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 use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.
Numerous studies suggest that the Montreal Cognitive Assessment (MoCA) is one of the most effective means of assessing cognitive deficits in acquired brain injury (for instance after transient ischemic attack and stroke) and is to be preferred to the Mini Mental State Evaluation (MMSE). MMSE may under-detect cognitive impairment in acquired brain injury; it is more appropriate for assessing dementia.
- Burton L, Tyson SF. Screening for cognitive impairment after stroke: a systematic review of psychometric properties and clinical utility. J Rehabil Med 2015; 47(3):193-203.
- Pendlebury ST, Cuthbertson FC, Welch SJV, et al. Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke 2010; 41(6):1290-3.
- Pendlebury ST, Mariz J, Bull L, et al. MoCA, ACE-R, and MMSE versus the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery after TIA and stroke. Stroke 2012; 43(2):464-9.
- Srivastava A, Rapoport MJ, Leach L, et al. The utility of the Mini-Mental Status Exam in older adults with traumatic brain injury. Brain Inj 2006; 20(13-14):1377-82.
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.