Collaborative Management for Spine Care

Spine related disorders are among the most common, costly and  disabling problems in Canada. Spine related disorders are defined as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy,  some causes of vertigo and other conditions directly related to the spine. Virtually 100 percent of the population are affected by this group of disorders at some point in life. Treatment for spine related disorders have become increasingly specialist focused, imaging oriented, invasive and expensive with no evidence of improved outcomes for patients. SPINEgroup brings together a team of clinical experts targeted at diagnosing and managing spine related disorders. The group encompasses skills to maximize value in the management of spine related disorders including:

• skills in differential diagnosis

• skills in the management of different patient populations

• wide range understanding of complex nature of  spinal pain with biopsychological factors

• ability to detect and  manage psychological factors • appreciation in minimalism in spine care

• an understanding of the methods, techniques and indications interventional treatments and surgical procedures

• a unique understanding of work related spinal disorders • a unique understanding of motor vehicle accident related spinal disorders and injuries

• public health perspective and comorbidity relationship with diabetes, hypertension, obesity, dementia and depression

• the ability to coordinate the efforts of a variety of providers; case management

• the ability to follow patients over the long term to monitor and treat re-occurence and educate patients in self-management

• the ability to performance manage and assess outcome measures

We are undertaking a research pilot on developing a Collaborative Management Model for degenerative disorders causing back pain. Our objective is to develop and evaluate a model to reduce the clinical and economic impact of this prevalent condition on our senior population with multiple comorbid conditions including diabetes, dementia, depression and hypertension. The pilot will address the impact of back pain on seniors across the long term care (LTC) continuum through the development of an interdisciplinary management model that takes into account the impact of co-morbid chronic diseases.

We are in the process of partnering with a Long Term Care organization in Canada and want to extend the pilot to adults and seniors living independently in the community. We will be seeking funding from the LHINs and other research funding organizations. We are looking for physicians in the Vaughan and North York community to participate in our pilot by referring patients to our assessment team. In return, you will receive detailed triage information including outlining appropriateness of specialist consult, MRI and/or CT Scan. Assessments and triaging will be fully funded.

I look forward to your participation in this exciting project!

Kindest Regards

Dr. Connie D’Astolfo, DC, PhD (c)

Clinical Director, SPINEgroup

To register for the pilot or for more information, please contact:

Dr. Connie D’Astolfo, DC, PhD (c) at 905-850-SPINE (7746), ext. 22 or

James D’Astolfo, RN (Nurse Case Manager) at 905-850-SPINE (7746), ext. 67 or
















Assessment &   Triage:a)   Triage Expert Consultant for rapid   and timely assessment of your back pain patients (through phone, onsite or offsite consult) with the aim of:(i) Improving outcomes and satisfaction   with health care delivery for patients with acute, recurrent, or chronic LBP;(ii) Decreasing unnecessary utilization of   lumbar spine MRIs and CT scans;(iii) Identifying appropriate referrals to LBP-related specialists, i.e. orthopaedic surgeons and rheumatologists and;(iv) Timely access to a shared care treatment plan emphasizing chronic disease management, patient education and self-management strategies(v) Early identification of back pain related conditions and reduction of impact of associated chronic diseases including diabetes, depression,  dementia and hypertension.Back pain is a highly prevalent condition with approximately 90% of cases demonstrating “positive” findings when sent for CT or MR imaging. The clinical relevance of many of these findings is   questionable. While the vast majority (approximately 80-90%) of patients do   not require any intervention beyond rehabilitation and lifestyle management,   the “positive” findings from imaging results usually lead to a higher intensity of medical care than evidence would suggest is necessary, resulting   in patients waiting upwards of one year for unnecessary consults and delays in appropriate rehabilitation. Back pain is also highly correlated with many   chronic diseases attributable to aging including dementia, depression,   diabetes and hypertension.Our expert trained clinicians (physiotherapist or chiropractor) will perform an assessment on your patient,   including the identification of Red and Yellow Flags and inflammatory   conditions. Patients will receive a tailored treatment plan that emphasizes chronic   disease management and self-management strategies.  Cases requiring further investigation by   either a medical specialist or MRI/CT scan will be identified. Our triage   model is in line with a new model of care for LBP proposed by the MOHTLC (Inter-professional   Spine Assessment and Education Clinics (ISAEC) pilot.) with the additional   focus on chronic disease management.You will be provided with a summary consult   outlining the patient’s diagnosis, self-management plan, chronic disease   management plan and rehab treatment plan, including a recommended schedule   for follow-up treatment. You will also receive interim and discharge reports   on your patient.

b) Monitoring, tracking and evaluation of   outcomes:

We track and evaluate clinical outcomes including risk factors for chronic diseases associated with spinal pain including diabetes, depression, dementia and hypertension and   communicate these findings to you for more efficient co-management. In the case of diabetes this enables you to qualify for OHIP reimbursement through   the OHIP Incentive Funding for   Physicians, i.e. Diabetes Management Incentive.

Rehabilitative Services:

Quality & cost effective rehabilitation by our highly trained professionals backed by evidence based practices and outcomes evaluation. The interdisciplinary rehab team will be comprised of specialists including a chiropractor, physiotherapist, massage therapist as well as a clinical psychologist.  Treatment will be delivered through our Senior Restorative Program or Spine Care Program over the course of 6-12 weeks, with a focus facilitating self-management skills.

The objective of our Senior Restoration Program is to assist patients to achieve a higher level of function and reduce disability with a focus on chronic disease management. It is designed specifically for the senior with physical and/or cognitive impairments affected by co-morbidities including depression, dementia, cardiovascular disease, obesity, musculoskeletal pain and/or diabetes and designed to address physical deconditioning often experienced with post hospitalization.

Our focus is on active rehabilitation designed to assist the patient achieve a level of health assuredness, compliance and stability; enabling the patient to continue to live independently and safely at home. Assessment includes clinical measures of stability (Bergs Balance Test) and Timed up and Go tests as well as patient report of disability. Patient will be discharged with a home rehab plan designed to be fun, interesting and progressively challenging and easily incorporated in the patient’s routine for greater adherence and effectiveness.

Our Senior Spine Care Program is an extension of our clinic based Spine Care Program adapted to fit the unique needs of the senior patient.

Our Spine Care Program utilizes an innovative approach to the management of complex spinal conditions resulting in a pain disorder. Cases of complex spinal pain involve multiple sources of pain mechanisms including injury and dysfunction of various spinal structures (ligaments, disc, muscle, tendon, bone and joints), neurological compromise, metabolic and hormonal alterations as well as psychological involvement. The treatment plan will target common causes of back pain in this population including degenerative disc disorders, spinal stenosis and osteoporosis.  We recognize that chronic diseases, including spinal (back) conditions, heart disease, depression, diabetes and asthma share common risk factors and “co-morbidities”. Modifiable health habits and risk factors such as physical inactivity, poor diet, smoking, hypertension, high cholesterol, and being overweight account for a substantial proportion of all chronic diseases including painful back conditions. Rehabilitation is concentrated on balance, proprioceptive training, increasing muscle strength and coordination.  Over the treatment plan, some “hands on” therapies, i.e. mobilization, modalities as indicated will be performed to quicken recovery time. Overall the program supports facilitating self–management of the spinal condition and/or pain through education, reassurance and lifestyle modification. Patients will be discharged with a home rehab plan designed to be fun, interesting and progressively challenging and easily incorporated in the patient’s routine for greater adherence and effectiveness. Program is delivered over 6 to 16 weeks as required by patient needs.