Optimizing health outcomes in arthritis care: Promoting knowledge translation through digital media

Arthritis consists of more than 100 types of conditions and is the most common cause of severe chronic pain and disability in Canada, affecting 4.4 million Canadians. While effective treatments are available, they are not consistently prescribed by health professionals or used by patients. Currently, researchers and research funding agencies have focused on tailoring research findings to specific audiences via methods such as plain language summaries, education sessions, public symposia, and media events. However, the impact of this information can be limited if it is provided at a different time and place than when people need to use it. Digital media offer a range of applications – social networking tools, interactive games, animation, and video/audio recordings – that provide tremendous flexibility for delivering “just-in-time” information when and where it is needed by the user. The depth, richness, and accessibility of this information are infinitely greater when conveyed via digital media than the current methods of publishing research results.

The goal of Dr. Linda Li's research program is to optimize the health of Canadians with arthritis by studying how people make treatment decisions and by improving the use of effective treatments using innovative digital media tools. Her program focuses in three areas: 1) understanding how patients with arthritis make treatment decisions; 2) evaluating models for health professionals who provide arthritis care; and 3) developing digital media interventions and evaluating their effectiveness to improve clinical practice, treatment decisions, and patient health.

This research program focuses on improving the health outcomes of people with arthritis by harnessing the engaging power of digital media to deliver research knowledge when and where it is needed. This approach is unique because it targets both patients’ behaviors and health professional practices to help close the gaps between what we know about arthritis management and the actual use of effective treatments. This innovative combination of health and digital media will help us modernize the way we deliver evidence-based treatment information for the 21st Century.

Physical Activity, Femoroacetabular Impingement(FAI) and Hip Pain: A Population-Based Case-Control Study

Osteoarthritis occurs when cartilage (the gristle that lines the ends of the bones) is damaged. It is the most common form of hip arthritis and is responsible for more than 90 percent of hip replacements. Recently, subtle deformities of the hip have been linked to hip osteoarthritis, and it is now believed that these deformities, combined with certain types of physical activities, such as hockey, soccer and bicycling, are one of the major causes of damage to the hip. Since the deformities have been observed in young adults, it may be possible to detect and treat osteoarthritis at an earlier stage, or prevent its development. Dr. Chuck Ratzlaff’s research will demonstrate how physical activity and one or more subtle deformities of the hip can cause cartilage damage and eventually osteoarthritis. He will determine the frequency of deformities in the Caucasian population in comparison to the Chinese population, which is thought to have a lower frequency of osteoarthritis. He will also determine how physical activity over one’s lifetime contributes to osteoarthritis. For this study, participants with and without hip pain from both Caucasian and Chinese populations will attend a two-hour assessment session consisting of a physical examination, a hip x-ray, and a questionnaire on physical activity. He will use new magnetic resonance imaging (MRI) techniques to see how the physical motion and the deformity combine to damage cartilage. This research program will generate the new knowledge needed for major breakthroughs in the prevention, detection and treatment of hip osteoarthritis. Given an aging population and the increased prevalence of chronic diseases in Canada, physical activity is an important intervention for health. Knowledge of how to modify and perform physical activities, and identification of susceptible individuals, will lead to inexpensive and practical recommendations that maximize the benefits of physical activity without increasing the risks of joint disease. It may also lead to identification of a subset of people that will benefit from minor hip surgery to correct the subtle deformity, thus preventing the later development of hip osteoarthritis and its associated burden of suffering and other costs to the individual and society.

Validating a computer adaptive test for the measurement of health outcomes in adults with musculoskeletal disorders

Although effective medical treatments and supportive services for people with joint problems (such as arthritis) are available, the choice of specific treatments and services offered must be guided by knowledge about the various challenges they encounter in their daily lives. Important health outcomes reported by people with joint problems can include their competence with daily activities, their ability to walk and handle objects, their pain or discomfort, and their emotional wellbeing. Computerized adaptive assessment systems can be used to efficiently obtain information about self-reported health outcomes by selectively administering questions that are most meaningful and relevant to an individual’s condition. The resultant information can be used to track changes in a person’s health outcomes over time and facilitate decision-making and communication between patients and health care professionals about the impact of arthritis. This can provide the patient with more information and control with respect to their choice of treatment. Dr. Richard Sawatzky is investigating whether a recently-developed computerized health outcomes assessment system for people with arthritis provides accurate and trustworthy information. He is specifically examining the extent to which the information provided by system is valid irrespective of differences among individuals that may lead to variations in how they interpret and answer the questions. His assessment uses data from almost 6,500 participants across the country. Sawatzky’s research will ensure that the individual’s experiences with respect to several health outcomes relevant to arthritis are obtained and reported in the most accurate, informative, and efficient manner.

