The Royal Australasian College of Physicians (RACP) has today released a series of new recommendations to deliver better care for those undergoing rehabilitation treatments and to help avoid low value and potentially harmful tests and treatments.

There are now 18 Evolve lists published, with a further 14 in development. The full list of Evolve recommendations can be downloaded at the Evolve website.

Discussing the latest recommendations from the Australasian Faculty of Rehabilitation Medicine (AFRM), Associate Professor Andrew Cole said patients with fractures caused by weak or brittle bones should be assessed and treated for osteoporosis before being discharged from hospital.

“During our review, we came across reports where patients with osteoporotic fractures faced early discharge from hospital before their osteoporosis had been adequately assessed and treatment commenced through an appropriately designed care plan,” A/Professor Cole said.

“Once a patient with osteoporosis has a fall they are likely to have more falls. The consequences of osteoporotic fractures, such as hip or pelvic fractures, can be very significant, resulting in serious injury or even death.

“If a patient is identified as at risk, we recommend doctors investigate for osteoporosis and ensure the patient is comprehensively assessed and treatment has commenced before they leave the hospital.”

It is estimated that over 10 per cent of Australians aged 50 years and over have osteoporosis. Elderly people are far more likely to have a fracture as a result of osteoporosis, than the general population.
The AFRM has also made recommendations to improve treatment for patients experiencing low back pain.

“Low back pain is one of the most common reasons that people see their doctor,” A/Professor Cole said.
“Spinal orthotics and braces are often used to support and redirect the spine, but there is insufficient and conflicting evidence about whether orthotics are actually an effective treatment option.

“Bed rest is sometimes an effective treatment for low back pain, however, too much bed rest can result in complications like muscle wasting and weakness and increase the risk of respiratory infections.
“Eventually your body needs to move, so we recommend a maximum of two days bed rest.”

A/Professor Cole said the majority of acute low back pain episodes are not serious and in the absence of red flags such as indicators of recent infection or spinal fracture, x-rays for patients with low back pain isn’t recommended and may even be harmful if it leads to invasive and unnecessary surgery.

These recommendations are part of the Evolve physician-led initiative, which encourages each medical specialty to identify practices that may be over-used, inappropriate or of limited value and consider appropriate evidence-based alternatives.

“Evolve aims to drive high-value, safe and quality care to improve patient health outcomes,” RACP President Dr Catherine Yelland explained.

“Even if tests and treatments are available to diagnose and treat a condition, doctors and patients should be questioning if they are necessary, do they carry risk, or will they make any difference to a clinical outcome.”