Knee osteoarthritis (OA) is the most frequent cause of joint replacement and of early retirement. It therefore has considerable economic and societal costs. With the rapidly aging US population, the prevalence of Knee OA is increasing exponentially. In the absence of effective disease-modifying medical interventions for knee OA, the availability of multiple symptomatic treatments as well as the high health care costs, have made treatment decisions difficult. The latest published treatment guidelines cite limitations due to the lack of well synthesized evidence. The traditional meta-analysis approach is unable to deal with the availability of multiple treatments, multiple outcomes and multiple follow-up times. The main objective of this study is to show how all the different treatments for knee OA rank against each other and how big the differences are between them. This project will be one of the first studies in the field of knee OA to use an innovative network meta-analysis approach to compare the efficacy of different medical treatments for knee OA and to rank the treatments based on their relative efficacy. The availability of this kind of ranking between the treatments will provide patients and providers with better information with which to make decisions between competing therapies. The results of this study will also be helpful in performing future cost effectiveness analyses and clinical decision analyses. This research training plan will also help me acquire new skills in advanced meta-analysis methods. This research aligns with the AHRQ mission and priority research areas of comparative effectiveness research in elderly in need of chronic care.

Public Health Relevance

Knee Osteoarthritis is a major public health problem in the U.S. especially in the elderly, often leading to early retirement and joint replacement. In the absence of effective disease- modifying medical interventions for knee OA, treatments are primarily symptomatic in nature. Making treatment decisions from among the wide variety of available treatments has been difficult for the patients and providers. This research will help in ranking these treatments based on their relative efficacy, which will help the patients and providers in making evidence-based treatment decisions.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Postdoctoral Individual National Research Service Award (F32)
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HSR Health Care Research Training SS (HCRT)
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Benjamin, Shelley
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Tufts University
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