December 2020

Setting Up USBJI Stage Three

Toby King

King, Toby.jpg

Yesterday was my last USBJI Board meeting. The Board presented me with a compilation of reflections from the many people with whom I have worked as your Executive Director during my 19 years with the USBJD and USBJI. It has been a wonderful journey and I have enjoyed it enormously. I thank everyone who helped me along that journey.

I decided that at the end of this year I would hand the reins over to someone with the kind of drive and energy needed to take the USBJI to the next stage in its evolution. Also, my work for the USBJI means that I have spent far too little time with my family -- my children and grandchildren in Canada as well as other family in Europe. It is time to spend more time with them.

What I call the Bone and Joint Decade, Stage One, was a relatively easy ride. The concept of raising the priority of musculoskeletal (MSK) health was not generally a difficult sell as our community is closely invested in it. It was intriguing, though, that so many thought the job could be achieved and put to bed in ten years -- or had an end stop.

There is, as I can tell you, still much more to do.

At the beginning, we knew that a much-needed goal was to break down the silo mentality among specialties. Coming from a different environment into this job, I was struck by the competitiveness in an area dedicated to treating people’s health. Today, it feels as if we have come a long way on that front. But not always. Too many occasions arise when silo mentality rears its ugly head. This cannot be beneficial to treating people’s MSK health. But the USBJI is proud of the feedback it receives for its efforts to promote team-based, coordinated and multi-disciplinary care. I hope this continues.

We stumbled over activating the Decade, the assumption being that our members would develop programs to achieve its goals. When it became clear that this wouldn’t largely happen, we began putting programs together to meet our various goals. A meeting was held early on, hosted by the NIH and chaired by then-NIH Director Dr. Elias Zerhouni. It was highly instrumental in guiding us. That meeting identified two issues that needed addressing:

The need to improve MSK health knowledge and skills among all students at Medical Schools. That became Project 100 and achieved much progress. It continues to this day, currently with a particular focus on students pursuing primary care.
The need to increase the pipeline of funded young investigators to increase MSK research. The Young Investigator Initiative is one of our most rewarding achievements. More information follows.

Other programs were started:

Many people saw the importance of BMUS (burden of MSK disease data) as a foundational resource for everything we need to do, for many societies and their members, for promoting the need for raising the priority of MSK health and promoting the value of MSK care. We have published four editions and multiplied the number of Users.
Our public education programs were gaining recognition by the end of the Decade.

Our Stage Two aim was to move beyond the Bone and Joint Decade and become a sustainable organization. Our goals remained: to raise the priority of MSK health as well as increase awareness of MSK health, education, and research. Our most challenging years (2011-2015) were transitioning to become an ongoing initiative. Many people and organizations thought we would just lock the door and throw away the key on all we had achieved -- and what still needed to be done. In fact, it has been over the last six years (2015-2020) that we have accelerated our achievements. Hence, I believe we are at the onset of Stage Three.

We have maintained and expanded BMUS (Burden of Musculoskeletal Diseases in the United States, prevalence, healthcare utilization, economic cost data – www.boneandjointdisease.org). We have just released the 4^th Edition, have 230,000 Users and expanded its use for advocacy. We took over BMUS from the AAOS to help it become a joint project of societies, which it has. The USBJI sees its role to support its members’ advocacy activities by providing data and BMUS central to that.

And the future? We are set on two major expansions of the publication – the first is the integration of the MSK Health Index which presents prevalence data down to zip-code level and many useful filters, including by Congressional District. The second expansion will be a new section with data tailored for specific MSK health policy issues, led by Dr. Daryll Dykes.

The one USBJI goal popular throughout the community is to increase MSK research. We are very proud of our Young Investigator Initiative (YII) which has helped 284 participants succeed in obtaining their first significant funding – $544 million for 1,843 projects. One participant called recently to tell us he has been awarded two grants totaling $2 million following his participation in YII. We plan to expand the program to assist those who have received their first major grant by helping them address the next steps and establish a sustained career in MSK research.

