HOLLAND MUSCULOSKELETALHOLLAND MUSCULOSKELETALPROGRAM TEAMPROGRAM TEAM

Welcome to the seventh edition of the Holland Musculoskeletal Team News.

Every few months, you’ ll fi nd updates on clinical services, education

and staff activities.

We welcome your suggestions for content and your articles for future issues.

Please send any ideas and/or submissions to sandeep.deol@sunnybrook.ca

or call 416.967.8554

NEWSNEWSSeventh Edition February 2009

Successful Holland Centre Christmas Drive Supports Philippine Children with Disabilities

In December 2008, four generous staff members at Sunnybrook’s Holland Orthopaedic & Arthritic Centre launched their annual Christmas drive to support the rehabilitation needs of children living in poverty in the Philippines.

As members of the Philippine Working Group (PWG) of the International Centre for Disability and Rehabilitation (University of Toronto), staff members Mark Anunciacion, Hilda Ho, Cecilia Nguyen and Jeffrey Andrion are supporting the rehabilitation needs of five children in Davao City, Philippines, in partnership with the Kaakbay Rehabilitation Centre (www.kaakbay.tk).

With the help of Sunnybrook staff, the Holland Centre team raised funds by selling Christmas tree ornaments ranging from $1, $2, $5, $10, and $20 to staff. Initiated in December 2007, the

Decorate-a-Christmas-Tree project has since become an annual Holland Centre tradition. The drive offi cially kicks off after the hospital’s holiday party and continues for three to fi ve days.

“The amount that we raise each year is used to finance the physiotherapy, occupational therapy, and speech therapy needs of five children with disabilities in the Philippines,” says Jeffrey Andrion, chairperson of PWG and a physiotherapist with the Holland Musculoskeletal Program. “This year, we are continuing to support these children. They have been chosen by the staff of the Kaakbay Rehabilitation Centre in the Philippines as the patients who need the services the most.”

PWG initiated the project after they were informed by their partner organization in the Philippines that some children were no longer receiving the therapy services they required because their families could not afford them. The children, who are between six and eight years old, are assisted in basic areas of living such as bathing, sitting, toileting, writing and speaking. With the generosity of the PWG, these children have achieved notable improvements in their daily quality of life.

“According to the World Health Organization (WHO), 10 per cent of the world’s population is disabled, and 80 per cent of them live in developing countries. From the 600 million

some of my colleagues will join me for a trip to my home country and see what disability in a developing country is all about.”

PWG organizes a number of projects to help raise funds for children with disabilities in the Philippines. A lecture series for fi eld professionals is held each year; the lecture series is a joint partnership with the Philippine-Educated Physical Therapy Graduates Association in Ontario, an organization recognized by the College of Physiotherapists of Ontario. PWG also offers a Mentoring and Networking Program that helps internationally-educated physiotherapists prepare for their fi eld’s national exam.

“The entire Holland Centre has been so generous with their donations,” adds Jeffrey. “As a matter of fact, one staff member went on to pay for an entire year of rehabilitation services for one child!”

(Left to right): Mark Annuciacion (PT), Jeffrey Andrion (PT), Cecilia Nguyen (OT). Hilda Ho

(PT) is absent.

disabled people worldwide, only two to three per cent have access to rehabilitation services,” says Jeffrey. “It is my hope that in two years’ time,

SCIL Honoured by Unique String Quartet Performance

In November 2008, Sunnybrook staff and patients enjoyed a beautiful concert preformed by a string quartet in the Sunnybrook Centre for Independent Living (SCIL) clinic area.

Sunnybrook staff listened in amazement as The Amaro Quartet played selections from artists like Haydn, Bach, Mozart and Vivaldi. The quartet also traced the historical beginnings of the string quartet to contemporary tunes such as The Beatles.

The concert was generously arranged by Kent Teeple, a musician with the Toronto Symphony Orchestra (TSO), who offered the exceptional hour of music to staff and patients in SCIL as a token of his gratitude for the prosthetic services offered to him by SCIL staff.

Kent was born with a condition that led to the amputation of his legs below the knee at the age of three and fi tted for his fi rst pair of prosthetics at the age of five. He has been receiving prosthetic care at Sunnybrook for the past three years.

