Improving care for patients with hip/knee and low back pain conditions through Rapid Access Clinics 

The Ministry of Health and Long-Term Care and the South West LHIN are committed to improving appropriateness of care for people with musculoskeletal (MSK) conditions.

One way to improve care is to expand MSK central intake, assessment and management models that have proven benefits to patients and providers. Rapid Access Clinics have been introduced across the province to help people with musculoskeletal conditions access the right treatment - starting with moderate to severe hip/knee osteoarthritis (OA) and low back pain.

Primary care providers, including family doctors, will soon have one point of contact to refer patients (i.e. central intake). Patients are triaged to receive a timely assessment from an Advance Practice Provider (APP), which is typically a physiotherapist, nurse practitioner, occupational therapist or chiropractor with specialized skills and training. 

Advanced Practice Providers will see patients within four weeks to determine if surgery is appropriate or connect them with local community services or a self-management plan to manage their condition. Patients who require a surgical consultation can choose the first available surgeon or a surgeon of their choice. 

Implementing Rapid Access Clinics is the first step in an ongoing process to improve hip/knee and spine treatment and to gain a better understanding of which patients require surgery versus other kinds of care and how that aligns with our funding needs. While this strategy will be rolled out based on a provincially standardized model, there is flexibility to evolve the model according to the south west region’s unique needs.

The South West LHIN looks forward to working with system partners to build a sustainable health care system that provides better care for patients with MSK conditions including lower back pain and hip and knee osteoarthritis.

For additional information on the implementation of Rapid Access Clinics in the South West LHIN, please contact Faadia Ghani, Communications Business Partner at:

What does this mean for you?


Primary care


  • Patients will be assessed within four weeks of referral.
  • Patients undergo a comprehensive assessment, including standardized outcome measurement (e.g., patient-reported outcomes and objective functional tests).
  • Non-surgical patients receive education on treatment options, individualized recommendations, community linkages and a plan of care.
  • For surgical candidates:
    • Choice of hospital
    • Choice of surgeon or next available surgeon
  • One point of contact for referrals (hip, knee, and low back pain) and clear referral criteria.
  • Enhanced communication between providers.
  • Assistance with conservative management of patients.
  • Maintained provider and patient choice.
  • Receive more appropriate referrals, which allows for more predictable practice management and reduced wait lists.
  • Receive full history and physical examination, with outcome measurement.
  • Focused assessment with appropriate work up completed.
  • Avoids surgical delays/cancellations with health issues identified earlier.
  • Team approach maximizes efficient use of surgeon’s time.


Introducing South West LHIN Advanced Practice Leads

MSK Advanced Practice Leads are unique to the South West LHIN and will play a key role in this strategy. In addition to working closely with strategy leads to develop this program, they will be the primary point of contact for consultation and assessment of musculoskeletal patients. Below are the South West LHIN Advanced Practice Leads for both hip and knee, as well as low back pain.


Rhonda Butler – Advanced Practice Lead (hip and knee)

Rhonda Butler completed her Bachelor of Science in Physiotherapy (with distinction) from Western University in 2001.  She has practiced in a variety of settings along the continuum of patient care from emergency/trauma, through inpatient acute care and rehabilitation to ambulatory care physiotherapy, with a focus on the adult orthopaedic population.  Rhonda has additional experience in a multi-disciplinary team environment, working collaboratively with surgeons, primary care providers, psychologists, occupational therapists and kinesiologists.  In this role, as a member of a health care team, she provided case management, health system navigation and therapeutic care to injured workers in order to maximize symptom and functional outcomes utilizing a whole-patient approach. Rhonda is currently practicing as an Advanced Practice Lead in the Musculoskeletal Rapid Access Clinic strategy at London Health Sciences Centre.


Ravi Rastogi – Advanced Practice Lead (low back pain)

Ravi Rastogi completed his Bachelor of Science in Physical Therapy from Western University in 1998. Ravi’s interest in research led him to return to Western University where he completed a Master’s degree of Science in Physical Therapy in 2006, with a focus on patient concerns following total knee replacements and the use of the right outcome measures at the right time. Since graduating Ravi has continued with an orthopedic specialization, working in the private sector and as a physiotherapist and clinical specialist in orthopaedics at London Health Sciences Centre. Ravi credentialled in the McKenzie method of Mechanical Diagnosis and Therapy (MDT) in 2011. Over the past few years Ravi was involved in a randomized controlled trial to determine the response to physiotherapy using the MDT method in the severe knee osteoarthritis population. His latest research project involves determining the proportion of extremity pain with a spinal source. Ravi is currently practicing as an Advanced Practice Lead in the MSK Program Rapid Access Clinic at London Health Sciences Centre.