Researchers need to address evidence gaps in osteoarthritis studies

May 13, 2014 – DCRI and Duke researchers conducted a meta-analysis of osteoarthritis studies to create a prioritized research agenda.

Investigators need to prioritize and address existing gaps in the current research on osteoarthritis, according to a new meta-analysis conducted by DCRI and Duke researchers.

The study, by Jennifer M. Gierisch, PhD; Evan R. Myers, MD, MPH; Kristine M. Schmit, MD, MPH; Douglas C. McCrory, MD, MHS; Remy R. Coeytaux, MD, PhD; Matthew J. Crowley, MD; Ranee Chatterjee, MD, MPH; Amy S. Kendrick, RN, MSN; and Gillian D. Sanders, PhD; appears in the current issue of the Annals of Internal Medicine.

Osteoarthritis (OA) is a common chronic condition that leads to functional limitations, pain, disability, and lost earnings and is associated with high utilization of health care. It is a leading cause of disability in the United States, and the healthcare costs of OA are high. Approximately 27 million adults in the United States are living with OA in one or more joints, and this number is projected to increase steadily over the coming decades because of an aging population and an increasing prevalence of obesity.

A prioritized list was developed for the Patient-Centered Outcomes Research Institute after a group that included clinical experts and researchers in OA treatment strategies was engaged to identify where there are gaps in the research. A search of the medical literature and a search of a national database of clinical studies showed that there are many OA studies that compare the effectiveness of nonsurgical therapies, but few of these studies compare treatment strategies across categories (such as drug therapy vs weight management) or combined therapies (such as medication plus exercise), and few address the other areas identified as high priority. Also, many current and ongoing studies focus on short-term outcomes and do not necessarily provide the needed information about long-term outcomes reflecting the chronic nature of the disease.

The high-priority gaps in the research include the need to determine or evaluate key outcomes for the patient; optimal duration, intensity, and frequency of nonsurgical interventions; whether the effectiveness of nonsurgical interventions varies by socioeconomic factors; when and how to transition from nonsurgical to surgical interventions; effective ways to engage patients early in their own care and to promote long-term behavior change in patients; standardized screening tools that improve early diagnosis; ways of applying mechanics to biology that improve patient symptoms; ways to promote and deliver coordinated, long-term care; comparing the safety and effectiveness of nonsurgical treatment; and identifying ways for setting up patients to succeed with nonsurgical treatment.

The results of the study include an ordering of 48 identified research gaps into top-, middle-, and lower-priority tiers. The top 12 research needs were chosen, and appropriate study designs and analyses were suggested to address these needs. A key theme that emerged is that future research priorities should focus on attending to patients’ needs across the entire spectrum of OA, from its detection through decisions to go from nonsurgical to surgical OA treatment. So far, few studies evaluate early engagement of patients, methods for setting patients up for success, and coordinating OA care in today’s new healthcare delivery system.

The most highly ranked research needs focused on identifying nonsurgical treatments that give the patient the best long-term outcome, taking into account the patient’s preferences and willingness and ability to comply with the treatment in the long term. If the 12 research areas identified as the greatest need are studied, it may improve the patient experience of managing OA symptoms and enable patients to optimize their most valued health outcomes.