Our public education programs are reaching more Americans, with upgraded editions launched last year. COVID-19 has given us an opportunity to offer the programs as videoconferences and recorded sessions as well as in the traditional live in-person format. This has boosted the number of sessions taking place and broadened the number of people reached. In addition, we are ready to launch new and expanded versions – Creating Opportunities for Arthritis Control @ Home (COACH). It will target non-rheumatology specialists who see people with arthritis to help them address the rheumatology workforce shortage. And we are using the MSK Health Index to locate communities with high levels of prevalence as well as underserved communities. In short, there has been increased interest in our public education programs.

There are so many more issues the USBJI could or should address and which may provide opportunities for expansion. Consider:

Many of those I work with know I have been fighting cancer for several years and that it has become much worse during the past year. My stepping down as your earnest and intense staff person is also necessary for that reason. And while my personal experience is in a different area of medicine, the last few years have taught me a lot about patient advocacy. I regularly get invited to patient advocacy meetings and have felt increasingly knowledgeable and useful at these. I have learned a lot, aided by my own experience, about the science and approach to treatment, such as precision medicine and personalized/individualized medicine, particularly side effects. I have learned a lot about patient-oriented departments and systems in hospitals – some are excellent, some are dreadful. We rarely talk about this within USBJI, but those aspects of patient-orientation hugely affect a patient’s life during treatment.

The biological and pharmaceutical industries focus a lot on patient advocacy. Not so much orthopaedics. Consider Zimmer Biomet’s Movement is Life as a notable exception. The USBJI should talk with orthopaedic companies about patient advocacy which would greatly assist with our overall effort.
Falls – the USBJI has almost exclusively focused on the types of falls in the home (items on the floor, stairs, bathrooms, etc.) and outdoors, especially in the winter. Yet, we have never addressed a vast number of people falling due to the side effects of a drug that results in an osteoporotic fracture or other injury.
We have talked over the past 10 years of increasing awareness of MSK disorders connected to other morbidities or causing them. That is an opportunity to work with other well-established groups to leverage our cause.

There are many issues like this which we have either only marginally touched or not at all. And these are opportunities for the USBJI to broaden its scope.

As I tried to drift out of the door, our Board President lassoed me with the words “not so fast” and was supported by the other Executive Committee members. He said they would like to keep me on in some type of consulting role and to help with the transition for my successor. I am more than pleased to do this. I have thoroughly enjoyed working for the USBJD/USBJI, facing the challenges we have had and working with many wonderful people. A particular shout out to my marvelous office colleagues, Shari, Tara, and Carol as well as Emily, who has been working with us for the past several months. I leave with strong positive feelings for the organization and am more than willing to continue contributing where I can. I wish my successor all the joy I have experienced, and to raise the USBJI to another level.

A Misnomer of Muscular Strength: Understanding Mind Over Mass

Nathan Wages, Ph.D., Postdoctoral Research Fellow, Joint Appointment at Ohio University and at Wright State University, a participant in the USBJI Young Investigator Initiative

Nate_Photo for USBJI-2.jpg

When most people think of muscular strength, they visualize those that possess big, bulging muscles. People logically assume that one’s strength is directly proportional to their muscle’s size or mass. Many fail to realize is that the nervous system is an integral part of volitional muscle performance. To quote Brian Clark from Ohio University, “the nervous system is the puppeteer that makes muscles move”. While it is important to tease out the underlying physiological contributions of the nervous system versus the muscle to understand how physical strength develops and improves across time. This information becomes imperative when determining how physical weakness develops and declines across time, especially in certain populations or under certain conditions (e.g., aging, disuse, illness, neurological injury, neurodegenerative disease, or in reduced-gravity environments [i.e., prolonged space flight]).

Like many of you, I once thought physical strength was determined solely from muscular size or mass without giving thought to the neural aspects that contribute to purposeful force development. It was not until I started to study neuromuscular physiology, as a graduate student, that I began to learn about the various mechanisms that lie within the muscle and in the nervous system. And it was not until I became a postdoctoral research fellow that I began to dive into cellular neuroscience and its role in volitional force capabilities. Who would have thought that all the “boring” information I had to learn as an undergraduate physiology student related to ion channels and electrical properties of cell membranes would be so critical for my professional development and career path many years later?

