Research in Action

We share our knowledge with others. 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 healthcare.

We promote knowledge-sharing in other ways too. Each year at Research Day, we showcase our latest projects and findings. Toronto Rehab is also a founding partner of a unique international conference, the Festival of International Conferences on Caregiving, Disability, Aging and Technology (FICCDAT).  Our conferences and events bring together bright minds from around the world to promote the sharing of knowledge, foster collaborations and stimulate new ideas.

Our research is having an impact. Some examples of our research in action:
 

A new approach for hip-fracture patients with cognitive problems

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 Toronto Rehab researchers challenged that assumption. Senior scientist Dr. Kathy McGilton and 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 recent 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 healthcare institutions across the Greater Toronto Area (GTA) have implemented the new model of care. An evaluation of the model of care focused on long-term patient outcomes is now underway in two hospitals outside of the GTA, led by Dr. McGilton.

An estimated 17 per cent of people who are living in the community and break a hip have a diagnosis of cognitive impairment―and the numbers are expected to increase.
 

Enhancing client-centred care

Client-centred care is a term often used but not always well understood, even by the very people who care for patients. A recent survey of Ontario long-term care homes identified a need for greater support to make this philosophy part of everyday practice. Dr. Pia Kontos, a Toronto Rehab scientist, is known for her research with people with dementia and how they continue to express their individual identity, or ‘selfhood,’ through actions and gesture, even when words fail. Her pilot research shows that when caregivers respond to residents’ expressions of selfhood, interactions between them improve, and the use of psychotropic medications and other forms of restraint declines. Dr. Kontos decided to communicate her findings by developing a series of vignettes about practitioner-client interactions to show caregivers what client-centred care actually looks like.

The vignettes have burst into cyberspace where they are reaching practitioners through an e-learning course developed by the Registered Nurses Association of Ontario, with funding from the Ministry of Health and Long-Term Care. Launched in summer 2009, the online course is available to nurses and personal support workers in Ontario’s 400 long-term care facilities. “This has enormous potential to change attitudes and practice by increasing understanding of client-centred care,” says Dr. Kontos, a CIHR New Investigator.
 

Preventing brain injury on the job

August may be the cruellest month for brain injuries in Ontario's construction industry, but October is not far behind, according to a 2009 study by Dr. Angela Colantonio, a senior scientist at Toronto Rehab. Few academic studies have looked at brain injury among construction workers. Yet the construction industry—with approximately 400,000 workers in Ontario alone—is known to have a high rate of serious brain injury.

The authors didn't expect to find a second peak of injuries in October. This may reflect a surge in work to complete projects prior to the winter months. Contributing factors, they speculate, could be shorter days to work, less light, and more adverse weather conditions. Their study also begins to raise questions about the time of day when many construction–related brain injuries occur. It identifies two peaks during the day: the hour before and the hours after lunch.

Doug McVittie, assistant general manager and director of operations for the Construction Safety Association of Ontario (CSAO), says his group will circulate the findings to construction companies across the province, as well as labour and management health and safety committees. The results will also be shared with CSAO staff members who provide training and safety seminars for construction workers.

Read more about the study
 

An award-winning program for people living with heart disease

Cardiac rehabilitation saves lives. But despite the proven benefits, studies show that only 30 per cent of people who would benefit from taking part in a cardiac rehab program actually enrol in one. Toronto Rehab set out to change that. Scientists and clinicians at the hospital used their experience with Toronto Rehab’s successful on-site cardiac rehab program to create a home-based cardiac rehab program. Launched in 2007, the program has already reached hundreds of patients.
 
Here’s how it works: participants undergo a fitness assessment at the hospital and are given an individualized exercise plan. They work out from home, e-mailing exercise logs to a case manager who follows up with weekly prescheduled phone calls. Patients also learn about nutrition, psychosocial and other heart-related issues using a workbook and videotaped Internet lectures. 

Preliminary findings are encouraging. Eighty per cent of participants complete the program. Their heart and lungs show an average 21 per cent improvement, compared to 17 per cent for on-site patients. Satisfaction levels with the program are high. Most encouraging is that the service is reaching people who would otherwise have no access to cardiac rehab. 

The research-based program is quickly gaining recognition. In 2008, it won an Innovation in Health Care Award from the Ontario government for outstanding innovation in improving quality and patient safety. The $20,000 award is being used to develop materials to help other facilities run home programs.
 

Addressing a brain-injury information gap 

Brain injury is a leading cause of death and disability, yet there has never been a centralized dataset to assist in planning and evaluating services for brain injury survivors. Dr. Angela Colantonio, a senior scientist at Toronto Rehab, led an ambitious project to create a registry with information on Ontarians living with traumatic and non-traumatic brain injuries.  
 
The dataset 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. 

Launched in mid-2009, the registry is already being used by planners at some of Ontario’s local health integration networks (LHINs). “Providers are using this vital data for planning, placement and budgeting, and ensuring the right services are provided,” says Dr. Colantonio.

Using drama to improve care 

Survivors of brain injury need compassion, choice and control to recover; caregivers need strategies to help people with these serious injuries. So Toronto Rehab scientists are using the dramatic medium of theatre to train health professionals to provide better care for patients with brain injury.

Drs. Pia Kontos and Angela Colantonio, working with playwright Julia Gray, developed After the Crash, a play based on their studies. The remarkable play follows a patient and his wife through the healthcare system as he struggles to recover from brain injury. 

Now in its third year, the production has been performed 18 times and seen by audiences that include health professionals, hospital volunteers, survivors and their families. Response has been overwhelmingly positive. The play also resonated with the public and media when it was featured at the Toronto Fringe Festival in 2009.