Hard work and reward in doctoral challenge

Two months after Marie Westby embarked on the long journey toward a doctorate in Rehabilitation Sciences, she and her husband received confirmation of something they had suspected for months: Their son, Mattias, was diagnosed with autism spectrum disorder.

“I said to myself, ‘What have I done? I need to drop out. This is obviously not going to work,’” Westby recalls thinking in 2004. “I thought I was being selfish by going back to school—I knew how much time it was going to take to do everything for him. But then I thought, ‘This is going to be my saving grace.’ I thrive on challenges, and I thrive on learning. I had to drop the guilt that I wasn’t going to be able to do enough for him, or be there for my daughter, Delaney, and my husband.”

Westby, who earned a bachelor’s degree in Physical Therapy from UBC in 1988, was able to forego a master’s degree through a special “fast track” option and continue straight toward her doctorate while working part-time as a physical therapist at Vancouver’s Mary Pack Arthritis Centre.

But her accomplishment goes beyond earning a new credential—Westby’s dissertation might also improve outcomes for the hundreds of thousands of North Americans who receive knee or hip replacements each year.

At Mary Pack, which is operated by Vancouver Coastal Health, Westby routinely received calls from B.C. therapists wanting to know the best practices for helping people recuperate from these surgeries—the number of visits, the duration of post-operative monitoring, what exercises to prescribe, whether there should be aquatic therapy, and whether there should be home care.

“There were no best practices,” says Westby, a clinical associate professor in the Department of Physical Therapy. “We could say what surgeon X, Y and Z preferred, but that didn’t mean the surgeon they were working with would like that. We did a survey of the Lower Mainland to find out what every site was doing, and there were more differences than similarities. It was all over the place.”

Westby organized focus groups of patients, therapists, orthopaedic surgeons and other physicians in Canada and the U.S. to find out what was working and what wasn’t. Westby also conducted a systematic review of research, though the most reliable data—randomized, controlled studies—were sorely lacking.

She then assembled two North American panels of experts and patients, one for knee replacements and one for hip replacements, each with about 40 members. Through an elaborate back-and-forth process that lasted several months, she sought to establish consensus on as many issues as possible.

“There aren’t enough high-quality research trials, so you have to base the guidelines on expert opinion, and you want to make that process as transparent and rigorous as possible,” she says. “It’s better than what is out there now, which is nothing.”

Each panel reached consensus on about two-thirds of the questions presented to them. The panels didn’t reach consensus on how much rehabilitation should be given, but they were clear that three visits—the current standard used in some B.C. hospitals following hip replacement surgery—is not sufficient.

One of Westby’s panel members was Pat Carney, the retired Senator from B.C., who learned of Marie’s research after undergoing hip replacement surgery.

“Marie’s innovative work is crucially important to physiotherapists, surgeons and patients since it will give them clear guidelines for successful physiotherapy,” Carney says. “I have known of patients who were improperly advised on their exercise program and suffered poor outcomes. How she did it, given her workload and domestic responsibilities, is an amazing story.”

Westby was fortunate to get a two-year leave from the arthritis centre during her studies. She also had to adjust her timetable after realizing how much of a “juggling act” her pursuit of a PhD would be, and that it would have to accommodate such things as children’s colds and sleepless nights.

She also learned something else on her way to the degree: To ask for help. With no relatives in Vancouver, she asked friends for assistance in picking up and looking after her children, or even cooking the occasional dinner.

“I literally put out the call to friends via e-mail, saying, ‘I need help,’ and that was not easy,” she says. “It’s harder for people to take both kids, but there are a few friends who know Mattias well and feel comfortable with him, allowing me to stay a bit longer and work.”