To this point, my present research agenda is to determine how the intrinsic properties of various types of motoneurons contribute to the loss of strength following limb-disuse via immobilization. Similarly, I seek to determine how this information can be applied to populations that possess varying degrees of clinically meaningful weakness. My preliminary findings suggest that motoneuron hypo-excitability is concomitantly associated with relative strength loss attributed to disuse, as well as to aging. In addition, more recently I have begun to investigate the role of Ia sensory afferent nerve fiber stimulation as a method to improve motoneuron excitability, especially during times of intermittent physical inactivity. Hopefully, I will be able to continue this work and report back with positive findings in the coming years!

This passion to investigate the intrinsic properties of motoneurons would not have been possible without my participation in the USBJI YII Program. The support that I received from the committee members was instrumental to the acquisition of the NIH F32 postdoctoral fellowship that currently supports my research. Through both workshops I was introduced and received invaluable insight/ instruction from a set of wonderful advisors (Drs. Beaupre, Golightly, and Hillstrom), who continued to help me well- beyond the confines of these annual meetings. In addition to my advisors, I also received key guidance from many other illustrious researchers. Suffice it to say, the combined recommendations/ suggestions from my advisors and the other prominent researchers was a vital reason for my funding success.

As a result of my recent funding success, I am now often asked to provide guidance to those that are new to the “Great Game” of grant funding. My advice to them has been the following. First, always ask for help when you need it. Second, be open to new or alternative research ideas and methods. Third, get out of your comfort zone and learn something new. Fourth, do not forget to take time for yourself once, or even twice, a week. Whether that be to watch a movie, play a videogame, exercise, or sleep! Lastly, I tell them to make an effort to reach out to those researchers whose work they find interesting or novel because you never know what “vertically-advancing/ ground-breaking” research opportunities lie just around the corner. Remember, collaborations are what makes the world go ‘round!

Wishing you all the best and I look forward to receiving your emails!

Warm regards,
Nate Wages (wages@ohio.edu)

“Scientific Research is One of the Most Exciting and Rewarding of Occupations.” - Frederick Sanger

Elena Myasoedova, MD, PhD, Associate Professor, Department of Internal Medicine, Division of Rheumatology; Mayo Clinic, Rochester, MN, and a participant in the USBJI Young Investigator Initiative

ElenaMyasoedova.jpg

I am a rheumatologist with specific interest in clinical epidemiology, outcomes research and individualized medicine. My research focus is on rheumatoid arthritis (RA) epidemiology and ways to improve outcomes of patients with RA. Growing evidence of increased risk of heart disease in patients with RA compared to individuals without RA prompted my interest in epidemiology of heart disease in RA. I was interested in understanding why patients with RA are more prone to develop heart disease, what is the role of traditional risk factors such as lipids, smoking, blood pressure; how does autoimmune inflammation seen in RA interacts with these risk factors and how can treatments used in RA modulate the risk of heart disease.

As a Fulbright Scholar, I worked with an excellent research team at Mayo, mentored by Drs. Sherine Gabriel, Eric Matteson, Cynthia Crowson, and conducted studies on lipids and statin use, diastolic dysfunction and heart failure in patients with RA, studies on trends in heart disease occurrence and death from heart disease in RA. This work was continued when I joined the Clinician Investigator track as part of my Internal Medicine/ Rheumatology training at Mayo Clinic. I have contributed over a decade of work in this research area, which culminated in my Doctor of Medical Sciences Thesis and a few important publications including a population-based cohort study highlighting the interplay between inflammation and cholesterol levels on risk of heart disease in patients with RA. My work on epidemiology of flares in RA is summarized in my Master of Clinical and Translational Science Thesis, and shows increased risk of heart disease associated with each flare of RA and the protective effect of remission.