Statin therapy in the prevention and management of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the immune system attacks its own joints and organs. Aside from painful symptoms, people with RA are more likely to get heart disease and die at a younger age. Statins are drugs that lower cholesterol and are used in the treatment and prevention of heart disease. Recent studies have shown that statins also have anti-inflammatory properties that may help prevent the development of RA. They may also provide a benefit to people with RA by reducing heart disease and death. However, there have been no studies that have examined the association between statin use and the onset of RA, or whether statin use can lower heart disease and death in people with RA. Mary De Vera is investigating the potential role of statins in RA through a population-based analysis of British Columbians and their encounters with the health system. She is analyzing health care and prescription drug use of the general BC adult population to compare rates of new RA cases between statin users and non-users. She will use similar analysis in adults with RA to compare the rates of heart disease and deaths between statin users and non-users. By learning about the relationships between statin use and RA, this study has important implications for informing and improving care for people with RA. In addition, this study could provide information that will lead to a better understanding of how this devastating disease may be prevented.

Development and evaluation of a novel group educational intervention to promote partner support for people with rheumatoid arthritis

In addition to the many physical challenges that arise from rheumatoid arthritis (RA), related problems with pain, fatigue, sleep and depression can affect quality of family relationships, work and hobbies. Although current drug treatments for RA can improve symptoms in some people, there is still a great need for other types of help to make peoples’ lives better. Research has shown that good social support from family can result in better wellbeing, pain reduction and improved quality of life. With other types of arthritis, education programs have resulted in better coping among arthritis sufferers and their partners. However, there is no similar program specifically for people with RA. Dr. Allen Lehman’s study is the first to create and test a program to improve social support for people with RA and their partners. He will develop the program by conducting consultations with people with RA, their partners and couples together. Groups will discuss challenges and successes in getting support, what kinds of support work and what is not helpful. The program will then be piloted with 30 couples. This study aims help couples better understand the disease and learn more about what one can and cannot do to be supportive. Because social support predicts good health, the program could also be applied to people with other types of arthritis and chronic disease.

Modeling musculoskeletal diseases: from epidemiology to quality of life

Osteoarthritis (OA), which results in the breakdown of joint cartilage, is the most common form of arthritis. Despite much research on the condition, there is no primary prevention strategy for the disease. Macro-level studies evaluating different prevention and treatment strategies are also needed. In collaboration with colleagues in Canada, the US and Europe, Dr. Jacek Kopec is conducting three osteoarthritis studies. The first involves the development of a computer simulation model of OA. The model will synthesize data from different sources, creating the world’s largest database simulating the nature history of OA. Results from this study will be used to assess prevention strategies and develop optimal treatments for the disease. The second study investigates whether or not moderate physical activity can cause OA. The third study focuses on patients’ preferences about different treatment options for OA of the hip and knee. As part of the study Dr. Kopec is developing a questionnaire that can be adapted to individual respondents, making the assessment more precise and efficient than previous questionnaires. The studies as a whole could advance knowledge of osteoarthritis and improve treatment of the condition.

Glucosamine withdrawal study in Osteoarthritis

Affecting more than nine per cent of people over 63, osteoarthritis is the most common joint disease. Prevalence rises with age, so health care costs are expected to increase as our population ages. Glucosamine is a health food supplement that is widely promoted for treating osteoarthritis pain. Claims have been made that glucosamine may repair cartilage damage and cure osteoarthritis. Glucosamine use has risen dramatically as a result, but there is limited scientific evidence supporting these claims. Dr. Jolanda Cibere is conducting a study with patients taking glucosamine for knee osteoarthritis. Patients are randomly assigned to continue taking glucosamine or to receive identical-looking placebo tablets. Jolanda will assess whether people whose pain was relieved with glucosamine experience a flare up of pain when treatment stops. This research will provide insights about the effectiveness of glucosamine as a treatment for osteoarthritis pain.

Development and pilot testing of a novel intervention to ensure optimal support for arthritis patients

While family and friends of people living with arthritis have been identified as key sources of support, little research has been done on the specific role and impact of their support. Research suggests the well-being of patients with arthritis suffers when their spouses don’t understand what support they need. Through interviews and focus groups, Allen Lehman is identifying the types of support that arthritis patients want and need from family and friends. He is also identifying ways to increase positive support and assessing how support improves health and reduces health care costs. Lehman will use the results to develop a health education program for arthritis patients and their family and friends. Ultimately, Lehman hopes this research will provide a model for identifying support needs in people with other chronic illness.