Private clinics in Winnipeg to offer physiotherapy classes for knee patients

Private clinics in Winnipeg will soon offer the physiotherapy patients require after total knee replacement surgery — for a price.

The publicly funded classes, which are available at hospitals across Winnipeg until Nov. 24, are led by a physiotherapist to groups of between five and 10 people, twice a week, for about four to six weeks until their recovery. 

In November, the Reh-fit Centre and The Wellness Institute will have similar classes, with a $72 fee for the physiotherapist's initial assessment and classes for $15 to $25 each.

"Which is really unfortunate. In many ways I wish it was staying in the hospitals, because these are elderly patients who often don't have extended health coverage. So for them to pay out-of-pocket may be a financial hardship for those people," said Dorotea Cassels, a physiotherapist at The Wellness Institute who will be leading the classes there.

Cassels used to work at the Grace Hospital and taught the knee classes for several years. She said the format and space used at The Wellness Institute will be quite similar, and patients will be led through the same exercises, range-of-motion and strengthening activities and clinical assessments.

"Unfortunately, for us to run it as a business, we have to charge," she said, noting that since the sessions will be offered to groups as they are in the hospitals now, the rates are better than if patients had to pay for individual therapy.

She said typically, patients who go through 4 weeks of rehabilitation can expect to pay $272 for their recovery.

Patients confused

As the final classes in hospitals across Winnipeg wind down, many patients still doing them don't see the logic of it.

"Well, I think it's a real shame. I can't see how this is not a cost-effective program that they have," said Brian Wall, who had his knee replacement surgery in August.

He said while he has been able to do some of the recommended home therapies, nothing replaces the twice-weekly guidance of a physiotherapist, volunteers and other patients he sees at therapy.

"I think that this is a very worthwhile program. I've seen some people here, from when they start coming at the beginning, they really do need help. They can't just be left alone at home with no assistance or they're just not going to progress," he said.

Outpatient physiotherapy services are available in Nova Scotia and Alberta to patients who have had knee replacement surgery.

According to a spokesperson for Saskatchewan's Ministry of Health, all post-operative patients who have had knee replacement surgery receive post-operative physiotherapy service a few weeks after discharge, with "the frequency and length of follow-up dependent on the individual's progress."

In B.C., knee replacement surgery patients have access to outpatient physiotherapy service as long as they're still receiving hospital services.

In Ontario, there is public funding for in-home post-knee surgery physiotherapy through a network of outpatient clinics.

Movement is key to recovery

Cassels says for patients who have that 10-inch, painful scar across their knee, moving it is scary, but necessary.

"If you wait too long to start bending your knee then the scar tissue gets thicker and thicker and it becomes difficult to bend the knee at all," she said. That is why the physiotherapy classes begin early into a person's recovery and are "crucial," she said.

Cassels said it's "unfortunate" that the public system won't cover even a limited number of outpatient physiotherapy classes, without which she thinks patients will need to go back to their doctors for manipulations and ultimately cost the system more.

Surgeons perform a surgical "manipulation" which removes the scar tissue when a patient can't move their knee or has limited range of motion after surgery.

That procedure is on the WRHA list of clinical criteria for outpatient physiotherapy.  

Appeal for health care

While the WRHA has an appeals process in place for patients who may not be able to afford the physiotherapy after knee surgery, it has yet to disclose how the process will work.

Twenty physiotherapists will lose their jobs from various sites across Winnipeg as the Winnipeg Regional Health Authority centralizes outpatient services at the Health Sciences Centre, according to a spokesperson for the WRHA. There will be 12 physiotherapists there to staff the entire outpatient program.

"There's a big concern, talking to the hospital therapists. They worry about a lot of people who they really feel will not be able to afford to go into the classes," said Cassels.

She said given the location of The Wellness Institute in the city's North End, there are other concerns.

"We have a lot of immigrants, a lot of people that English as a second language, that maybe don't understand our systems, or what it means to pay or can't afford to pay, and often in some of those cultures, there's a huge fear of pain, and if that happens, then they don't move," she said.

"It does worry me a lot actually."

Any patients who haven't completed their knee therapy classes when they end on Nov. 24 can transfer to The Wellness Institute without having to pay the initial $72 assessment fee, she said, and the patient's progress will be transferred between physiotherapists.

She said people who know they have surgery in November have already been calling the clinic in confusion over what to do and trying to line up the classes. Classes are also available at the Reh-fit Centre for $15 a class, led by two physiotherapists, and will follow the same format as what was available at the hospitals as well.

She said everyone will strive to provide the same quality of care that outpatients were getting in the hospitals for decades.

"Physiotherapists have a high standard of what they try to provide to patients regardless of the setting they're in," she said.