“I have always wanted to play at Sunnybrook,” Kent says. “Without SCIL, my life would have been lonelier, and a lot more diffi cult. I fi nd that being a part of this place makes you feel supported.”

The Amaro Quartet, in which Kent plays the viola, performs in the community for nursing homes, high schools, hospitals, fi lm festivals and recently, the Centre for Addiction & Mental

Kent Teeple, second from left, performing with The Amaro Quartet

Continued on page 2

February 2009 Holland Musculoskeletal Program Team News2

Preparing for hip or knee replacement surgery? Sunnybrook Health Sciences Centre and Shoppers Home Health Care have teamed up to get you ready by offering a Pre-operative Education Program (Pr.E.P) class closer to home. Classes are now being offered in the Durham Region, as well as at Sunnybrook’s Holland Orthopaedic and Arthritic Centre in Toronto.

Pr.E.P. classes are led by an occupational therapist and a physical therapist. Topics covered include:

How to best maintain or improve strength and • fi tness before your surgery

Exercises and activities to do immediately • following surgery

How to plan for discharge from hospital •

Necessary or helpful equipment safety •

Transfers and mobility •

How to manage your every day activities •

If you live in the Durham Region, you can attend our next class!

Date: February 19, 2009 (phone for more dates)

Times: 10:30 a.m. for Knee Replacement Pr.E.P. class1:00 p.m. for Hip Replacement Pr.E.P. class

Location:Westney Heights Plaza, Shoppers Home Health Care store260 Kingston Road West, Unit 23Ajax, Ontario, L1T 4E4

Contact: Call Carmela at 905.427.4171 to reserve your place in one of these classes.

For further information, please visit: http://sunnybrook.ca/content/?page=Focus_MSK_Info_PrEP

Kent Teeple explains the historical beginnings of the string quartet

Health (CAMH). The quartet belongs to a program called Music Reaches Out, which consists of musicians from the TSO who support and fund each other as they perform in the community in their spare time.

“There is always someone who comes up afterward and says, ‘I never knew it sounded so beautiful’,” notes Kent. “That is what makes it worth-while.”

The other three members of The Amaro Quartet include violinists Amalia Joanou-Canzoneri and Anjelique Toews, and cellist Audrey King.

Sunnybrook Centre for Independent Living (SCIL) is a unique facility that provides services to people of all ages with disabilities to help them function optimally, including diagnostic clinics and customized manufacturing of assistive devices, foot orthotics and orthopaedic footwear. From its early roots in 1949 as the Prosthetic and Custom Footwear Services Centre providing care to injured Veterans in Canada, SCIL has become a leader in prosthetic, pedorthic and orthotic services through research and outstanding clinical teaching.

Use of New Anticoagulant

at Holland Centre Aims to Reduce

Surgical Complications Rivaroxaban (Xarelto ®) available

for all patients after total hip and knee replacement surgery

At the beginning of January 2009, the Holland Orthopaedic & Arthritic Centre became one of the fi rst organizations in North America to take a coordinated approach in the implementation of a new oral anticoagulant that has recently entered the market. In order to prevent blood clots and to optimize patient safety, the Holland Centre is using Rivaroxaban (XareltoR), a new Factor Xa inhibitor, to protect patients from the complications of total hip and knee replacement.

Developed by Bayer Canada, a 10mg dose of Rivaroxaban is now recommended once-daily for all hip and knee joint replacement patients regardless of their age or weight. Patients are recommended to take the oral anticoagulant for 15 days after surgery, as it is now the recommended method of prophylaxis for the majority of patients at the Holland Centre.

A multidisciplinary group of surgeons, medical specialists, anesthetists, nurses, pharmacists, physiotherapists and administrators at the Holland Centre worked together to ensure a smooth implementation of the new drug. Under a tight timeline, the group successfully launched the use of the new oral anticoagulant for surgical patients on January 5, 2009. This effort represents the fi rst large scale use of the drug, with a planned evaluation of the program in Canada.

Staff members hope that the new treatment program will lead to safer clinical guidelines regarding dosage and duration of treatment in order to protect hip and knee replacement patients from the serious complications that can arise with surgery, such as the formation of blood clots. The previously available anticoagulants required either frequent laboratory monitoring or patient self-injection after discharge. In research studies, Rivaroxaban has been found to be a highly effective agent and easy to administer.

