Seed Grant Lays Foundation for Research to Identify Effective Treatment Strategies for Obese Patients with Arthritis

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Drs. Deborah Marshall and Behnam Sharif

A research team led by Behnam Sharif, Alberta Bone and Joint Health Institute’s postdoctoral fellow, and Deborah Marshall, ABJHI’s research director, has been awarded a seed grant to conduct research groundwork that could lead to new and better ways to manage obese patients with osteoarthritis – a fast-growing problem in Alberta.

The grant was awarded by the Diabetes, Obesity and Nutrition Strategic Clinical Network (DON SCN). It will be used to gather evidence on effective strategies for managing obesity in people with OA and to select the strategies that would be most effective with Alberta’s population. An estimated one in eight adults in Alberta has OA.

“This work will give us the foundation we need for the next stage, which will be a proposal to develop a ‘what-if’ computer model that could demonstrate how the selected obesity management strategies would perform when used on individual patients,” Dr. Sharif said.

“It would be the first tool for determining the effectiveness of obesity management strategies at the individual OA patient level taking into consideration the patient’s individual characteristics and health condition.”

Obese people are up to four times more likely than non-obese people to develop OA, the leading cause of hip and knee replacements. Obesity and OA together present complex health and health care challenges, including associated chronic conditions such as diabetes and heart disease and elevated risk of infection and subsequent surgery to repair problems with a hip or knee joint implant.

The computer model would use discrete-event simulation (DES) to simulate a treatment strategy and immediately observe its predicted impact on patient outcomes and health system costs. DES is a mathematics-based method of analyzing complex systems using computer applications to simulate the effects of a change in one component on the entire system.

“Obese patients with OA require treatment that can be quite complex. DES answers the ‘what-if’ questions by reliably demonstrating what would occur if we tried different treatment approaches,” Dr. Marshall said. “It would allow health care providers to simulate different strategies for a patient and immediately observe their effects. New strategies that don’t work well or have negative consequences could be ruled out before resources are spent to use them on patients.”

Dr. Marshall has already designed a DES model for patients who have OA in the hip or knee. That work was funded by a grant from the Canadian Institutes of Health Research. The work funded by the DON SCN’s seed grant and the research proposal that will follow would extend the use of the model into the challenging area of obesity and OA.

Petra O’Connell, the DON SCN’s Senior Provincial Director and co-Principal Investigator on the research project, said: “Having a model that could evaluate the effects of different obesity management strategies on people with OA would give us the guidance we need to design optimal treatment strategies that would lead to better outcomes and improved quality of life for patients, and could also reduce health care costs.”

The researchers will use data on thousands of hip and knee replacements in Alberta since 2012 to help design different obesity management strategies for simulation. They will have access to ABJHI’s hip and knee replacement data repository, which is unique in Canada for capturing end-to-end data on patient experience and outcomes. They will also have data from Alberta Health Services and from Alberta Health.