New rehabilitation service opens doors

Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime. This ancient Chinese quote mirrors the philosophy University Health Network Rehabilitation Solutions (UHN RS) promotes with its clients.

"From day one, we encourage people to take control of their pain, control their life and teach them tools for self help," said Dr. Joel Andersen, medical director of the centre.

UHN Rehabilitation Solutions is a program of the Toronto-based University Health Network that offers specialized services to manage disabilities, prevent injury and promote good health.

The Sudbury site opened its doors in the downtown's Rainbow City Centre on October 5, 2009 and is the third branch to open within the last four years.

Clients afflicted with chronic pain, brain injury, fibromyalgia or other musculoskeletal injuries have access to 9,200 square feet of newly-renovated space filled with natural light and splashes of vibrant springtime colours.  High ceilings, bright open rooms and friendly, enthusiastic staff all contribute to a healing, regenerating atmosphere.

Clinic leader Lynne Raven said there was a need to provide services in Northern Ontario because many northern clients were travelling to UHN Rehabilitation Solutions' clinic at Toronto Western Hospital to receive treatment. Andersen's extensive experience in occupational medicine at his Sudbury practice made him an excellent candidate to oversee the operation.

UHN Rehabilitation Solutions is a Workplace Safety and Insurance Board-approved specialty clinic provider.


Pain program

"We offer an intensive six-week interdisciplinary pain program based on a bio-psychosocial model," said Raven. "One of the things that really drives our program and makes us unique is our interdisciplinary approach."

Raven explained that an interdisciplinary team comprised of a cognitive behavioural therapist, psychologist, physician, occupational therapist, physiotherapist, kinesiologist and return-to-work co-ordinator works with the client to help restore function.

Andersen describes the treatment as "active" versus conventional "passive" treatments such as massage therapy, trigger point injections or prescription drugs for which the client has no input. The cognitive behavioural therapy teaches people to put pain in one corner of their life instead of it being the dominant factor.

"We're dealing with a population that is extremely needy," said Andersen.

"They may have had economic failure, family relationship failure and therapeutic failures. These people, on average, are often 12 months off work and it is usually more than two years before they come to us."

The centre works under the publicly funded University Health Network, which is comprised of three Toronto hospitals: Princess Margaret, Toronto Western and Toronto General. Although Rehabilitation Solutions is a privately-funded branch of UHN, it has access to the Network's resources from the three hospitals. In return, all profits from the centre's services are funnelled back into the public hospital system. It is accredited through the Commission of Accreditation for Rehabilitation Facilities.

More than 90 per cent of the clients are referrals from WSIB, but others, including employers, insurance companies and even individuals can refer or self-refer. Clinicians will also go out into the community to promote health and safety via lunch 'n learns, or perform specific worksite assessments and recommendations to optimize a safe work environment. When the need arises, UHN RS specialists will travel to the Sudbury clinic to provide assessments, treatment and follow-up. 

Initially, people entering the program may be reluctant participants, Andersen said. "They come with the mentality that Rehabilitation Solutions will get rid of all the pain. Their expectations are way out of line...and we tell them very quickly that we are going to teach them how to help themselves, which may be totally different from what they've been told before."

At the outset, clients are assessed by the interdisciplinary team to determine the best possible way to achieve results. This may involve a review of the client's medication history, and current use of substances including alcohol and street drugs.

"Often, people coming into the program are either over-medicated or on inappropriate medications," Andersen said.

After the initial assessment, a customized rehabilitation program is created and put into effect. Various rooms at the centre provide exercise equipment or activities to restore function. An activity area has been set aside to focus on increasing sitting tolerance, concentration and improving memory. Work simulation boards are used for timed assembly-line work or to build certain muscle groups for specific tasks like overhead work. A relaxation/education room contains recordings and videos for relaxation exercises. A kitchen area provides an environment for cooking groups to learn to improve motor skills, pacing, and daily living activities. Walltalkers (dry erase wall coverings) are located throughout these rooms for clients to write inspirational messages.

Two weeks into the interdisciplinary pain program, a reassessment is performed to ensure the best possible treatment plan. That is often the time people realize they may be able to improve their function.

At the end of the six-week program, a discharge summary is sent back to the primary care physician, informing him or her about the treatment, the client's response and recommendations for follow-up. After three months, a one-day booster session is given in order to determine how the client is doing.

"We measure how well they've done in using the tools we've given them and whether we can refresh some of what may have slipped away," Andersen said.


Improvement

UHN RS statistics show that clinicians observed a 40 per cent improvement from pretreatment vocational status, which means more people were working, had returned to work or were involved in a labour market re-entry program.

After three months, 58 per cent of the clients reported they were slightly, much or completely improved. "It means they had less neck pain, less pain-related disability and fewer depressive symptoms than those who had not recovered," said Raven.

A Toronto-based research team comprised of medical and scientific experts continuously studies disability and how to improve outcomes. All of the programs are supported by evidence-based research.

"We're constantly evolving and trying to improve our outcomes," said Raven.

This is done by collecting data on subjects like medications, sleep, client satisfaction and pain perception, among others.

As UHN Rehabilitation Solutions becomes more widely recognized throughout the North, it will be like opening a new door for those caught on the treadmill of increasing physician and specialist wait times - a place where people with chronic conditions and medical issues can be seen, heard and access resources that will put them on the path to recovery, said Raven.


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