Envisioning new horizons for people with osteoarthritis

Arthritis is more than just aches and pains. In fact, among all causes of disability in Canada, arthritis ranks first among women and second among men, according to the Public Health Agency of Canada. The most prevalent type of arthritis is osteoarthritis (OA), which progresses when cartilage, the material covering and protecting the ends of bones, begins to wear away and results in joint dysfunction. The eventual result is pain, stiffness, swelling and bone-on-bone movement in the affected joint. A joint replacement may be decided upon to help maximize an individual’s mobility and minimize pain and dysfunction.

For Dr. Aileen Davis, of the University Health Network’s Toronto Western Research Institute, understanding the individual’s journey with joint replacement is vital. A Senior Scientist in Health Care and Outcomes Research, Dr. Davis has spent more than 15 years working toward a better understanding of OA. Last fall she teamed up with Dr. Fiona Webster, an Education Scientist in the Department of Family and Community Medicine (DFCM) at the University of Toronto, on a research study funded by The Arthritis Society that they hope will ultimately improve the lives of people with OA. As the project reaches its first year mark and the first data collection phase concludes, Drs. Davis and Webster offer a glimpse into this collaboration through a Q and A.

Q: What is the focus of your current research project?

A: Dr. Davis: We know that being physically and socially active are important aspects of healthy living overall – and also in managing arthritis. What some of my earlier research found, however, is that even after pain and function improve after joint replacement, individuals are not being more active in their leisure activities and roles. This was a compelling finding. I wanted to understand why this is the case, with a longer term view to identifying some possible ways those outcomes could be improved.

To explore this, I needed to ensure that the right questions were asked. This is where Dr. Webster’s unique expertise comes into play.  As an expert in qualitative research methodology, she has been able to design our current study in a way that will add important evidence from the patient perspective to what we already know through epidemiological data.

Q: What is unique about this particular study?

A: Dr. Webster: Social scientists aren’t typically working alongside arthritis researchers, and studies often don’t employ both qualitative and quantitative research methodologies. An interdisciplinary approach to research that draws from the best practices from both approaches is occurring more often, however, because it is an approach to making discoveries that otherwise could not be achieved. There seems to be a growing understanding about the important links between social and scientific dimensions of disease, and taking an integrated approach to research can help draw out these links in important ways.

For this study in particular, we needed to understand why, in spite of large changes in a person’s capability to participate in daily activities and social roles post-surgery, the person did not increase participation. This called for a qualitative research approach, so that is the framework put into place. The data collection is aimed at discovering and exploring a participant’s experiences and analysis is aimed at making sense of these experiences.

Q: What results do you anticipate?

A: Dr. Davis: This project began in October 2011, and is expected to wrap up in two years, so it is still early days. The data collected thus far through interviews with participants has yet to be fully analyzed.  However, we are collecting many insights into their experiences that, at an anecdotal level, are gripping.  Not surprisingly, dealing with the pain and disability associated with arthritis has an impact on people’s sense of themselves and how they interact with their world and others in it.  This dimension is compelling and we are indebted to the participants who play such an important role in helping to increase our understanding in this area.

Q: How does Knowledge Translation fit into this work?

A: Dr. Webster: Knowledge Translation (KT) is a critical component of this research project. To put it in its simplest terms, KT is the stage of the project which moves it out of the lab into the “real world”.  We will review the results of the research with a broad range of stakeholders, from consumers to policy makers, and explore implications and future directions. Ultimately, we are interested in exploring how the findings can inform and shape clinical practice, arthritis management, and, indeed, health policy itself.

A: Dr. Davis: We are confident that this research will contribute to the growing body of knowledge that underpins services and care for people with arthritis. This will allow for a rich critique of existing models of care – and the opportunity to build better programs. That means improving the lives of people with arthritis within the foreseeable future. Working so closely with the participants in this study keeps that goal front and centre for all of us.  It is a great collaboration that incorporates the expertise and experience that everyone involved brings to the table. We are really excited about that.

Arthritis Facts
•    4.6 million, or one in six, Canadians aged 15 years and older report having arthritis.
•    Among all causes of disability in Canada, arthritis ranks first among women and second among men.
•    More than 10 per cent of Canadian adults are affected by osteoarthritis (OA).
•    Joint damage caused by OA accounts for more than 80 per cent of hip replacement surgery and over 90 per cent of knee replacements in Canada.
•    A recent report estimates that arthritis may cost the Canadian economy more than $33 billion annually in health-care expenses and lost work days.

For more information and to learn about available services and supports, visit The Arthritis Society’s website at www.arthritis.ca or call the information line at 1.800.321.1433.