On the path to obtaining independent grant funding, I attended USBJI seminars, Rheumatology Research Workshops and was a participant in Creating Adult Rheumatology Mentorship in Academia (CARMA) program promoted through the American College of Rheumatology. These events were instrumental in understanding the grant application process and along with strong mentorship at Mayo Clinic prepared me for successful grant submissions.

In 2019, I was recruited on staff at Mayo Clinic Rheumatology and continued my research, supported by the Louis V. Gerstner, Jr. Fund at Vanguard Charitable Career Development Award. In 2020, I have been awarded an R01 grant from the National Institute of Aging aiming at investigating the role of chronic inflammatory burden in cognitive decline and dementia in patients with RA. This study builds up on my prior work in RA epidemiology and takes advantage of the rich population-based resources available through the Rochester Epidemiology project.

Academic career is a challenging yet very rewarding path. Resilience and perseverance in pursuing your research goals, as well as positive thinking and mentoring support can help overcome challenges with manuscript and grant writing, lack of success with grant submissions, and limited protected time for research. Staying focused but open-minded and positive will help in refining your research idea, gaining confidence in academic writing and progressing to a productive enjoyable academic career.

Myasoedova.elena@mayo.edu

Call for Applications Young Investigator Initiative - January 15, Deadline

The next deadline for young investigators to apply for the Young Investigator Initiative Grant Mentoring and Career Development Program is January 15, 2020.

The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada are dedicated to increasing research of musculoskeletal diseases. To keep pace with the high and increasing burden of these diseases, a higher level of research performed by young investigators in the musculoskeletal diseases is required, and future levels of research assured. This is particularly important given the current environment for research funding, and academic careers. In response, the Young Investigator Initiative is a grant mentoring and career development program providing early-career investigators an opportunity to work with experienced researchers in our field to assist them in securing funding and other survival skills required for pursuing an academic career.

This grant mentoring and career development program is open to promising junior faculty, senior fellows or post-doctoral researchers nominated by their department or division chairs seeking to pursue a career in clinical or basic research. It is also open to senior fellows or residents that are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards, are invited to apply. Investigators selected to take part in the program attend two workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The unique aspect of this program is the opportunity for attendees to maintain a relationship with a mentor until their application is funded. The Spring 2021 Workshop is planned for April 23 - 25, 2021, in Rosemont, IL (Chicago). Applications are due by January 15.

We plan to hold the workshop In-Person, but we are prepared to hold the workshop by video conference if needed due to the pandemic. We appreciate that investigators still have plans and a timeline for research grant submissions and resubmissions. The USBJI does not want the current situation to delay those plans.

Fall 2019 Workshop Toronto, Canada

For more about the program and detailed application instructions, please refer to www.usbji.org/programs/yii.

Own the Fall: The American Orthopedic Association Critical Issue Symposium

Paul A Anderson MD, Department of Orthopedics Surgery & Rehabilitation, University of Wisconsin UWMF Centennial Bldg, 1685 Highland Ave, 6th floor Madison, WI 53705-2281 email: anderson@ortho.wisc.edu

AOA_center_newtag.jpg

The American Orthopedic Association raised as a critical issue fall and fall prevention to increase awareness among orthopedic surgeons of their responsibility in the assessment and prevention of falls. Falls and fall-related injuries are associated with significant morbidity and mortality. For example, the 1-year mortality after hip fracture is 25-28% and less than 50% return to baseline functional status.¹

Falls are common but rarely identified by either orthopedic surgeons or primary care physicians. Approximately 35% of adults over the age of 50 sustain a fall resulting in 3 million Emergency Department visits per year.² Prior to sustaining a hip fracture, 40 to 50% patients report having a fall in the year prior to injury. Also 30 to 40% of patients sustain a fall after a hip fracture.²

Fall risk factors are categorized as intrinsic and extrinsic. Intrinsic factors include demographics, medications, comorbidities, fall history and disorders of balance. Extrinsic factors relate to the environment and activity. There is a strong correlation between an increasing number of risk factors and the incidence of falls. Medications are a common modifiable intrinsic factor that can be reconciled by primary care or gerontology. Environmental hazards such as poor lighting and lack of bathroom modifications to prevent falls are excellent interventional targets.

