Sunnybrook researchers find early physical medicine and rehabilitation consults benefit critically injured patients

Dr. Larry Robinson

Sunnybrook researchers find early physical medicine and rehabilitation consults benefit critically injured patients

Dr. Larry Robinson, Director of the St. John’s Rehab Research Program at Sunnybrook Research Institute.

Dr. Larry Robinson, a senior scientist and director of the St. John’s Rehab Research Program at Sunnybrook Research Institute, has shown that among people with traumatic injuries or burns, early consultation with a physiatrist (physical medicine and rehabilitation doctor) is associated with a shorter hospital stay.

Seeing a physiatrist during acute care is associated with shorter hospital stays

As a medical student, Dr. Larry Robinson considered specializing in neurology or psychiatry. Then he found his path. “I ultimately chose physical medicine and rehabilitation, because I thought we could have an impact on almost everyone we encounter—not necessarily [on] curing them, but a positive impact in terms of improving function,” says Robinson, a senior scientist in and director of the St. John’s Rehab Research Program at Sunnybrook Research Institute (SRI).

Physical medicine and rehabilitation doctors, called physiatrists, evaluate and treat people whose functional abilities, like dressing, walking and self care have been impaired. These impairments can result from conditions like stroke, musculoskeletal disorders, spinal cord injuries, burns and trauma.

Robinson is chief of rehabilitation services at Sunnybrook. As one of two major trauma centres in the Greater Toronto Area (the other is St. Michael’s Hospital), Sunnybrook admits between 800 and 1,000 severely injured people annually. He studies the impact of early physical medicine and rehabilitation consultation on people treated for traumatic injuries at Sunnybrook.

In a recent study, he and his colleagues found that consultation with a physiatrist within eight days of admission was associated with a shorter stay, fewer complications and less use of benzodiazepines and antipsychotics. These drugs, while good at keeping patients calm, can hinder learning in the long term. Physiatrists generally discourage use of them as it can impede recovery. The study was published on Jan. 1, 2019 in the Journal of Physical Medicine & Rehabilitation.

In the study, the team initially compared outcomes of trauma patients in acute care who did not receive treatment from a physiatrist, with those of trauma patients who did receive treatment. There were no significant differences between the two groups in length of stay, readmissions or complications.

Where meaningful differences emerged, however, was in outcomes of trauma patients in acute care who saw a physiatrist within eight days of admission, and those of patients who saw one after eight days in hospital. On average, trauma patients who saw a physiatrist sooner had a length of stay that was 11.8 days shorter. The severity of injury was similar between the two groups.

The findings led to Sunnybrook increasing the number of physiatry consults in acute care, converting the single part-time position into a full-time one. Moreover, Robinson is working with St. Michael’s Hospital to recruit a physiatrist for its trauma program on the basis of the research.

“This study suggests that there’s no financial drain; in fact, there’s probably financial benefit to have the consultant see the patients early on—it’s associated with earlier discharge from acute care and maybe less complications,” says Robinson, who was recently recognized with a Five-Year Exceptional Leadership award as director of the division of physical medicine and rehabilitation at U of T.

This July marks Robinson’s fifth-year anniversary at Sunnybrook and, when he officially will become a Canadian citizen. Originally from the U.S., he was recruited from the University of Washington, where he worked for 25 years.

He has also published a study co-authored by SRI senior scientist Dr. Marc Jeschke on the impact of physiatry on people admitted to hospital for burns. The research compared outcomes before and after the introduction of physical medicine and rehabilitation consultation to Sunnybrook’s acute burn care program.

Robinson and colleagues found that while the addition of a burn physiatrist did not shorten burn patients’ length of stay in acute care, it significantly reduced length of stay in the rehabilitation hospital. Compared to the 109 people who did not see a physiatrist after their burn injury, the 104 burn patients who received physical medicine and rehabilitation stayed in the rehabilitation hospital six fewer days (24 versus 30 days).

“It looks like having the burn physiatrist involved does improve efficiency for our rehab stay. Patients generally want to get home sooner, and don’t want to stay in the hospital any longer than they need to. Plus, it saves cost—at $500 per day, that’s $3,000 per patient,” says Robinson of the study, which was published on May 22, 2019 in the Journal of Burn Care & Research.

Ultimately, he says, integrating physiatry into acute care is better for patients because it eases the transition to an in-patient rehabilitation facility. “Transitions are points of risk in any patient’s journey. By bringing the physiatrist into acute care, we can start the patient’s and family’s rehabilitation earlier and help them know what to expect in in-patient rehab. We can start to prepare the groundwork for their rehab by keeping them off drugs that would be a problem, maintaining their range of motion and starting strengthening programs. So it’s not a distinct time in acute care, and a distinct time in rehab; it’s really a continuum,” he says.

Sunnybrook is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

St. Joseph’s Healthcare Hamilton using ultrasound to catch arthritis sooner

Dr. Margaret Larche in her office.

St. Joseph’s Healthcare Hamilton using ultrasound to catch arthritis sooner

Dr. Maggie Larché, clinician-researcher at St. Joseph’s Healthcare Hamilton.

