Patients and practitioners deserve the latest science has to offer. So do decision-makers, who have ready access to our findings through our Strategic Policy and Research Communications (SPARC) unit. A lot of our research has immediate implications for the delivery of health care.
Canada is one of the world’s largest per-capita consumers of opioid painkillers. These medications, such as morphine, codeine and oxycodone, help people deal with chronic pain not resulting from cancer. But there’s an alarming misuse of these pain drugs. Dr. Andrea Furlan, a Toronto Rehab scientist and clinician, has played a big role in developing a new guideline to help doctors when they are considering whether to prescribe opioids for their patients.
“The goal is to reduce abuse and addiction problems with these medications and ensure that the right people are getting them,” says Dr. Furlan, a lead author of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The Guideline includes 24 practice recommendations for doctors. To encourage widespread use of the Guideline, Dr. Furlan created a new app for iPhone and iPad that helps doctors decide whether to prescribe opioids and makes it easier to monitor patients taking these drugs for non-cancer pain, such as osteoarthritis and low back pain. Called Opioid Manager, the app launched in September 2012. Find out more at
The new app captures key information from the Guideline and is a technology-based interactive version of a paper tool, also called Opioid Manager, developed by Dr. Furlan in 2010, with the Centre for Effective Practice. The paper tool has been translated into French, Portuguese, Spanish and Farsi and can be downloaded from the
National Pain Centre. There’s also an
Opioid Manager video. Opioid Manager is being adapted for physicians using Electronic Medical Records. Dr. Furlan is a member of the National Faculty, a group that is implementing and evaluating the Guideline. She is also an associate scientist at the Institute for Work and Health and a University of Toronto assistant professor of physiatry.
Usually, hip-fracture patients who have dementia-like symptoms are moved directly from acute care to a nursing home. The reason? A belief that these patients can’t endure or benefit from an active rehab setting. But our researchers challenged that assumption. Senior scientist Dr. Kathy McGilton and her colleagues developed a new model of care for hip-fracture patients with cognitive impairment. The results show that, with a creative, sensitive and personally tailored approach, these patients can do just as well in active rehab as those who are cognitively intact. The key is to provide staff with a greater understanding of cognitive impairments – and the skills, knowledge and support needed to relate to patients with these conditions.
A study shows that, with the new approach, cognitively impaired patients made comparable gains in functional independence after breaking a hip. What’s more, they did not require extra days in hospital to make those gains. “Our study found that these patients were just as likely to walk out of the hospital on their own steam – and to live in the community after discharge,” says Dr. McGilton.
More than 30 health care institutions across the Greater Toronto Area have implemented the new model of care. An evaluation of the model of care, focused on long-term patient outcomes and led by Dr. McGilton, is underway in two hospitals outside of the GTA.
More than half of Toronto’s homeless population has had a traumatic brain injury. That 2008 finding sparked calls for routine screening for brain injury among the homeless. Now, work is under way at a Toronto shelter to determine how best to screen for brain injury in homeless people. “It’s a significant step towards routine early identification, which can lead to rehabilitation,” says Toronto Rehab senior scientist Dr. Angela Colantonio, project co-supervisor with Dr. Jane Topolovec-Vranic of St. Michael’s Hospital. Dr. Colantonio co-authored the 2008 study with principal author Dr. Stephen Hwang of St. Michael’s.
Dr. Colantonio has also led an ambitious project to create a registry with information on Ontarians living with traumatic and non-traumatic brain injuries. The new data set gives service providers an accurate picture of brain injury in their geographic region, including incidence and prevalence, and information on survivors such as age, gender, type of brain injury and which services they use and where. The registry is being used by planners at some of Ontario’s local health integration networks. “Providers are using this vital data for planning, placement and budgeting and ensuring the right services are provided,” says Dr. Colantonio.
Despite the introduction of mechanical patient lifts several decades ago, nurses continue to experience high rates of back injury. Many injuries occur during the transfer, lifting or repositioning of a patient. Enter Toronto Rehab, where research is pointing to ways to reduce these injuries.
“The problem of back injuries among nurses is huge,” says Dr. Tilak Dutta, a Toronto Rehab Scientist and Technology Team leader. Why do injury rates persist? With many pressures on their time, nurses may not always use overhead or floor lifts, says Dr. Dutta. More patients are obese, and that’s also putting a load on nurses’ spines.
Recent studies by Dr. Dutta and colleagues show that overhead lifts are significantly safer for staff than floor lifts. In fact, spinal load is lower when 1 caregiver uses an overhead lift than when 2 caregivers use a floor lift.
Concern about injuries on the job has prompted our researchers to invent several high-tech lifting tools. Take
SlingSerter™, a revolutionary new device that uses compressed air to insert a lifting strap under a patient, with no effort. There’s a special strap that allows for easy removal after the lifting task has been completed. A commercial partner, Andrew J Hart Enterprises Limited, is on board, and SlingSerter is expected to be commercially available soon. Also coming:
RoboNurse, a patient-lifting robot for areas lacking overhead lifts.