Manitoba health professionals who work with patients undergoing hip and knee replacements are worried about the pending removal of outpatient hospital physiotherapy services.
They say the savings -- estimated at $3.5 million for the entire system -- may be squandered through higher hospital readmission rates and a failure to identify post-operation complications soon enough.
Patients undergoing knee operations must perform exercises to improve their mobility and strengthen their quad muscles. Many patients attend "knee classes" at hospitals to aid them with their exercise program. These hospital outpatient services are currently offered free of charge.
"Our knee patients have to keep going (exercising). Otherwise, we put in the joints for nothing," said one Winnipeg hospital nurse who asked not to be identified.
Joint replacements are carried out at Concordia and Grace hospitals. Manitoba has had some of the longest waits for joint replacement in Canada.
Bob Moroz, president of the Manitoba Association of Health Care Professionals, which represents many of the physiotherapists working in hospitals, said his members are reluctant to speak on the record.
At Concordia, he said, all patients who are to receive a hip or knee replacement are seen by a hospital physiotherapist in advance of surgery to determine a baseline for care.
The "knee classes" that are held after surgery are done in a group setting and are carried out in an efficient manner, Moroz said. As many as 10 or 12 patients are put through their paces at the same time by one physiotherapist and one rehab assistant.
Concordia runs about a dozen knee classes a week. Patients attend twice a week for four to eight weeks.
The physiotherapy protocols are developed in conjunction with the surgeons and other health professionals, Moroz said. "So the surgeons know exactly what they're going to get with inhouse physiotherapy."
The exercise regime is less complicated for hip-replacement patients, as walking is the best thing they can do to aid in their recovery.
Officials say physiotherapists are able to detect infections and other surgical complications that might require readmission. The sooner these problems are caught the better.
Normally, physiotherapists will see a knee-replacement patient two weeks after surgery; the surgeon won't see them for six to eight weeks after the procedure.
The Winnipeg Regional Health Authority has said it plans to end its adult outpatient hospital physiotherapy and occupational therapy services by mid-October as part of its mandate from the Progressive Conservative government to find $83 million in savings this budget year.
The hospital nurse the Free Press spoke with Thursday expressed concern patients may not be willing or able to pay to receive post-op physiotherapy at a private clinic. Many lack secondary health insurance, she said.
"I find that there are a great number of patients who can't afford things that they need for knee-replacement surgery at the best of times," she said, including an anticoagulant used to prevent blood clots.
"What I'm afraid of is that there is a whole population that don't have Blue Cross (insurance), that aren't going to be able to afford to continue with their knee classes or seeing a physiotherapist. So there is potential for people to be neglected."
Sarah Eisbrenner, president of the Manitoba Physiotherapy Association, said if patients aren't able to receive adequate post-operation physiotherapy, they could wind in at a hospital emergency room.
She said her members are concerned about the impact on patient care of the decision to cease most hospital outpatient physiotherapy and occupational therapy services.
(There are exceptions. Folks who need special rehab services and those whose incomes fall below a yet-to-be-established threshold will continue to receive free service at Health Sciences Centre. A special rehab program at Misericordia Health Centre will also be maintained.)
"It evokes a lot of emotions and frustration and uncertainty and confusion and questions," Eisbrenner said Thursday.
"We want to make sure that the patients are going to access the services that they need, get the care that they need, in order to maximize quality of life."
A WRHA spokeswoman said late Thursday the health region’s surgery and physiotherapy programs are "working together to ensure that appropriate discharge information continues to be provided to patients who've recently received surgery."
"Patients receiving hip and knee surgery are first seen in a preoperative clinic where they are assessed by a variety of health professionals including physiotherapists," Bronwyn Penner Holigroski said in an email. "During a patients' stay in hospital, after surgery, their care is provided by a team that includes a physiotherapist. The physiotherapist will provide specific exercises and demonstrations (for) patients before they are discharged."