Rheumatoid arthritis (RA) is an auto-immune disease that affects approximately 1 in 100 Canadians. RA is caused by a malfunction of the body’s own immune system. The disease is characterized by joint inflammation that causes pain, stiffness, and swelling. Joint degradation occurs as a result of the immune system’s attack on the lining of the joints.

Early signs of RA can be vague, such as feeling tired and unwell, accompanied by sore joints. As the disease progresses, more joints may become affected. Detecting RA in its early stages is a major factor in the successful treatment of the disease. The window to achieve remission, thereby preventing permanent damage to the joints, is an estimated 6-12 months, and this narrow timeframe presents a challenge.

Dr. Maggie Larché is a clinician-researcher at St. Joseph’s Healthcare Hamilton. For years, Dr. Larché has been at the forefront of advancing the use of ultrasound in the diagnosis and treatment of RA. Dr. Larché also teaches musculoskeletal ultrasonography to medical trainees and clinicians in an effort to expand use of this diagnostic technique.

Research on the feasibility of ultrasound for RA diagnosis conducted by Dr. Larché and her colleagues is transforming the field of rheumatology in Canada. Though the technique may require longer clinical visits for patients at the point of care, its ability to enhance early detection and monitoring will help more Canadians start treatment sooner and avoid permanent damage to their joints. Not only does this reduce the health care resources needed to treat chronic RA, it assists in improving patient quality of life.

“We know that ultrasound can detect RA sooner than clinical methods, and an earlier diagnosis can have a significant impact on a patient’s recovery and overall quality of life,” explains Dr. Larché. “My colleagues and I have promoted the use of ultrasound in diagnosing and monitoring patients with RA, as well as increased the use to ultrasound training for health care providers in Canada.”

Overall, there are many advantages of using ultrasound over other imaging methods. Ultrasound is a non-invasive, radiation-free, portable, and inexpensive tool for diagnosing RA. In addition, diagnosis occurs in real-time with the patient, unlike an MRI or CT scan.

“I was diagnosed with RA in my hands. The treatment for RA involves injections to reduce the inflammation that causes pain. Her use of ultrasound to pinpoint the problematic spots of my hands allows her to find the best place for each injection, improving the effectiveness of the treatment. Dr. Larché has given me the use of my hands, which has greatly improved my quality of life,” said Margaret Clark, patient and research participant.

St. Joseph’s Healthcare Hamilton is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Research led by The Ottawa Hospital could help people with cancer avoid life-threatening blood clots

Patient Harold Black in the middle of his two doctors.

Research led by The Ottawa Hospital could help people with cancer avoid life-threatening blood clots

Harold Black (middle) suffered a life-threatening blood clot soon after being diagnosed with cancer. He survived the clot and today, people like Harold have a much better chance of avoiding blood clots, thanks to research led by Dr. Philip Wells (left) and Dr. Marc Carrier (right) at The Ottawa Hospital.

As a regular member of a church choir, Harold Black was used to standing and singing for long periods. But in September 2018, he had trouble catching his breath while singing in the congregation. Two days later he went to The Ottawa Hospital’s emergency department and was quickly diagnosed with a life-threatening blood clot in his lung, called a pulmonary embolism. The doctors also found a serious clot in his leg.

“It was a scary experience, but I feel very lucky because I was told that the first sign of a pulmonary embolism is often death,” said Harold, 76.

Harold had two days of intensive treatment and monitoring at The Ottawa Hospital. The clots have now cleared up, but he continues to take daily shots in his belly to prevent new ones.

Blood clots can occur in anyone, but they are particularly common in people with cancer, like Harold. In fact, blood clots are the second-leading cause of death in people with cancer, tied with infections.

“Cancer itself may increase the risk of blood clots, but chemotherapy, surgery and other factors can contribute as well,” explained Dr. Marc Carrier, who treated Harold’s blood clots at The Ottawa Hospital.

This problem inspired Dr. Carrier and fellow blood clot specialist Dr. Philip Wells to design a clinical trial to see if a low dose of a blood thinner pill could prevent blood clots in people newly diagnosed with cancer. The results, recently published in the New England Journal of Medicine, are now changing practice around the world.

The study included 563 people newly diagnosed with cancer who had a higher risk of developing blood clots (based on blood test results and other clinical factors). Half received a blood thinner pill twice a day and half received a placebo. Those who received a placebo were more than twice as likely to develop blood clots compared to those who received the blood thinner (10.2 percent with placebo compared to 4.2 percent with the blood thinner).

“Blood thinners are commonly used to prevent blood clots in other high-risk groups, but the traditional thinking has been that these drugs would cause too much bleeding in people with cancer,” said Dr. Carrier, who is also a senior scientist at The Ottawa Hospital and associate professor at the University of Ottawa. “Our study shows that if you select the right patients and use a relatively low dose of a certain blood thinner, the benefits easily outweigh the risks.”

