Laura Passalent
Laura Passalent, clinician-investigator at the Krembil Research Institute, works mainly with patients who have Ankylosing Spondylitis, an inflammatory arthritis that predominantly affects the spine. (Photo: UHN)

When Laura Passalent set off to volunteer in physiotherapy on a remote island in the middle of the Pacific Ocean, she didn't anticipate it would mark a turning point in her career.

As a young physiotherapist, Laura travelled to the Republic of Kiribati, a nation with about 100,000 residents. Her goal was to work with the community and help demonstrate to a country with no physiotherapists that they had a distinct need for the practice.

"At that point I had no idea what I was doing," says Laura, now a clinician investigator at the Krembil Research Institute. "But in fact it was public health enquiry that I was doing to try and show how many people had disabilities and what impact local physiotherapists could have."

She returned to Canada with a thirst for research.

"When I came back from that experience, I realized that I wanted to do more than just day-to-day clinical practice," she explains.

Her trip led Laura to complete a Master's Degree in Epidemiology and Community Health – a foundation that would help set her up for success for her work in Toronto Western's Arthritis Program.

The best of both worlds

Laura is now an Advanced Practice Physiotherapist with the Arthritis Program at TWH. Because of her Master's degree and additional training through the Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program, Laura is able to see patients and research at the same time – combining her passion for clinical care and examining research questions.

"One truly informs the other," she says. "Research informs clinical practice, but the clinical practice also informs the research questions.

"Not everyone is in a position to have the best of both worlds, and I feel very fortunate to be able to balance both in practice."

She works mainly with patients who have Ankylosing Spondylitis, an inflammatory arthritis that predominantly affects the spine. It can also affect peripheral joints, bowels, skin and eyes. About 1 per cent of Canadians have Ankylosing Spondylitis.

Laura's research focuses on three main areas: health services, through which she has helped develop a fast-tracked model of care for Ankylosing Spondylitis patients; clinical care, which has allowed her to examine the journey of these patients through the healthcare system; and patient education, where she lead the development, implementation and evaluation of an e-learning course for patients with Ankylosing Spondylitis.

"From a patient perspective, my research has reiterated to me the importance of a patient-centred approach," Laura says.

"A caring environment and ensuring that patients are listened to is very important."

In her time as a clinician investigator, her research has helped propel the creation of a unique spondylitis screening clinic where patients from the community and the hospital who have symptoms of Ankylosing Spondylitis are referred directly to Laura and her team.

"The average time for diagnosis (of Ankylosing Spondylitis) from onset of symptoms is anywhere from five to eight years," she explains. "It's important to identify these people early and provide them appropriate treatment in order to improve outcomes."

So far, this model of care has received positive evaluations in Toronto. The team is developing a national network of similar models across Canada, with invitations to share the knowledge abroad as well.

"It's great to see our clinic and our research having national and international impact," she says.

A holistic approach to care

Because of her diverse background and the path she took to get to this position, Laura says she always thinks about the big picture when consulting with patients.

This frame of mind informs her clinical work in the Hip and Knee Triage Clinic, where she works every week in addition to her role in the Spondylitis Program.

In one instance, Laura was able to recognize that a patient's hip pain – which prompted a visit to the Hip and Knee Clinic – was attributed to unidentified Ankylosing Spondylitis. With the appropriate management the patient is now doing much better and is no longer in debilitating pain.

"My skillset and experience have allowed me to be very holistic when I look at patients," she explains.

"I don't know if I would have picked up on that if I didn't have the ACPAC training or my career experiences so far."

The needs of patients come first

Whether it's through her research, development of educational materials, or clinical care, for Laura the patient is at the centre of everything she does.

"We learn from our patients," she says.

"There are important research questions that can be asked as a result of our interactions with patients."

It's also the learning and supportive environment at TWH that drives Laura in her work.

"I love what I do," she says. "It's the job itself – it's that clinical and research balance, because you feel that you have direct impact on how patients are being treated – but it's also the team I work with.

"It's an excellent team – we all stimulate each other's motivation and research questions on how to best serve our patients.

"By working with a great team, everything else just sort of falls into place."​

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