By Phoebe Dey
Simply stated, Dr. Lauren Beaupre is an orthopedic researcher. But that description only touches the surface of her scope of activities. An assistant professor in both the Faculties of Rehabilitation Medicine and the Faculty of Medicine, Beaupre runs her own research projects while collaborating with clinical groups in medicine, diagnostic imaging, surgery and rehabilitation. Armed with a physical therapy background with a specialization in orthopaedics and a PhD in Epidemiology, Beaupre has a lot on her plate.
Recently, her newest study investigating hip fractures in an often-ignored population has earned Beaupre an Alberta Heritage Foundation for Medical Research Population Health Investigator award.
Beaupre's primary line of research is hip fractures, which is, significant considering health-care professionals in the Capital Health region see more than 800 such cases a year. Beaupre, along with her clinical research staff and collaborators investigated how clinical pathways, which standardize care worked in the hip fracture patient population. "The more streamlined care, the better for patients and staff," says Beaupre. "And that leads to more success with recovery."
She has also studied how to make things easier for people lacking social resources who would then find it difficult to receive appropriate services once they left a hospital. The clinical pathway helped identify those patients before they were discharged and ensured that they would receive
appropriate care once they were home. That project then led to investigating people with hip fractures in continuing care, a group typically overlooked by researchers and at times, health-care practitioners. Although this group is lower in functionality and is not as active as other hip fracture patients from the community, there is still much room for improvement following a hip fracture, says Beaupre. Research has shown that before a fracture, 70 per cent of this group was
walking on their own. Six months after a fall and subsequent hip fracture, only 22 per cent are walking.
"We want to see if we can make improvements to get these frail elderly patients to a more independent status," says Beaupre. "You can't put an 85-year-old into a wheelchair
for six weeks and then expect them to walk." This population typically has a shorter hospital stay because they have residential beds waiting for them. This early discharge changes the way rehabilitation is delivered. There is also a belief by health-care staff that because some of the patients suffer from dementia, rehab is not important, says Beaupre. But her new funding will allow for multidisciplinary teams to provide rehab to these patients, while establishing best practices for this population. "It's a new concept and this group has been ignored in the past but they represent 25 per cent of hip fractures," says Beaupre. "It's a real concern for families who wonder how a parent is going to get rehab after such a major fracture. Continuing care staff members try their best but some facilities are so understaffed. When there is one physiotherapist for 100 beds, it's impossible to give adequate rehab to everyone."
Beaupre is confident her team can make modest improvements, even by implementing such simple suggestions like having the patient take a few steps from the wheelchair to the bed rather than having a health-care worker do a full transfer lift. "As patients, this group is likely not going to advocate for themselves so they are going to slip through the cracks," says Beaupre. "To see them regain mobility closer to what they had before the fracture would be great."
Beaupre's other main line of interest in the hip fracture population is in the area of osteoporosis management. Researchers know that hip fractures are commonly due to the presence of low bone density but the majority of patients are still not tested regularly either before or even after a hip
fracture. Even when patients are admitted to the hospital with a fracture, they leave without being properly diagnosed with low bone density.
"Simple steps could make a big difference," says Beaupre. "We found that the use of a case manager to arrange diagnosis and appropriate treatment following hip fracture significantly increased osteoporosis treatment rates. Similarly, even putting bone density testing results in front of family doctors improved the treatment rates of osteoporosis for these patients. There is a huge cost benefit to prevent additional fractures."
And when Beaupre and her team aren't studying hip fracture patients, they are looking at outcomes following total joint arthroplasty and how to improve rehabilitation services to these patients. Approximately three thousand total hip and knee replacements are performed a year in the Alberta Health Services Edmonton area. In the early 1990s, patients undergoing this surgery stayed in the hospital for two weeks and were then sent to stay at the Glenrose for another week or two of rehabilitation. Today, patients are home by the third or fourth day following surgery. "This has significantly changed the management of this patient group without having a negative impact on their outcome," says Beaupre. "We have made a really substantial change over the last few decades in patient care."
Beaupre's commitment to her work is part of the reason for that change, says Dr. Bill Johnston, medical site director at the University of Alberta Hospital. Johnston supervised Beaupre in the research office 10 years ago and has since seen her "absolutely blossom in her job."
"She's so keen, dedicated and hard working and went on to get her PhD after her clinical and research experience," says Johnston. "As a researcher, she's been spectacular and very accomplished in getting papers published at major forums but aside from that, she's also very valuable in teaching residents. She has had an effect on a lot of surgeons passing
through here.
"Lauren is a finisher. So often in the research field, people tend to get bogged down but she is so organized and self motivated and she gets to the finish. We're lucky to have her."