Musculoskeletal (MSK) disorders represent a broad group of conditions with diverse etiologies that result in pain and functional impairment of bones, joints, tendons, ligaments and/or muscles. These disorders are the leading cause of work disability and the most frequent source of dependency in the elderly. In the US, over 3 million hospitalizations for MSK problems occur annually, primarily for orthopaedic surgical interventions. Rigorously designed patient oriented research studies create the basis for evidence-based practice and serve as powerful tools to bridge patient expectations, clinical care and shared decision making. Presently, the evidence base in musculoskeletal and orthopedic clinical science has large gaps. I have dedicated much of my effort in the last decade to addressing these research needs. Through the K24 Mid Career Investigator Award, I hope to continue this work through patient oriented research and, importantly, to engage the next generation of clinical scientists in rigorous studies of MSK and orthopaedic problems. The Mid-career Award in patient oriented research (K24) will enable me to dedicate a substantial portion of my time to pursue a robust program in patient oriented research in orthopedics and to mentor young clinical scientists committed to orthopaedic and musculoskeletal patient oriented research. This Award will support my mentoring and research program with the following aims: I) To develop a research training program that will prepare young clinical investigators for rigorous evaluation of frequently utilized and/or recently developed orthopaedic interventions in patients with MSK disorders. II) To further develop a comprehensive patient oriented research program in MSK disorders and orthopaedics. The overarching goals of my mentoring program include: 1) providing training in patient oriented research in orthopedics, including design and conduct of randomized clinical trials, observational studies and developing new diagnostic criteria in patients with MSK disorders;2) increasing the number of researchers focused on patient oriented research with rigorous training in the study of MSK disorders;3) fostering new multidisciplinary collaborations;and 4) facilitating the transition from traineeship to faculty. While the goals of the program span multiple clinical problems, I highlight two research studies in this proposal: Study 1: To conduct a randomized controlled clinical trial to determine optimal timing for withdrawal of epidural anesthesia in patients undergoing total knee replacement. Study 2: To determine the diagnostic value of clinical history for the diagnosis of symptomatic meniscal tears in the presence of knee osteoarthritis (OA). Each of these studies, coupled with a comprehensive structured mentoring program, will help to address important unanswered questions in the management of patients with MSK disorders. The program will also help the next generation of clinical scientists to develop, evaluate and implement efficient and effective treatment strategies in patients with MSK conditions.

Public Health Relevance

The Mid-career Award in patient oriented research (K24) will enable me to dedicate a substantial portion of my time to pursue a robust program in patient oriented research in orthopaedics and to mentor young clinical scientists committed to orthopaedic and musculoskeletal patient oriented research. I highlight two research studies in this proposal: Study 1: To conduct a randomized controlled clinical trial to determine optimal timing for withdrawal of epidural anesthesia in patients undergoing total knee replacement. Study 2: To determine the diagnostic value of clinical history for the diagnosis of symptomatic meniscal tears in the presence of knee osteoarthritis (OA). Each of these studies, coupled with a comprehensive structured mentoring program, will help to address important unanswered questions in the management of patients with MSK disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24AR057827-03
Application #
8212399
Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Panagis, James S
Project Start
2010-02-01
Project End
2015-01-31
Budget Start
2012-02-01
Budget End
2013-01-31
Support Year
3
Fiscal Year
2012
Total Cost
$164,380
Indirect Cost
$12,176
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Deshpande, Bhushan R; Katz, Jeffrey N; Solomon, Daniel H et al. (2016) Number of Persons With Symptomatic Knee Osteoarthritis in the US: Impact of Race and Ethnicity, Age, Sex, and Obesity. Arthritis Care Res (Hoboken) :
Suter, Lisa G; Smith, Savannah R; Katz, Jeffrey N et al. (2016) Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis Care Res (Hoboken) :
Deshpande, Bhushan R; Losina, Elena; Smith, Savannah R et al. (2016) Association of MRI findings and expert diagnosis of symptomatic meniscal tear among middle-aged and older adults with knee pain. BMC Musculoskelet Disord 17:154
Katz, J N; Smith, S R; Collins, J E et al. (2016) Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities. Osteoarthritis Cartilage 24:409-18
Klara, Kristina; Collins, Jamie E; Gurary, Ellen et al. (2016) Reliability and Accuracy of Cross-sectional Radiographic Assessment of Severe Knee Osteoarthritis: Role of Training and Experience. J Rheumatol 43:1421-6
Michl, G L; Katz, J N; Losina, E (2016) Risk and risk perception of knee osteoarthritis in the US: a population-based study. Osteoarthritis Cartilage 24:593-6
Losina, E; Collins, J E (2016) Forecasting the future pain in hip OA: can we rely on pain trajectories? Osteoarthritis Cartilage 24:765-7
Usiskin, Ilana M; Yang, Heidi Y; Deshpande, Bhushan R et al. (2016) Association between activity limitations and pain in patients scheduled for total knee arthroplasty. BMC Musculoskelet Disord 17:378
Tuakli-Wosornu, Yetsa A; Selzer, Faith; Losina, Elena et al. (2016) Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis. Arch Phys Med Rehabil 97:1945-1952
Smith, S R; Deshpande, B R; Collins, J E et al. (2016) Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis Cartilage 24:962-72

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