Fall assessment is rarely performed by orthopedic surgeons and primary care. Obtaining a fall history is important as a previous fall is highly predictive of future falls. There are many simple to use office-based tests such as the Timed Up and Go, grip strength using dynamometer, and functional reach test that predict fall risk. Orthopedic surgeons are encouraged to develop within their pratice an assesment tool to identify patients who need further fall assessment and intervention.

Falls are common immediately following discharge from the hospital. Hoffmann reported in a Medicare population that fall-related injuries were the third most common reason for 30- day hospital readmission occurring in approximately 5% of patients. ³ Fall-related injuries were the second most common reason for readmission after primary hospitalization for cognitive impairments or an initial fall-related injury. Likely unrecognized by most orthopedic surgeons, is the association of arthritis and fall risk. A fall occurs in over half the patients in the 12 months before total hip and total knee replacement. Postoperatively, falls continue to occur at alarming rate, in up to 40% of patients after total hip replacement and 20 to 50% after total knee replacement. ⁴ A postoperative fall can result in periprosthetic fracture, wound dehiscence, other fractures, and re-hospitalization.

Methods to mitigate fall risk in the older population are available. Modifiable factors should be identified such as reconciliation of medications and improvement of the environmental conditions. Exercise programs are essential and can include programs such as Fit to a T as promoted by the Bone and Joint Initiative and tai chi. In addition, formal referral to a fall prevention or physical therapy service should be considered in patients with a history of fall or fall risk. Similar to the concepts of Own The Bone for management of post fracture osteoporotic care, the American Orthopedic Association recommends that orthopedic surgeons “Own the Fall” by assessing fall risk and recommending interventions when indicated.

^{1. Hansen DB, C; Pellzzari, P; Pyenson, B. MILLIMAN RESEARCH REPORT: Medicare cost of osteoporotic"fractures. The clinical and cost burden of an important consequence of osteoporosis 2019 August 2019.

2. Cumming RG, Nevitt MC, Cummings SR. Epidemiology of hip fractures. Epidemiol Rev 1997;19:244-57.

3. Hoffman GJ, Liu H, Alexander NB, Tinetti M, Braun TM, Min LC. Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Netw Open 2019;2:e194276.

4. Lo CWT, Tsang WWN, Yan CH, Lord SR, Hill KD, Wong AYL. Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis. Osteoarthritis Cartilage 2019;27:979-93.}

American Osteopathic Academy of Orthopedics Supports USBJI Goals and Initiatives

James S. Mason, DO, FAOAO, Executive Director

AOAO-Logo-2013-black.jpg

The American Osteopathic Academy of Orthopedics (AOAO) facilitates the education and continuous development of Osteopathic orthopedic surgeons to improve the care, healing and quality of life of patients with musculoskeletal health issues. The AOAO is aligned with and supportive of the United States Bone and Joint Initiative. Our academy is the premier, nationally recognized orthopedic organization that represents osteopathic principals and beliefs, while advocating for all orthopedic surgeons, their patients, and the communities in which they live.

The AOAO currently offers quality continuing medical education for osteopathic orthopedic surgeons and is committed to expanding our educational resources to include allopathic physicians, physician assistants and nurse practitioners. Our CME courses are offered twice yearly and include lecture topics in all orthopedic subspecialties. We also offer osteopathic orthopedic board review courses, hands-on skills labs, resident focused workshops and education for osteopathic medical students. Although 2020 has been a difficult year, we were able to convert to a successful all virtual fall meeting, with over 1100 registered attendees. The AOAO serves osteopathic orthopedic surgeons, but our membership is open to all including allopathic orthopedic surgeons, physician assistants and nurse practitioners.

The AOAO, with over 3,000 members, is proud to support the USBJI and agree that musculoskeletal disorders are under-appreciated, under- resourced and under-funded. We share many of the same goals:

Promoting the development of more data and taking an active role in improving racial and ethnic disparities in health care.
Improving public education on arthritis and fracture prevention
Striving to encourage research by supporting the Young Investigator Initiative

In partnership together, we resolve to work with the USBJI in improving the lives of all patients with musculoskeletal disorders everywhere.