A collaborative partnership with Sunnybrook’s Thromboembolic Services and Bayer HealthCare will allow the Holland Centre to closely monitor and evaluate this change in clinical practice.

Getting a Leg Up!Sunnybrook’s Pre-operative Education Program Classes Now in Durham

Continued from page 1

SCIL Honoured by Unique String Quartet Performance

Toronto

Holland Musculoskeletal Program Team News February 2009 3

SCIL’s New Hand Splinting Service

Aims to Fill Health Care Gap

In recognition of a growing need for customized hand care in the community, the Sunnybrook Centre for Independent Living (SCIL) has recently opened a new Hand Splinting Service. Many professionals who are not linked to hand clinics, including neurologists, family doctors, and surgeons, have identifi ed the need for a hand splinting program.

“People in need of customized hand splints are often at a loss of where to go, particularly if they need conservative management and do not require surgery,” says Debra Carson, Managing Director of Rehabilitation Operations at Sunnybrook. “Individuals in this situation will now be able to come to SCIL for a comprehensive hand assessment and custom splint if needed. By operating this service at Sunnybrook, patients will be able to coordinate clinic/medical appointments with an appointment with our occupational therapist, Andrea Rabiewsky. We are pleased to be able to fi ll a gap in health care!”

At SCIL’s Hand Splinting Service, clients will experience a customized process that aims to provide thorough and individualized treatment of hand problems. An individual assessment of the hand concern, injury or diagnosis is preceded by treatment, which includes education about the client’s condition and then possibly splinting. The client will be educated about the wear and care of their splint, and how changes to posture and type of activity can also promote a healthier hand.

Historically, patients have experienced diffi culty f inding available hand splinting services, particularly if the service is not linked with a surgeon. Within Ontario, most splinting services are associated with plastic surgeons or orthopaedic hand surgeons. Patients undergo long wait times to be seen by this type of specialist and receive referral for a hand splinting service. As a result, clients often resort to purchasing ill-fi tting splints from their local pharmacy with little or no relief for their symptoms, and some clients give up on treatment altogether.

Patients who will benefit from the new hand splinting service at Sunnybrook include patients with hand contractures due to a musculoskeletal or neurological condition, such as rheumatoid arthritis, osteoarthritis, Dupuytren’s contracture, cerebral vascular accident or stroke and cerebral palsy.

The SCIL Hand Splinting Service is not funded by OHIP, but some clients may be able to access third party insurance benefi ts. The new service will be managed by Karen Fairley, Clinical Coordinator, and services will be delivered by Andrea Rabiewsky, an occupational therapist. Medical referrals are now welcome by fax at (416) 480-5975.

A Brief Message from Sunnybrook Foundation

Sunnybrook Foundation would like to sincerely thank the Holland Centre and Holland MSK Program staff for all your help in fundraising for our hospital! Many of you may have seen Paul and Catherine taking visitors on tours of the Holland Centre. Our visitors have been thrilled to see the work that you are doing and have been so thankful to be offered an opportunity to talk with many of you. It is this added touch that makes these visits so special. We are getting close to reaching our goals to start construction and you will notice, in a few months, posters around the hospital highlighting the fundraising campaign for Sunnybrook and Holland in particular. Thank you all for your help and support!

- Paul McIntyre Royston, Campaign Director, and Catherine Argiropoulos, Development Offi cer

AccomplishmentsDr. Jeffrey Gollish and Anne Marie MacLeod are members of a Steering Committee for the National Hip & Knee Knowledge Translation Network of Bone & Joint Canada. The Group has recently received Health Canada funding to develop a toolkit that provides a roadmap for the management of patients requiring hip and knee replacement surgery.

Dr. Markku Nousiainen, a new orthopaedic surgeon with the MSK program, was recently awarded a grant from the Canadian Orthopaedic Research Legacy in November 2008 for his work, Training Femoral Neck Screw Insertion Skills to Surgical Trainees: Computer Assisted Surgery Versus Conventional Fluoroscopic Technique. In collaboration with Duke University in North Carolina, Dr. Nousiainen’s work takes a closer look at how useful computer-assisted surgery is in training fi eld professionals and if technology can be used to educate future surgeons to perform better.

Congratulations to Deborah Kennedy, who has been selected to receive the Ontario Physiotherapy Association’s Special Award for Research. The award is a symbol of the association’s appreciation for demonstration of leadership in scholarly activities and recognizes signifi cant contributions to research within the physiotherapy profession.

