A Canadian research team is developing a tool that will calculate the risk of early osteoarthritis (OA) in the knee progressing to the severe stage requiring joint replacement.
The risk calculator will be made available to patients and family physicians to predict the rate of OA progression and to graphically illustrate for patients how lifestyle changes they can make, such as weight loss, could slow the disease and forestall surgery or avoid it altogether.
“We envision a tool that will give patients the information they need to actively manage their disease themselves. It will be a powerful self-management aid for one of the fastest-growing chronic medical conditions,” Dr. Deborah Marshall, the principal investigator, said.
An estimated 4.4 million Canadians have OA and the rate is forecast to double within a generation. Knees are among the joints most commonly struck by OA, which causes severe pain and restricted movement.
Funded by a $200,000 Knowledge to Action grant from the Canadian Institutes of Health Research, the research team will develop the web-based tool and evaluate it in a pilot in Alberta. The two-year study will begin this year.
The tool will designate individual patients as high-risk, medium-risk or low-risk for severe, end-stage OA based on their knee OA progression score.
“We know the predictive factors for knee OA and we have developed risk algorithms through previous research,” Dr. Behnam Sharif, a co-investigator in the study, said. “We will apply this information to develop a unique tool that assigns an OA progression score in individual patients over a seven-year period based on x-ray, patient symptoms, pain site, age, sex and body mass index (BMI) score.” Dr. Sharif led the research to develop the risk algorithms in 2015-16.
Excess body weight, as indicated by BMI, is a major risk factor for OA developing in load-bearing joints. The tool will calculate for individual patients the anticipated delay in months or years to end-stage knee OA for different amounts of weight permanently lost during a predetermined period. It will also show how strengthening exercises tailored to the condition of the joint can alleviate symptoms such as pain and stiffness that hasten patient decision to have surgery.
The research team will consult a broad spectrum of stakeholders for the tool’s design, including family physicians, patients, analytics experts from Alberta Bone and Joint Health Institute (ABJHI), OA researchers from the University of Calgary and University of British Columbia, and Alberta Health Services’ Bone and Joint Health Strategic Clinical Network. OA patient engagement researchers Dr. Jean Miller and Sylvia Teare will participate through the University of Calgary’s Patient and Community Engagement Research (PaCER) program led by Dr. Nancy Marlett, and primary care researchers will be engaged through the University of Alberta’s Enhancing Primary Care Research Networks program led by Dr. Lee Green, the Alberta Innovates – Health Solutions Translational Health Research Chair.
Other members of the research team are: Dr. Jolanda Cibere, associate professor, Department of Medicine, University of British Columbia; Tracy Wasylak, senior program officer, Alberta Health Services (AHS); Dr. Peter Faris, director of research facilitation, AHS, and analytics advisor, ABJHI; Dr. Denise Campbell-Scherer, family physician and associate professor, Family Medicine, University of Alberta; Dr. Jacek Kopec, professor and division head, School of Population and Public Health, University of British Columbia; Kelly Mrklas, knowledge translation implementation scientist, AHS; and Drs. Svetlana Shklarov and Nancy Marlett, PACER founders.
Dr. Marshall is a professor in the Department of Community Health Sciences, University of Calgary, and director of Health Technology Assessment and Research for ABJHI, and Dr. Sharif is an ABJHI Music in Motion postdoctoral fellow under Dr. Marshall’s supervision.