Understanding relevance of health research: considerations in the context of research impact assessment.

Background: With massive investment in health-related research, above and beyond investments in the management and delivery of healthcare and public health services, there has been increasing focus on the impact of health research to explore and explain the consequences of these investments and inform strategic planning. Relevance is reflected by increased attention to the usability and impact of health research, with research funders increasingly engaging in relevance assessment as an input to decision processes. Yet, it is unclear whether relevance is a synonym for or predictor of impact, a necessary condition or stage in achieving it, or a distinct aim of the research enterprise.

Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers.

Background: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR.

Estimating the Burden of Osteoarthritis to Plan for the Future.

Objective: With aging and obesity trends, the incidence and prevalence of osteoarthritis (OA) is expected to rise in Canada, increasing the demand for health resources. Resource planning to meet this increasing need requires estimates of the anticipated number of OA patients. Using administrative data from Alberta, we estimated OA incidence and prevalence rates and examined their sensitivity to alternative case definitions.

The use of magnetic resonance imaging in acute knee injuries can be reduced by non-physician expert clinics.

Introduction: The routine use of magnetic resonance imaging (MRI) for the assessment of acute knee injuries is controversial. The goal of this study is to present an audit of patients seen in a dedicated Acute Knee Injury Clinic (AKIC) to determine the frequency and appropriateness of MRI utilization.

Methods: A retrospective review identified all patients who had an MRI and a randomly selected control group without MRI.

You'll know when you're ready: a qualitative study exploring how patients decide when the time is right for joint replacement surgery.

Background: While some studies have identified patient readiness as a key component in their decision whether to have total joint replacement surgery (TJR), none have examined how patients determine their readiness for surgery. The study purpose was to explore the concept of patient readiness and describe the factors patients consider when assessing their readiness for TJR.

Methods: Nine focus groups (4 pre-surgery, 5 post-surgery) were held in four Canadian cities.

Continuous quality improvement program for hip and knee replacement.

Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program.

Patient factors in referral choice for total joint replacement surgery.

Background: Although the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices.

Objectives: Objectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon.

Methods: Questionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons.

Hip resurfacing versus total hip arthroplasty: a systematic review comparing standardized outcomes.

Background: Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies.

Questions/purposes: We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis.

Evaluating the primary-to-specialist referral system for elective hip and knee arthroplasty.

Rationale, Aims And Objectives: Persistently long waiting times for hip and knee total joint arthroplasty (TJA) specialist consultations have been identified as a problem. This study described referral processes and practices, and their impact on the waiting time from referral to consultation for TJA.

Methods: A mixed-methods retrospective study incorporating semi-structured interviews, patient chart reviews and observational studies was conducted at three clinic sites in Alberta, Canada.

Voluntary versus involuntary waiting for joint replacements: new Alberta wait times rules for hip and knee arthroplasties, with provincial consensus.

Despite various health system improvements across Alberta, the wait times benchmark was not being met for all patients requiring hip or knee arthroplasty. Alberta Health Services Bone and Joint Clinical Network working groups, in collaboration with other provincial organizations, gained consensus on the development and implementation of a set of provincial Wait Times Rules. These rules standardize the definition and measurement of data elements specific to joint replacement and distinguish between voluntary (patient-related) versus involuntary (healthcare system-related) wait times.

Measuring the value of total hip and knee arthroplasty: considering costs over the continuum of care.

Background: Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.

Questions/purposes: The purpose of this study was to inform estimates of the value of THA and TKA by determining: (1) the data sources data required to obtain costs across the care continuum; (2) the data required for different analytical perspectives; and (3) the relative costs across the continuum of care.

Methods: Within the context of a pragmatic randomized controlled trial comparing alternative care pathways, we captured healthcare resource use: (1) 12 months before surgery; (2) inpatient; (3) acute recovery; and (4) long-term recovery 3 and 12 months postsurgery.

Validation of a prediction model to estimate health utilities index Mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the hip.

Objective: To examine the validity of a newly developed prediction model translating osteoarthritis (OA)-specific health-related quality of life (HRQL) scores measured using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) into generic utility-based HRQL scores measured using the Health Utilities Index Mark 3 (HUI3).

Methods: Preintervention data from 145 patients with hip OA and complete WOMAC and HUI3 baseline assessments from the Alberta Hip Improvement Project study were used to validate three utility prediction models. These models were estimated using data from a previous study of knee OA patients.

NSAID use and progression of chronic kidney disease.

Purpose: The effects of nonselective and selective cyclooxygenase-2 specific (COX-2) nonsteroidal anti-inflammatory drug (NSAID) use on the progression of chronic kidney disease (CKD) is uncertain. Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort.

Methods: All subjects > or =66 years of age who had at least one serum creatinine measurement in 2 time periods (July-December, 2001 and July-December, 2003) were included.

Estimating osteoarthritis incidence from population-based administrative health care databases.

Purpose: The aim of the study is to develop a method to estimate osteoarthritis (OA) incidence by using administrative health care databases.

Methods: Using actual counts of OA diagnoses in different periods, we generated an equation that estimated the number of new OA diagnoses based on the length of time used for excluding prevalent OA cases. Physicians billing files from 1983 to 2002 maintained at Alberta Health and Wellness were used to verify the proposed method.

The Alberta Bone and Joint Health Institute: creating sustainable accountability through collaboration, relevant measurement and timely feedback.

A robust accountability strategy is at the core of creating a safe, efficient, effective and sustainable system of healthcare. The commitment to be accountable must extend far beyond the providers of care to include every person involved in the funding, administration, delivery and support of patient care (both directly and indirectly). The Alberta Bone and Joint Health Institute has fostered a new system that will measure, analyze and give valuable feedback to all stakeholders in all three essential domains of system accountability: access, quality and cost.

Proposed model of botulinum toxin-induced muscle weakness in the rabbit.

Osteoarthritic patients show only a weak association between radiographic signs of joint disease and joint pain and disability. Conversely, muscle weakness is one of the earliest and most common symptoms of patients with osteoarthritis (OA). However, while many experimental models of osteoarthritis include a component of muscular weakness, no model has isolated this factor satisfactorily.

Acute botulinum toxin-induced muscle weakness in the anterior cruciate ligament-deficient rabbit.

We established botulinum type-A toxin (BTX-A) injections as a powerful tool to cause knee extensor weakness in New Zealand White (NZW) rabbits. The purpose of this study was to determine if BTX-A induced quadriceps weakness causes muscle dysfunction beyond that caused by anterior cruciate ligament (ACL) transection in the knee of NZW rabbits. Twenty animals were randomly divided into four study groups (n=5 each); uninjected controls, BTX-A injection alone, ACL transection alone, BTX-A injection and ACL transection combined.

Modelling the behaviour of ligaments: a technical note.

Experimental observations suggest that during a ligament tensile strain test, water and glycosaminoglycans are exuded. Many attempts have been tried to model this behaviour using continuum mechanics. We have investigated this unique behaviour and have established three mechanisms which may contribute to the experimental observations: the slackness of the fibres before stretching can lead to a decrease in volume upon straightening; a Poisson's ratio higher than 0.