With about 1.9 million people diagnosed with cancer every year in Canada and the U.S., the researchers estimate that about half, or 950,000 could be considered for the blood clot prevention strategy tested in the study. In this population, the strategy would be expected to prevent clots in six percent, or 57,000 people.

“Blood clots are not only life-threatening, but they can also cause pain, reduce quality of life and can be expensive to treat,” said Dr. Wells, who is also senior scientist and Chief of Medicine at The Ottawa Hospital and the University of Ottawa. “We expect that this study will change practice and help many people with cancer avoid blood clots.”

Black continues his cancer treatment, but he is back to singing in his church choir.

“If this research prevents people like me from developing blood clots, that will make a big difference for a lot of people,” he said.

The blood clot (thrombosis) program at The Ottawa Hospital and the University of Ottawa is the largest and the most research-intensive in the world. With four publications in the New England Journal of Medicine since 2015, their research is transforming lives both in Ottawa and around the world.

“I want to thank the outstanding physicians, nurses, research coordinators and other members of our thrombosis team,” said Dr. Wells. “But above all, I want to thank our patients for participating in our research and helping us improve care for them and others around the world.”

The Ottawa Hospital is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Building a SMARTER Ontario: Dr. Janet Rossant’s Story

Building a SMARTER Ontario: Dr. Janet Rossant’s Story

Ontario research hospitals contribute to a smarter Ontario by attracting, training and retaining some of the world’s most highly skilled researchers that help to establish our province as a destination for discovery and research development while building our knowledge-economy. Among these researchers is Dr. Janet Rossant, who proved the pluripotency of embryonic stem cells, in collaboration with Dr. Andras Nagy, in 1993 right here in Ontario.

Continue reading “Building a SMARTER Ontario: Dr. Janet Rossant’s Story”

Research Wrap-Up: CAHO Catalyst Fall 2015

”Without health research, you can’t have clinical trials, and without clinical trials, you can’t improve the health of Ontarians.” – Gretta Hutton’s Mantle Cell Lymphoma is in remission, thanks to a clinical trial at Hamilton Health Sciences.

Research Wrap-Up: CAHO Catalyst Fall 2015

“Without health research, you can’t have clinical trials, and without clinical trials, you can’t improve the health of Ontarians.” – Patient Gretta Hutton’s Mantle Cell Lymphoma is in remission, thanks to a clinical trial at Hamilton Health Sciences. Just one of many inspiring stories in this season’s Fall Catalyst.
Continue reading “Research Wrap-Up: CAHO Catalyst Fall 2015”

Groundbreaking Health Research is Happening Here

Groundbreaking Health Research is Happening Here

Research hospitals play a leading role in Ontario’s knowledge-based economy. To demonstrate the world-class research happening right here in our province, CAHO was delighted to host Deputy Minister of Research and Innovation, Giles Gherson, and Director Allison Barr on a 3-stop Innovation Tour to research labs at The Hospital for Sick Children (SickKids) and University Health Network (UHN). Continue reading “Groundbreaking Health Research is Happening Here”

Healthier, Wealthier, Smarter Conference Highlights

Healthier, Wealthier, Smarter Conference Highlights

THANKS TO YOU our HWS conference was an outstanding success! Now let’s carry the momentum forward

On June 1, 2015, the Healthier, Wealthier, Smarter Campaign was launched by CAHO and its membership with a conference at MaRS Discovery District. We were thrilled by the energy, the insight and the momentum that was generated and is continuing in the virtual world.

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Healthier, Wealthier, Smarter: A Snapshot of Ontario’s Health Research Success

Healthier, Wealthier, Smarter: A Snapshot of Ontario’s Health Research Success

CAHO’s 24 research hospitals are leaders in Ontario’s health care system, and collectively, we make Ontario healthier, wealthier, and smarter. Our blog series is dedicated to telling stories that showcase the research of our member hospitals across the province, but before we kick things off, we want to share a snapshot of the success we’ve contributed to so far.

Health research pays off
In 2014, CAHO member hospitals invested $1.4 billion in health research—and it paid off and then some. Every $1 dollar spent by research hospitals generated nearly $3 of economic output. The research initiatives at CAHO member hospitals have attracted the attention of industry investment, which accounted for 14% of research funding in 2014—that’s over two times the OCED average for business investment in higher education research and development. By contributing to Ontario’s health research, we have seen new economic growth in the form of jobs, new business opportunities, and marketable innovations.

How does that funding translate?
Health research funding has allowed the 16,400 researchers and staff at CAHO’s 24 member hospitals to make this province a Healthier, Wealthier, and Smarter place to live. For example, research hospitals have made Ontario healthier by discovering better cares, cures and treatments, and by decreasing the delivery time between lab bench and patient bedside to improve quality care. They’ve made Ontario wealthier by introducing 77 new health-tech products to the market in 2014, while stimulating nearly 41,000 jobs, and contributing $3.8 billion to the provincial economy. And they’ve made Ontario smarter by attracting and supporting the brightest and the best researchers and clinicians to deliver health innovations of the future to patients who need it today.