Helping patients get back on their feet

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Helping patients get back on their feet

New clinic at St. Michael’s Hospital is improving the quality of care for people with low back pain

Toronto, July 26, 2019

By Anna Wassermann

Neng Li on the ice with his two young children
Neng Li on the ice with his two young children.

Neng Li was playing ice hockey with his two young children when he suddenly felt a pain in his lower back. Having suffered a herniated disk before, he thought he knew what to expect. But this time it was worse.

“The pain was excruciating,” said Li. “And it progressed over the next few days to the point that I became entirely bedridden. I couldn’t do much of anything.”

Looking for a solution, Li visited his family doctor, who provided him with a referral for a new St. Michael’s Hospital clinic that would help get him back on his feet.

Opened in January 2019, the Rapid Access Clinic (RAC) for Low Back Pain was designed to help improve access, wait times and quality of care for people with low back pain. Stemming from the Inter-professional Spine Assessment and Education Clinics (ISAEC) model of care, the RAC at St. Michael’s is one of only three specialized sites across the Toronto-Central Local Health Integration Network (LHIN).

True to its name, the clinic sees patients quickly. Within four weeks of a referral, patients are scheduled for a consultation, where they receive a standardized assessment and self-management strategies, or a referral for a surgical or other specialist consult.

Dr. Andrew Bigness, practice lead at the St. Michael’s clinic, says this system is intended to help patients self-manage their back pain, and reduce unnecessary diagnostic imaging and specialist referral.

Dr. Andrew Bigness discusses how to manage lower back pain with patient Neng Li
Dr. Andrew Bigness discusses how to manage lower back pain with patient Neng Li.

“Eighty per cent of people will experience back pain in their lifetime, and their episodes are often recurrent,” said Dr. Bigness, who also works as the clinic’s advanced practice practitioner. “If people learn to manage their pain on their own, it lessens the burden on the system by reducing wait times for surgical consults and MRIs.”

It’s a model that pleases Dr. Henry Ahn, the clinic’s surgical lead and an orthopedic surgeon at St. Michael’s Hospital. Typically swamped with referrals, this system ensures that Dr. Ahn only meets with patients who’ve been pre-screened by Dr. Bigness and deemed a possible candidate for surgery, like Li.

“This method eases the clinic load and means that I can focus my time in the area that I serve best,” said Dr. Ahn. “There’s still the traditional route of receiving a referral for a surgical consult from your family doctor, but this method reduces the number of consults with patients that don’t need surgery.”

So far, only 15 per cent of the clinic’s 100 patients have needed a surgical assessment, and even fewer have required surgery. But with Drs. Ahn and Bigness shouldering the workload themselves, they’re limited in the types of cases they can take on.

Dr. Henry Ahn
Dr. Henry Ahn

“At this time, we’re really focused on particular conditions,” said Dr. Ahn. “We’re starting out with smaller spine surgeries that cause tremendous disability, but stand a great chance of improvement.”

Moving forward, Drs. Ahn and Bigness say they hope to recruit and train more assessors to work in the clinic, allowing them to continue to help patients like Li, who at two months post-op, says he couldn’t be happier with how everything turned out.

“Thanks to Dr. Ahn and Dr. Bigness, I’ve been able to get back to being my active self,” said Li. “My kids are happy too. They’re always asking me to play hockey or basketball outside, and it’s nice to be able to say yes again.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit

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