American Orthopaedic Foot & Ankle Society Releases Podcasts for Healthcare Professionals

AOFAS-full-color.jpg

AOFAS recently launched Orthopod-cast, a new podcast series featuring interviews with leaders in foot and ankle orthopaedic surgery and hot topics affecting physicians and their practices. The weekly episodes delve into current issues including patient care, education, work/life balance, underrepresented minorities in the field, and more. You can listen to AOFAS Orthopod-cast on Apple Podcasts, or wherever you subscribe to your podcasts.

“The Orthopod-cast will serve as a link between the younger generation of surgeons and the leaders and pioneers in the field,” said AOFAS member Joseph S. Park, MD, who serves as one of the podcast’s hosts. “I hope that it will provide an extension of the in-person mentorship that often influences our work to improve patient care, surgical outcomes, work-life balance, diversity, practice management, and leadership.”

Orthopod-cast is the latest addition to AOFAS’ collection of podcast series covering topics related to foot and ankle orthopaedic surgery:

Foot & Ankle International (FAI) Podcasts offer an in-depth look at articles from the official medical journal of AOFAS. Designed for foot and ankle orthopaedic specialists and advanced health practitioners, the podcasts are released monthly and present peer-reviewed research and new approaches to foot and ankle pathology and treatment.
Foot & Ankle Orthopaedics (FAO) Podcasts summarize articles from the open access medical journal of AOFAS, including clinical and basic science research, systematic and topical reviews, and technique tips. Created by the AOFAS Young Physicians Committee, the podcasts are an ideal resource for orthopaedic surgeons, fellows, residents, and allied health practitioners.
AOFAS Resident Lecture Podcast Series includes 15-minute episodes that give an overview of fundamental foot and ankle topics for residents and fellows.

For more information visit the American Orthopaedic Foot & Ankle Society online at aofas.org.

Collaboration Leads the Way

AOSSM Text CMYK_25.jpg

AOSSM-AANA Combined 2021 Annual Meeting brings expanded education offerings to the sports medicine and arthroscopy communities

AANA_text.jpg

Partnership, teamwork, cooperation, and collaboration. These are more than just words in 2020. These are the actions we have all incorporated into our lives in order to discover new ways to work together toward our common goals.

Now more than ever, collaboration among like-minded individuals is vital. In the true spirit of collaboration, the leaderships of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA) are proud to announce the AOSSM-AANA Combined 2021 Annual Meeting, July 7-11, 2021 in Nashville, Tennessee.

This extraordinary event will include the most comprehensive level of education and research provided by the world’s leaders in all areas of sports medicine and arthroscopy. It will highlight the synergistic expertise of both great organizations while deeply celebrating each of our traditions, including the start of AOSSM’s 50^th Anniversary and AANA’s 40^th Anniversary. To enhance the collaboration, the 2^nd Annual Biologic Association Summit will be held on July 7 in conjunction with the AOSSM-AANA Combined 2021 Annual Meeting.

The AOSSM-AANA Combined 2021 Annual Meeting will be a premier educational event of the year and we look forward to welcoming everyone to this historic meeting.

Additional information will be available soon. Questions? Contact aossm-aana@sportsmed.org.

First-Ever APTA Clinical Practice Guideline Targets TKA

APTA logo_6x6.jpg

APTA's first self-produced clinical practice guideline combines careful review of evidence with expert consensus on best practice to create the first-ever CPG on total knee arthroplasty specifically for the physical therapy profession. APTA's development of the Total Knee Arthroplasty Clinical Practice Guideline is a winner of the 2020 American Society of Association Executives gold Power of (A) Awards.

In this review:

Physical Therapist Management of Total Knee Arthroplasty
(PTJ, June 2020)

The Message
In addition to evaluating some of the most common interventions for rehabilitation after total knee arthroplasty, the new clinical practice guideline also makes recommendations around the factors PTs should take into account when determining a patient's prognosis, group versus individual therapy, timing of PT management, and discharge planning. Among the results: preoperative exercise, cryotherapy, and motor function training are among the interventions with the strongest support, while use of a continuous passive motion device for mobilization is the approach to avoid.

