Next month, Winnipeggers who need knee or hip replacement surgery will no longer receive publicly funded outpatient physiotherapy to help them recover.

The two procedures are not on the WRHA list of clinical criteria, released last week, for patients to receive outpatient physiotherapy service when it's centralized at the Health Sciences Centre in late November.

"I'm not eligible. I have no private insurance, so I'm just on my own. There's no help from the government. No help from our healthcare system. I feel totally abandoned," said Meridel Archambeau, 81, who has osteoarthritis and needs both of her knees replaced.

She has volunteered for 12 years with the outpatient knee replacement therapy sessions at Victoria General Hospital. Her own meeting with the orthopedic surgeon is in February, when the program won't exist anymore.

The province expects to save $5 million in the next five years from shifting many publicly funded outpatient therapy services to the private sector.

"I feel betrayed. We've been helping in our community hospital, so many volunteers, and then they just decimate the community hospitals," said Archambeau.

All patients who receive total knee replacement surgery, which replaces a damaged knee joint with artificial material, do require physiotherapy to heal, according to Dr. David Hedden, an orthopedic surgeon at Concordia Hospital who specializes in hip and knee surgery.

"However, there is evidence that many do well with a home-based program," he wrote.

Hip replacement surgery patients, on the other hand, don't generally require outpatient physiotherapy services, he added.

Forcing tough decisions

According to a spokesperson for the WRHA, patients who have received knee or hip replacement surgery 'would have the option to obtain the physiotherapy [or occupational therapy] privately' for this service.

Next month, Winnipeggers who need knee or hip replacement surgery will no longer receive publicly funded outpatient physiotherapy to help them recover. 2:21 But the union representing physiotherapists says that's forcing a tough decision on people needing surgery, many of whom are seniors without health insurance.

"Can you afford the therapy following it, or not, or do you wish to spend the money on the therapy, or not, and that's going to make people decide whether or not they're even going to go through the surgery in the first place," said Bob Moroz, president of the Manitoba Association of Health Care Professionals, which represents physiotherapists and occupational therapists.

He said after speaking with members, "well over" the 1,600 joint revisions — hip, knee, and the less common shoulder and elbow — that were performed in Manitoba received outpatient physiotherapy service in 2016.

"So it stands to reason that there's going to be a very similar number in the coming year that simply won't have access to this public therapy," he said.

When patients don't or can't access the rehabilitative services, he stressed, it will cost the system more in the long run.

"You're increasing the chances of that person showing up at the hospital in need of more medical attention. It's a short sighted budget number that makes no sense."

Calling for clarity

The chair of the Manitoba Physiotherapy Association says the clinical criteria the WRHA released last week is "helpful," but physiotherapy classes after total knee replacement surgery — like the ones Archambeau volunteers with — must continue.

"Because … in order to achieve that range of motion, there is physiotherapy expertise that is needed in order to guide the patients through that recovery process," he said.

He added peer support is also a big part of a patient's success in those classes.

Private clinics, like the Reh-fit Centre, are just in the process of developing those same classes that were previously available at each of the hospitals in Winnipeg, he said.

"We need to transition that effectively so it's seamless for those that are getting the surgery."

Both Moroz and Jim Hayes, executive director of Manitoba physiotherapy association, are calling for greater clarity from the WRHA on its list of clinical criteria so patients understand — in plain language — what is and isn't covered.

"I didn't understand 75 per cent of what those conditions were," said Moroz.

"It's a very technical list. People see 'joint revision.' They think that means joint replacement. Well that's simply not true," he said.

And now that the means test, which assessed patients for free outpatient service based on their income, has been scrapped, both have concerns for patients who don't meet the criteria and can't afford the required therapy.

In a statement a WRHA spokesperson wrote "we recognize though that there may be cases where other factors need to be considered, and an appeals process will be available to ensure that where there is reason to consider a patient for outpatient therapy — even though they may not meet the clinical criteria — those factors can be taken into account."

"I've talked to our members too and they don't even know what this appeals process would be. How do you complete it in a timely manner?" questioned Moroz.

"We encourage the WRHA to provide that clarity," added Hayes.

Therapy gets people back on feet

Archambeau has worked alongside the physiotherapists to see hundreds of knee replacement patients walk, climb stairs and get stronger, and credits therapy as the "primary thing" that helps them recover.

"If you don't do any therapy or exercises, you will not get your mobility back," she said.

She said in her experience, most patients require between six to 10 weeks of therapy in the outpatient setting.

"The government is putting money ahead of patient-care in every aspect of our health care system," she said.

Opposition NDP leader Wab Kinew brought up Archambeau's story in the Manitoba Legislature during question period on Tuesday, and called her situation a "sad irony." He asked the premier what evidence he had to support changes to physiotherapy in the province.

Premier Brian Pallister said the changes will improve the system for all Manitobans and ensure more efficient care. He told the House his mother waited over a year for a knee replacement surgery.

"I know, and I sympathize with the pain Manitobans feel when they wait for health care treatment," he said. "I sympathize with Mrs. Archambeau and the pain she's experiencing while waiting."

Archambeau said she'll continue to bring heat, ice and encouragement to the patients until the last day they're seen on Nov. 24.

"I'm glad to help them, but I'm just sorry that it won't be available for myself."

Full coverage of health cuts in Manitoba

If you have a health-related story, you can reach Erin at her email: erin.brohman@cbc.ca