Research Priorities for Osteoarthritis of the Knee

Chard JA, Tallon D, Dieppe PA.

What Biases Exist in Research Output?

• “Agenda” biases– Researche

r interests– Vested

interests– Funding– Culture

• Reporting biases– Publicatio

n– Language– Citation– Funding

• Research biases– Study

design– Inclusion

criteria– Statistical

analysis

Objectives

• To contrast available evidence with consumer requirements for knee osteoarthritis

Who Are Consumers?

• Consumers includes patients, health professionals and managers

Methods

• Systematic review of available research

• Convening of focus groups of consumers

• Undertaking questionnaire survey of consumer

• Results of review and consumer opinions compared

Review

• Search designed to identify research on osteoarthritis of the knee

• Search strategy applied to electronic databases, bibliographies, and survey of experts (undertaken in 1998)

• Inclusion/exclusion criteria applied to studies

• Summary data extracted from studies

Identified studies

Total number of studies identified

Studies fitting a priori selection criteria (all languages)

Studies collected and reviewed (English language only)

5237

1292

930

Review ResultsIntervention Total studies

(column %)RCTs (% of total studies)

Positive outcome (% of total)

Alternative & complementary 49 (5.3) 29 (59) 43 (87.8)

Drug (injected) 89 (9.6) 50 (56) 87 (97.8)

Drug (oral) 461 (49.6) 330 (71.5) 447 (97.0)

Education 33 (3.5) 14 (42.4) 29 (87.9)

Physiotherapy & exercise 60 (6.4) 24 (40) 55 (91.7)

Surgery 238 (25.6) 13 (6) 215 (90.3)

TOTAL 930 (100) 460 (49.5) 874 (94)

Pearson X2 =

4.9, 1 df, p=0.027

Conclusion compared by funding source

Chi2 Conclusionsupportedtrial agentYes No

Commercial 105 2Other/unknown 524 44

Focus Group Methodology

• User groups identified and meetings convened (undertaken in 1998)– Rheumatologists [5 attended], general practitioners [3 attended],

physiotherapists [5 attended], and patients [7 attended], Surgeons [failed]

• Asked for opinion on research needs for osteoarthritis of the knee

• Group discussion tape-recorded and transcribed verbatim

• Data analysis using qualitative software

Focus Groups Results

• Specialist – Wanted more time with

patients– Didn’t want any more

drug trials

• Physiotherapists – Wanted funding for

research– Didn’t want poor

quality research

• General Practitioners – Wanted education for

patients– Didn’t want drug trials

• Patients – Wanted information on

disease– Wanted physiotherapy– Didn’t want side-effects

of drugs

Patient Survey Methodology

• Patients with osteoarthritis of the knee identified through existing study (undertaken in 1998)

• Survey mailed to patients (n=120; 112 responses)• Survey asked about:

– experience of treatments for osteoarthritis of the knee– experience of osteoarthritis– research priorities for osteoarthritis of the knee

• Responses entered on Excel worksheet and analysed

Research Priorities of PatientsTreatment Priority 1st-5th (n = 258) (%) 1st choice (n = 67) (%)

Knee replacement 16.3 35.8

Education and advice 15.1 20.9

Physical therapy 14.0 3.0

Tablets 11.2 4.5

Injections in the knee 9.3 4.5

Complementary therapy 7.8 6.0

Removal of fluid/ debris 7.8 0.0

Aids and adaptations 6.2 0.0

No treatment at all 0.8 1.5

Other priority 11.6 23.9

Conclusion (1)

• Research dominated by drug trials and observational surgical studies

• Consumers want more research in non-pharmaceutical areas

Conclusion (2)

• Mismatch between evidence being gathered and evidence required by consumers

• Likely to be due to commercial and researcher interests

Publications

• Chard JA, Tallon D, Dieppe PA. Epidemiology of research into interventions for the treatment of osteoarthritis of the knee joint. Ann Rheum Dis 2000;59:414-418.

• Tallon D, Chard JA, Dieppe PA. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care & Research 2000;13:312-319.

• Tallon D, Chard JA, Dieppe PA. Relation between agendas of the research community and the research consumer. Lancet 2000;355:2037-2040.