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Alberto Esquenazi, MD, and Dylan Edwards, PhD

Designing a Collaborative Approach to Excellence in Rehabilitation

While MossRehab clinicians use the latest evidence-based practices in medical care, scientists within Moss Rehabilitation Research Institute (MRRI) remain at the forefront of scientific discovery to advance neurorehabilitation assessment and treatment. Research findings bring new clinical practices and scientific advancements that benefit the patient while clinicians keep researchers current on rehabilitation trends. In this episode of MossRehab Conversations, Alberto Esquenazi, MD, The John Otto Haas Chair of Physical Medicine and Rehabilitation and Chief Medical Officer at MossRehab, and Dylan Edwards, PhD, Director of MRRI, discuss how the clinical and research arms of MossRehab work together.

Read the Transcript

Here is a transcript of our conversation with Drs. Esquenazi and Edwards:

Welcome to MossRehab Conversations. Part of a continuing series of discussions with pioneers in physical medicine and rehabilitation from one of America's top U.S. News ranked rehab facilities. In this episode, Dr. Alberto Esquenazi, Chief Medical Officer at MossRehab and chair of the department of physical medicine and rehabilitation, talks with Dylan Edwards, PhD, Director of the Moss Rehabilitation Research Institute, about the importance of research to clinical care and clinical care to research.

Dr. Esquenazi: Today, I have the privilege of having Dr. Edwards with me, and we're going to spend some time exploring the benefits of what we've termed a collaborative approach between rehabilitation scientists, rehabilitation clinicians, and together, deliver better care, better outcomes, better education, promote research, and as such, a way to improve our institutional reputation.

Dr. Edwards: This idea of being at the forefront of advanced medical care with the latest evidence-based practice, but also at the forefront of scientific discovery is the aspiration of the world's best medical centers. And at least for rehabilitation medicine, we have a number of things in place that put us at the forefront of this clinical and research integration. And this has been through a cultural track record and a lot of work over the years that have led up to this point. So it's a pleasure to be able to discuss that today.

Dr. Esquenazi: Thank you, Dylan. Maybe we'll start from the beginning. What attracted you to MossRehab and MRRI? You know, you've been here for a little bit over three years, and recruitment of individuals like you who have stellar scientific careers is quite challenging, but I wish, if you could be kind enough in sharing, what attracted you to this institution and to the position that you hold now.

Dr. Edwards: Of course, the Institute here has an impressive reputation, nationally, if not internationally, for translational neuroscience. And this is specifically my area of research interest. And the Institute has around 10 laboratories that span these human functional domains of cognition and language and behavior and emotion and the psychosocial aspects of human function and the mobility side

as well and that we're looking to build up the mobility side, and this is my background. So from my own research, this was particularly appealing, but from a managerial and leadership perspective, the integration of the Research Institute as a part of the rehabilitation hospital was very appealing because this is something that is attempted nationally. People know that this is very important, but few places do that well, and I could see from the outside, but certainly once I got to know more about MossRehab and how the Institute worked within MossRehab, that it was very  impressive to me. And I knew that it was a place that not only had a current outstanding track record, but had a lot of potential for the future with growth. So it was appealing both from a scientific perspective to me to be to compliment the growing program at the Institute and from a leadership and management perspective, to help with the vision of the direction of MossRehab and the Institute.

Dr. Esquenazi: And I have to say that, that is in part what has retained me at Moss for nearly 35 years. I came to Moss as a young resident in training, and I was able to stay here as a clinician, but I am not someone that can sit on his hands for very long. And the fact that there was eventually the development of the Research Institute, which now has been in place for about 25 years, and then, really this vision of integrating both of them, the clinical and the research piece, made it very attractive for me to not only stay, but grow into a leadership position and then work towards that. And I will tell you that as a clinician, the clear advantage to me is that having research scientists, researchers, and individuals who really look at the world from a perspective of scientific inquiry, really opens the door for me to see where and how we can benefit clinical outcomes. And so I see that you could have excellent research in one side, you could have excellent clinical work in the other, but without that integrated collaborative approach, you really cannot deliver what we deliver here, which is better outcomes, clinically. I think that as we do that, we're able to retain staff who see clearly that their work and their efforts provide better outcomes for the patients and better result to the efforts that they put in. So the fact that we are able to bring together and stitch together the research and the clinical approach, gives our patients, our staff, our scientists, really an opportunity that is quite distinct and quite unique. And I think you mentioned, Dylan, that other places have tried to emulate that, and I trust that our efforts, not only having parallel lines running, a research line and a clinical line, but really intertwining them, has made a difference to what we do.

