements for Studying Medicine in Australia and New Zealand document that was published by the Medical Deans Association of Australia and New Zealand, to determine the appropriate Faculty response to this document.

6. Other 

FPAC has contributed its expertise to a number of recent College matters including:

  • Stroke Foundation Draft Clinical Guidelines
  • Draft Victorian Osteoarthritis Model of Care and endorsement of the final version of the Victorian Osteoarthritis Model of Care
  • NSW State Insurance Regulatory Authority -  Reforming insurer profit in compulsory third party (CTP) motor vehicle insurance 
  • Draft Fifth National Mental Health Plan 
  • NSW Upper House Committee Inquiry into the provision of education to students with a disability or special needs in government and non-government schools in New South Wales.

Faculty Education Committee Report – April 2017

Dr Greg Bowring
Chair, Faculty Education Committee​

The AFRM Faculty Education Committee (FEC) held meetings on Friday, 10 March 2017 and Thursday, 1 June 2017.

New Committee or Sub-Committee Members

Trainee Representative, Dr Emma-Leigh Synnott, has now been admitted to Fellowship of AFRM and Dr Annie Sunderland has stepped into this position on the AFRM FEC. Dr Ashlyn Alex has been appointed Chair of the AFRM Trainee Committee.

Training Program Development and Implementation

From 2017, trainees have the option to complete External Training Module 3: Clinical Research (two article critiques and one research project, or two research projects) or the new RACP Research Project. The 2019–20 handbooks are currently being developed. The program requirements will be sent to all AFRM members later this year for consultation.

Education Policy and Implementation

The College implemented the revised Flexible Training, Progression through Training and the Academic Integrity in Training policies from 1 January 2017. 

Trainees now need to refer to the 2017–18 Handbook for details regarding examination attempt limits, which were previously outlined in the Progression through Training Policy.

Further, the Academic Integrity in Training Policy outlines the College’s approach to academic integrity, academic misconduct and the roles and responsibilities of the trainee and relevant committees. This policy will assist the decision making process for dealing with issues involving plagiarism.

Advanced Trainees in Rehabilitation Medicine 

As at 26 April 2017, there were 204 general adult trainees and nine paediatric trainees of AFRM.

The breakdown of trainees per region is:

  • Australian Capital Territory – 4
  • New South Wales – 89
  • Northern Territory – 2
  • Queensland – 49
  • South Australia – 15
  • Tasmania – 4
  • Victoria – 39
  • Western Australia – 7
  • New Zealand – 4.

Updates from Sub-Committees

Accreditation

There are currently 123 Accredited Training Sites for Advanced Training in Rehabilitation Medicine (General and Paediatric combined).

Assessment

From 2018, new trainees will have three attempts to complete the AFRM Module 1 and 2 Examinations as well as the AFRM Fellowship Written and Clinical Examinations. This is in line with the Divisional training programs. 

Training

The 2017 Annual Trainee Meeting was held on Saturday, 4 and Sunday, 5 March in Sydney. For the first time, the event included both General and Paediatric Rehabilitation Medicine trainees. The weekend ran smoothly and the social aspect proved to be a positive experience, especially for first year trainees who were able to meet other trainees.

Advanced Trainees in both Paediatric and General Rehabilitation Medicine are reminded that all training requirements for term one 2017 are to be completed and submitted by Thursday, 31 August 2017.

The Faculty Training Committee has been looking at ways to improve the monthly Bi-National Training Program (BNTP). Feedback from the Faculty Trainee Committee has been taken into consideration for planning the 2018–2020 BNTP cycle.

Recent discussions have revolved around how the Advanced Training Program in Rehabilitation Medicine can be improved in the coming years.

Completion of the AFRM Training Program

The following trainees have recently been approved for the award of Fellowship of AFRM;

  • Dr Rania Abdelmotaleb
  • Dr Talia Cantwell
  • Dr Lincoln Jansz
  • Dr Olivia Shien Hui Lee
  • Dr Eliza Maloney
  • Dr Ben Manion
  • Dr Simon Mosalski
  • Dr Ching Lee (Lily) Ng.

Mind Special Interest Group (SIG) update

Dr Jane Malone
Chair, Mind SIG 

The Mind SIG is very much looking forward to the RMSANZ ASM featuring two of our favourite speakers. Professor Lorimer Moseley, a world expert in pain and neuroplasticity, is bringing his warmth, pragmatism and expertise to the podium. We’re sure the result will be at once informative and entertaining. Lorimer is an Associate Editor of PAIN and the Journal of Pain, and it will be fascinating to hear his thoughts on the latest in pain and neuroplasticity. Lorimer launched the Mind SIG’s ‘Art V Science: Why the V?’ lecture series for AFRM way back in 2008 so it’ll be terrific to reconnect and welcome him to the RMSANZ ASM.