Notable PresentationsIn December 2008, Dr. Jeffrey Gollish and Susan Robarts delivered a presentation at the City Hospital in Saskatoon, Saskatchewan, titled Hip and Knee Multi-Disciplinary Clinic – Special Meeting with Dr. Jeffrey Gollish and Susan Roberts. The presentation and group discussions aimed to assist the development of a new model of care in Saskatchewan.

February 2009 Holland Musculoskeletal Program Team News4

The Centre for Health Services Sciences ( C H S S ) a n d t h e Musculoskeletal Program (MSK) we lcome F iona Webster as a Knowledge Translation (KT) scientist. Fiona is an experienced soc ia l sc ience resea rche r and knowledge translation expert who has participated for over 14 years in research across various health care set t ings, including publ ic health, community organizations and hospitals.

Fiona comes to Sunnybrook from the Canadian Institutes for Health Research (CIHR), where she worked as the Assistant Director of Knowledge Translation at the Institutes of Circulatory and Respiratory Health (ICRH) and Population and Public Health (IPPH). Her PhD dissertation in sociology utilizes institutional ethnography to study the uptake of research evidence in relation to physician use of acute stroke therapies, therefore contributing to the fi eld of implementation science. In addition to her in-depth theoretical understanding of KT, Fiona has also been involved in overseeing the practical implementation of knowledge into practice. Fiona will be pursing KT research at both the Bayview and Holland Centre campuses at Sunnybrook.

New Knowledge Translation Scientist Joins Team

From L to R: Dr. Chris Idestrup, Dr. Colin McCartney, Dr. Su Ganapathy, Dr. Alayne

Kealey, Dr. Andrew McNaught

Past Events

The Rehabilitation Team surrounds cupcakes and fruit at their mission, vision and values session

SCIL staff discuss how the leaf should represent their team

Optimizing Functional Outcome Following Total Knee Replacement Symposium

In October 2008, the Holland Orthopaedic & Arthritic Centre hosted a symposium called Optimizing Functional Outcome Following Total Knee Replacement, where an exceptional line-up of internationally and nationally renowned experts discussed preoperat ive and postoperat ive pa in management. Organized by Dr. Jeffrey Gollish and Dr. Colin McCartney, the symposium has become an annual Holland Centre event, with preparations for the 2009 symposium currently underway.

Presentations from Sunnybrook included:• Preoperative management: Management of the

patient with preexisting chronic pain - Colin McCartney, MD, Sunnybrook Health Sciences Centre

• Indications for TKA: What makes a surgical candidate? - Ashley Carr, MD, Department of Orthopaedic Surgery, University of Toronto

• Managing the patient with peripheral nerve blocks in the post operative period - Alayne Kealey, MD, Department of Anesthesia, University of Toronto

• How to avoid side effects/complications regional anesthesia - Andrew McNaught, MD, Department of Anesthesia, University of Toronto

• Management of thromboprophylaxis and regional anesthesia - Joseph Kay, MD, Department of Anesthesia, University of Toronto

• Complexities of TKA in relation to pain - Jeffrey Gollish, MD, Sunnybrook Health Sciences Centre

• Multimodal analgesia in the elderly - Joseph Kay

• Post-discharge pain management - Mona Sawhney, RN, Pain Service, University of Toronto

Sunnybrook’s Mission, Vision and Values Campaign

In November 2008, the Sunnybrook Centre for Independent Living (SCIL) and the Rehabilitation Team buckled down to work, designing a leaf for their respective departments in celebration of Sunnybrook’s new mission, vision and values campaign. Staff enjoyed a leaf-shaped cake and lively discussion about what the new statement means to staff.

Ken Cheddie, senior technician for prosthetic services, says, “I think this session is a great idea because it gives staff something they can focus on and identify with. It helps to orient new staff coming in to work at Sunnybrook and it helps to reinforce with old staff what they do everyday. It also helps outside of work too; it’s like a code that everyone can live by.”

Pain Myths and Misconceptions Lunch and Learn SessionStaff members from all disciplines at the Holland Centre attended an internal lunch and learn session titled Pain Myths and Misconceptions in January, 2008. The session aims to increase staff awareness and attitudes relating to pain.