Dr. Edwards: I agree with the concept of what others have tried and what actually we do well here already, but we're trying to build that together. And I very much value these discussions as to how we can go about doing that. And what others have tried is there's physical proximity between clinicians and scientists. And we certainly have that here, you know, the bulk of activities, although not all of the Institute, are right here at Elkins Park and much of the activity, although not all of MossRehab, is local here as well, but we have other tentacles elsewhere with other projects running. Yet, it's not just the physical proximity. It doesn't happen by osmosis. We need, certainly, chance contact between clinicians and scientists help, but we have structural things in place that will lead to formal interaction between clinicians and scientists. And one of the examples is this TRIA Family Topics in Rehabilitation Science lecture series that we hold, which is on translational clinically relevant topics at which scientists and clinicians attend and can brainstorm and question and learn together. But that's not all. As well as that, we have the more technical side of a very rich lecture series here at the Institute with advanced technical aspects of the various domains of science that we study here. And albeit by Zoom at the moment in the COVID era and clinicians attend those where relevant and can learn. And similarly in the hospital, I guess Doctor Esquenazi can speak to that as well, there is a rich educational program within the hospital that the scientists are invited to attend, too, that's more clinically relevant. And these are examples of formal structural processes that are really key for promoting this interaction and the co-learning because the scientists, while at the forefront of their mind must justify and rationalize the clinical impact of this translational work, we're often not at the coalface. You know, most of the scientists are full-time in laboratories and, while running human studies, they need to be at the forefront with advanced clinical practice that happens in MossRehab. And similarly, the rehabilitation clinicians cannot be expected to have advanced science training. So this kind of interaction for a leading center such as this, is critical to the productivity and reputation.

Dr. Esquenazi: I'm glad you brought the issue of reputation. As you may have learned recently, MossRehab was named again, one of the top 10 rehab hospitals in the country, and we are top rated in the Philadelphia region and the state. So that rating occurs not by any set of lucky stars. It really is because we've worked hard at doing the important things in rehabilitation. And by that I'm referring to our focus in excellence in clinical care, our focus in research, education, promoting for an accessibility in the world so that those individuals that have limitations in their mobility because of their rehabilitation needs, can access the world and then bringing patients to the best that they can be. And so that has been recognized over and over, but, you know, we could not do that without the constant reminder of what really the most important scientist in the rehabilitation field who happened to be sitting here, not by chance dance, but because there was a planned structure that that's something we needed to have. So on the other hand, the scientists can not really know what's important for the future of rehabilitation if they don't have somehow, a finger on the pulse of what's happening in clinical activity, a large group of patients that we serve, with nearly 3,000 new admissions a year and close to 195,000 outpatient visits, you have a rich source that you can tap on. And maybe you can just elaborate on that.

Dr. Edwards: Certainly. So I would echo that the Institute being part of a hospital of this stature is instrumental to the success of our scientists. And one of the examples that was alluded to was the infrastructure around being able to recruit participants for our studies. And this is a patient registry that's been set up sometime back that is really enviable across the nation. Others are trying to do this as well, and it's a rich resource, and this is where future potential participants would agree to be contacted for possible research studies. And some of them might be cross-sectional in nature, some of them might be clinical trials, but we can build up a list of people interested to maintain contact with us for this possibility. Now this of course involves some resources and effort from the Institute side, but importantly, the orchestration around the hospital, leadership and administration, because we are doing this as part of normal hospital business, and this impacts nurses and clinicians and administrators and staffing and these things, and especially in the times of the COVID pandemic, but certainly even before that. So we're very proud to have a functioning research registry that I would say is a great example of the cooperation between the Research Institute and the hospital.

Dr. Esquenazi: That is certainly important and it reminds me that recently through philanthropic donation, we were able to establish a Parkinson's rehabilitation program. And I think that bringing that kind of thinking from the very beginning where we have researchers and clinicians working really shoulder to shoulder and developing this and conceptualizing what that registry has to look like for use in the future and thinking about elements that need to go in it, it's a clear example of the value of this intimate collaboration, intimate interaction, that is, I think, essential to not only the work we do, the clinical outcomes that we deliver, but the reputation that we have built and that I hope we will be able to continue for years to come.

Dr. Edwards: Absolutely. And thanks for raising about these programs that are a cooperation between the hospital and the Institute. And another example might be the Aphasia Center where clinicians and scientists work together for the mutual benefit of clinical practice and for research studies, but also the traumatic brain injury model system of care, which we've been fortunate enough to have through our talented staff for some years now. And this is primarily a research grant that could not happen without the clinical and administrative support from the hospital. And there is a symbiosis that occurs with the clinical practice and the research outcomes that brings research findings to patients and statistical findings from the national center, the best practice for clinical practice and indeed the scientific advancement as well. And so this is something that we're very proud of and takes effort from both sides and is a real partnership. I am very grateful for the support of the hospital administration, yourself, Tom Smith, and the broader administration. And recently we were externally evaluated. And the Institute was found to be highly competitive relative to its size amongst national rehabilitation medicine organizations. And this is with metrics such as number and publications per scientist, the impact of the publications, the number of competitive grants, and this attests to not only the talent of the scientists that we have, but the support of MossRehab to enable this work to be done and it's a source of pride for me, but it's also a source of inspiration for the scientists and clinicians and the administrators as part of the culture here. So I really appreciate this time to chat about this. Thank you very much.

Dr. Esquenazi: I am very proud of the work that you've done and what MRRI does every day. You bring high recognition to MossRehab, and I know that that intimate and collaborative relationship will continue in the future. And I thank you for giving us an opportunity to chat about this important topic.

You've been listening to Dr. Dylan Edwards, Director of the Moss Rehabilitation Research Institute in a leadership discussion with Dr. Alberto Esquenazi, Chief Medical Officer at MossRehab and chair of the department of Physical Medicine and Rehabilitation. Be sure to subscribe or check back at our website for otherdiscussions with pioneers in physical medicine. I'm Bill Fantini. Thanks for joining us on MossRehab Conversations.

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