We’re also looking forward to reconnecting with Associate Professor Craig Hassed. Craig has previously presented popular webinars for the Mind SIG on psycho-neuro-immunology and mindfulness and it’ll be great to hear him speak in person. Craig is a widely published evidence based academic on mindfulness and integrative health. In 2014 Craig welcomed Mind SIG and AFRM colleagues to participate in his online weekly evidence based mindfulness course and those who partook found it to be very useful, both professionally and personally.

Canberra in spring is always so beautiful and as an added bonus, Floriade will be on at the same time as the ASM. I look forward to seeing you there.
 

Paediatric Rehabilitation Special Interest Group (SIG) update

Dr Simon Paget
Chair, Paediatric Rehabilitation SIG

The Paediatric Rehabilitation SIG met in October 2016 and March 2017. 

The Group remains active in supporting member’s interests, contributing to AFRM and RACP activities, and enabling discussion of issues and projects that involve or are pertinent to members.

Projects and issues discussed at our recent meetings and between meetings with the group have included: 

  • development of the paediatric AROC (APROC) dataset to enable benchmarking of paediatric rehabilitation units across Australia and New Zealand
  • ongoing work by members to work towards a national approach to consent and information for botulinum toxin A injections
  • discussion of infection control requirements for invasive procedures (including BoNT-A) in light of changes required at some sites
  • discussion of the impact of the National Disability Insurance Scheme on paediatric rehabilitation services. 

The next Paediatric Rehabilitation SIG meeting will be a face-to-face meeting during the RMSANZ ASM in Canberra in September.

The SIG remains keen, as always, to attract new members. Please feel free to contact me through the Faculty office at afrm@racp.edu.au if you would like to join the SIG or learn more about it.

Rural, Remote and Isolated Special Interest Group update

Dr Louis Baggio
Chair, Rural, Remote and Isolated SIG

We have added 'isolated' to encourage Fellows and trainees that may be working in relative isolation in metropolitan or regional centres to participate in our SIG.

Following our Annual Members' Meeting at the RMSANZ ASM in October 2016, I have taken over as Chair, and the SIG welcomes Dr Ingrid McGaughey, Dr Howard Flavell, Dr Jeremy Christley, Dr Rachael McQueen, Dr Tracey Symmons, Dr Martin Dunlop, Associate Professor Michael Pollack and Dr David Murphy to the Executive.

We have decided to pursue a few projects for the next 12 months.

Firstly, we will clearly outline the purpose of our SIG and what it can offer Fellows and trainees. Some concepts we will expand on include:

  • collegiality
  • peer support
  • mentorship especially for trainees and New Fellows
  • peer review
  • education including a regular journal club
  • promotion of Indigenous health and utilisation/advice of different models of care. For example, here in Wagga Wagga we recently expanded our rehabilitation service with the introduction of an in-reach model to the Wagga Wagga Rural Referral Hospital and an outreach model to three district hospitals: Temora, Tumut and Narrandera with onsite allied health assistants and hub allied health professionals.

Secondly, we would like to encourage and recruit trainees to the SIG as our diversity of clinical practice and years of experience is really an untapped wealth of knowledge. We are all happy to assist with trainee education. We just need to be asked.

Thirdly, we will again present a concurrent session at the RMSANZ ASM in Canberra and undertake a number of journal clubs this year.

Lastly, we will update and provide some new and useful resources on the Rural, Remote and Isolated SIG webpage. So watch that space.

We want to know what you as Fellows or trainees would like from the RR&I SIG. I would like to invite any Fellow or trainee interested in our SIG to contact any of the executive and come along to our annual dinner at the ​RMSANZ ASM in Canberra and meet our diverse and friendly team.

afrm-rhaia-wagga-wagga
Part of the ambulatory rehabilitation service in Wagga Wagga, New South Wales

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

Dr Alex Ganora
President, RMSANZ

On 22 February 2017, the Rehabilitation Medicine Society of Australia & New Zealand (RMSANZ) celebrated its second anniversary as a legal entity and at about the same time, welcomed its 400th Member.

RMSANZ Annual Scientific Meetings (ASMs)

The first RMSANZ ASM was held in Melbourne in October 2016 with the theme 'Change, Challenge and Opportunity' and was attended by over 400 delegates and received widespread acclaim. The proceeds generated by this successful meeting are retained for the benefit of members in the pursuit of rehabilitation medicine, as will be the case for all future meetings. 

It is now time to register for the second RMSANZ ASM to be held in Canberra from 17 to 20 September 2017. The theme of this event is 'The Leading Edge: Innovations in Rehabilitation Medicine' with a focus on pain and musculoskeletal, neuroplasticity and rehabilitation, and spinal rehabilitation and technology. 

RMSANZ is responsible for all future ASMs in rehabilitation medicine and plans are already under way for 2018 in Auckland as a Conjoint International Asia Oceania Society of Physical and Rehabilitation Medicine (AOSPRM) meeting and 2019 in Adelaide. In addition to the ASM each year, we also plan to repeat the Rehabilitation Snapshots Workshop by holding it in June 2018 in Melbourne.

