Australasian Faculty of Rehabilitation Medicine
Recommendations from the Australasian Faculty of Rehabilitation Medicine. The Australasian Faculty of Rehabilitation Medicine (AFRM) is a Faculty of the Royal Australasian College of Physicians (RACP). AFRM provides training and continuing education for Rehabilitation Medicine Fellows and trainees throughout all stages of their career. AFRM trainees and Fellows are committed to providing high quality rehabilitation care to individuals and communities in Australia and New Zealand.
Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis.
Studies of patients with osteoporotic fractures have found that they are at significantly greater risk of suffering a new fracture compared to the general population. This risk is particularly marked in but not restricted to elderly patients, particularly given that recent clinical guidelines recommend that all individuals over the age of 50 who sustain a fracture following minimal trauma (such as a fall from standing height or less) should be considered to have a presumptive diagnosis of osteoporosis. Despite this, there have been reports of insufficient provision for the management of these patients before discharge.
Osteoporosis assessments and/or treatments before discharge are clinically very important and moreover may be highly cost effective even after taking account of the additional resources associated with providing these services.
- Johansson H, Siggeirsdóttir K, Harvey NC, et al. Imminent risk of fracture after fracture. Osteoporos Int 2016; 28 (3):775-80.
- Johnell O, Kanis JA, Odén A, et al. Fracture risk following an osteoporotic fracture. Osteoporosis Int 2004; 15:175-9.
- Lih A, Nandapalan H, Kim M, et al. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 2011; 22(3):849-58.
- McLellan AR, Wolowacz SE, Zimovetz EA, et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 2011; 22(7):2083-98.
- Otmar R, Henry MJ, Kotowicz MA, et al. Patterns of treatment in Australian men following fracture. Osteoporos Int 2011; 22(1):249-54.
- The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn 2017.
- Teede HJ, Jayasuriya IA, Gilfillan CP. Fracture prevention strategies in patients presenting to Australian hospitals with minimal-trauma fractures: a major treatment gap. Intern Med J. 2007; 37(10):674-9.
A working group within AFRM initially identified 10 recommendations on low value practices in the field of rehabilitation medicine that may be widespread in Australia and New Zealand. Following a review of the evidence these were reduced to seven. An online survey based on these seven recommendations was distributed to all AFRM members asking them to rate these recommendations based on whether they thought they were evidence based, whether the low-value practices targeted were still being undertaken in significant numbers, and whether the recommendation was important in terms of reducing harm and unnecessary costs to patients. The working group reviewed the feedback and finalised the ‘top 5’ recommendations which were approved by AFRM Executive in mid-2017.
- 1 Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis.
- 2 Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain.
- 3 Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.
- 4 Do not routinely use splinting for prevention and/or management of contractures after stroke.
- 5 Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags.