Musculoskeletal (MSK) disorders and particularly osteoarthritis (OA) are a major source of pain, functional impairment, and worsening quality of life across all age groups. Total knee replacement (TKR) is a costly, frequent intervention for knee OA. Its success is generally measured on the basis of implant longevity and pain relief. However, compelling evidence that moderate physical activity enhances overall health indicates that the value of TKR could be increased substantially if TKR recipients engaged in adequate levels of physical activity after rehabilitating from their surgeries. The evidence base in MSK and orthopedic clinical science has substantial gaps. I have devoted the last 15 years to addressing these research needs by designing rigorous patient-oriented research studies and mentoring younger clinical scientists. Through the next K24 cycle, I hope to continue to train young scientists in rigorous studies of MSK and orthopedic problems. In this competitive renewal application, I request five years of funding to enlarge and strengthen the mentoring and research programs.
Aim I : To further strengthen my research training program, which focuses on preparing young investigators for rigorous patient-oriented research on MSK and orthopedic disorders.
Aim II : To further develop a comprehensive patient-oriented research program in MSK and orthopedic disorders. I highlight two research studies in this proposal: Study 1: Portraying physical activity (PA) over 5 years among recipients of total knee replacement (TKR).
Aim 1. 1: To follow an established cohort of TKR recipients over 5 years to document long-term trajectories of engagement in PA.
Aim 1. 2: To determine risk factors for low or declining engagement in PA over 5 years post-TKR. Study 2: Raising awareness of knee OA and willingness to undertake behavioral changes to reduce the risk of knee OA.
Aim 2. 1. To develop an individualized web-based knee OA risk calculator that incorporates demographic and clinical factors to predict 5, 10, 15, 20, 25, 30-year and life time risk of symptomatic knee OA.
Aim 2. 2. To conduct a proof of concept randomized trial to establish whether the use of a knee OA risk calculator results in greater readiness for behavioral changes to reduce the risk of knee OA.

Public Health Relevance

Musculoskeletal and orthopedic problems are extremely common and disabling. Research on ways of preventing and treating these problems is sorely needed. I propose to further develop my patient-oriented research and mentoring programs so that I can continue to train younger investigators to perform cutting edge research on these important problems and so that I can continue to lead my own research, particularly in the areas of enhancing physical activity following total knee replacement and using innovative online tools to prevent osteoarthritis.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Washabaugh, Charles H
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Brigham and Women's Hospital
Independent Hospitals
United States
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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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