RMSANZ Regional Branches

Branches in New South Wales/Australian Capital Territory, Victoria/Tasmania and South Australia/Northern Territory have been formed and a QLD Branch is about to form. All Branches have already achieved a positive cash flow in their operations and are actively planning collegiate activities. 

Branches are vital structural elements of RMSANZ which represent the interests of members at a local level. They receive full encouragement from the RMSANZ Board and administrative support to conduct their meetings. 

RMSANZ Special Interest Groups (SIGs) 

Two SIGs have already been established and a third is on the way. 

The Private Practice SIG is currently interested in the interface between rehabilitation medicine practice in private hospitals and health insurance funding issues for rehabilitation services. 

The Pain SIG is planning an online survey of members' areas of interest in educational workshops and CPD activities to plan future presentations and meetings. 

A NeuroRehab SIG is about to form and apply to the World Federation for Neuro Rehabilitation (WFMR) for Australian and New Zealand Affiliate Membership as a prelude to a bid for hosting the WFNR Congress in Sydney in 2022. 

Each SIG facilitates meetings and the pursuit of advocacy on behalf of members in the hope that momentum, and influence, will build eventually leading to Associate Membership of the Society by interested medical, nursing and allied health professionals in Australia and New Zealand.

RMSANZ communications

The RMSANZ website has been very popular and is growing in scope to cater for the diversity of activity within the Society and to keep a record of publications, submissions and position statements. As Branches and SIGs expand their activities and resources, the RMSANZ website will grow to make information available to members. Past lectures and presentations will become available to members. Connections with online journals and other Societies' websites will expand, for example, the open access journal Advances in Clinical Neuroscience and Rehabilitation (ACNR) has published a report on our 2016 ASM and we are exploring the possibility of linking with the Journal of Rehabilitation Medicine (JRM)

RMSANZ advocacy 

A major role for RMSANZ is to advocate on behalf of rehabilitation medicine physicians in Australia and New Zealand to improve health, function and quality of life of people living with disabilities, with a dedicated and clear focus that is independent and unconstrained by competing interests.

A number of important submissions have been prepared by the Society including:

  • a request to review the closure of the Centre for Disability Health services in South Australia
  • a submission to the House of Representatives Standing Committee on Chronic Disease Prevention on how we can assist in primary health care management and prevention of chronic disease
  • a submission for an item number provision for pulmonary rehabilitation
  • an application to loosen restrictions on funding access to botulinum toxin type A for the treatment of adult patients with focal spasticity
  • a representation on the NSW Health State Scope of Clinical Practice
  • a membership to Stop Osteoporotic Secondary (SOS) Fracture Alliance
  • an appeal to the Medical Deans Australia and New Zealand to review their draft guidelines on requirements for studying medicine in order to avoid the unintentional exclusion of people with disabilities from the medical workforce
  • the development of a Position Statement on the Therapeutic Use of Botulinum Toxin in Rehabilitation Medicine for spasticity and dystonia which will be published on the RMSANZ website.

Advisory Council

RMSANZ has a membership driven organisational structure and philosophy. The newly formed Advisory Council allows direct representation from Branches and SIGs to the Board and helps prevent the Board from operating in isolation of the sentiments and needs of the membership. It also allows links to be formed with the outside community and other professional bodies. The Advisory Council is chaired by the Society Vice President and held its first meeting on 22 May 2017. 

RMSANZ Scientific Committee

One of RMSANZ’s objectives is to advance and promote research, education and training relevant to the practice of rehabilitation medicine, rehabilitation, disability and related areas; to liaise with AFRM/RACP, government, educational and research institutions and to oversee the planning and content of ASMs. This is implemented by an active Scientific Committee which meets regularly and is represented on ASM Organising Committees for each event.

Trainee members’ workshops

With the help of the RMSANZ Trainee Members’ Committee, we explore the interests of vocational trainees who are members of the Society and develop a program of workshops to supplement the available activities within AFRM. 

Workshops in Musculoskeletal Clinical Examination Technique and OSCE preparation have been conducted in Orange and Adelaide. Preconference workshops at each ASM are prepared with trainee needs in mind and have so far included access to a neuroimaging workshop and two botulinum toxin injection workshops. Future workshops are planned to cover ultrasound anatomy for injectors, prosthetics and orthotics, and exercise prescription. 

All RMSANZ clinical meetings and workshops are heavily discounted for members.

RMSANZ elections

The inaugural Board of Directors of RMSANZ will complete their first term in September 2017 and Members will be invited to seek nomination for positions on the new Board which will be chaired by President-Elect Dr Lee Laycock when he takes my place as RMSANZ President at the Annual General Meeting on 18 September 2017 during the ASM in Canberra.

RMSANZ is dedicated to its active membership and is driven by the needs of its members. We have a singular and independent focus on rehabilitation medicine. The growth of the specialty is reflected in the growth of the Society. Make the Society stronger by your active membership.

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