The CPG
APTA sought out the expertise of the AAOS Evidence-Based Medicine Unit as paid consultants to assist in the creation of this CPG. An APTA volunteer guideline development group consisting of PTs from different APTA sections, an orthopedic surgeon, a nurse, and a consumer developed the guideline through analysis of 192 research articles (whittled down from 1,258 English-language articles reviewed from 1995 to 2018) and extensive discussions on the relative strength of each recommendation. In the end, the group identified 17 recommendations with varying levels of strength.

APTA members Diane Jette, PT, DPT, DSc, FAPTA; Stephen Hunter, PT, DPT; Bud Langham, PT, MBA; David Logerstedt, PT, PhD; Noreen Poirier, PT, DPT; Jennifer Ritter, PT; David Scalzitti, PT, PhD; Jennifer Stevens-Lapsley, PT, MPT, PhD; James Tompkins, PT, DPT; and Joseph Zeni Jr., PT, PhD, were among the authors of the guideline.

Strength of Recommendations
Recommendations were rated according to an assigned level of strength — "strong," "moderate," "weak," "theoretical/foundational," and "best practice."

Strong: A high level of certainty of moderate-to-substantial benefit, harm, or cost; or a moderate level of certainty for substantial benefit, harm, or cost.

Moderate: A high level of certainty for a slight-to-moderate benefit, harm, or cost; or a moderate level of certainty for moderate benefit, harm, or cost.

Weak: A moderate level of certainty of slight benefit, harm, or cost; or a low level of certainty for moderate-to-substantial benefit, harm, or cost.

Theoretical/foundational: A preponderance of evidence from animal or cadaver studies, conceptual/theoretical principles, basic science research, or published supporting expert opinion.

Best practice: Recommended practice based on current clinical practice norms; exceptional situations in which validating studies have not or cannot be performed, yet there is a clear benefit, harm, cost; or expert opinion.

Findings: Interventions for Patients Post-TKA
It's important to note that a recommendation's strength rating isn't necessarily a reflection of the panel's position on its effectiveness or importance, but rather a combination of the quality of definitive research on an intervention and its demonstrated ability to affect outcomes, either positively or negatively.

Strong Recommendation

Motor function training (for example, balance, walking, and movement symmetry).

Moderate Recommendation

Preoperative exercise.
Neuromuscular electrical stimulation.
Resistance and intensity of strengthening exercise.

Weak Recommendation

Immediate postoperative knee flexion.

Best Practice-Based Recommendation

Preoperative education.
Physical activity.

Moderate Recommendation Against Use

Continuous passive motion device used for mobilization.

The CPG also includes recommendations for PTs to factor in various "prognostic factors" — BMI, depression, preoperative range of motion, physical function and strength, age, diabetes, number of comorbidities, and sex — when assessing potential outcomes (moderate strength). In addition, the guideline includes moderate-level strength support for PT management to begin within 24 hours of surgery and prior to discharge, and for the PT's participation in discharge planning.

Why It Matters
Total knee replacement surgery is widely performed and likely to increase in prevalence. Authors of the CPG write that the number of TKAs performed — an estimated 662,545 in 2013 — are predicted to grow by 855% between 2012 and 2050. Given the important role of the PT and PTA in rehabilitation after TKA, it's imperative that the profession develop practice guidelines that are rooted in a careful analysis of available evidence and best-practice standards.

More From the Study
The CPG also points out where additional research is particularly needed. Some of the interventions cited as being ripe for more investigation include motor function training (especially around long-term impact), physical activity, preoperative education and exercise, aquatic therapy, and group versus individual physical therapy sessions.

Pocket Guides Available
APTA produced a series of pocket guides that distill the CPG recommendations for quick reference and easy sharing. Four digital "flipbooks" are available: one aimed at PTs, one for physicians and other providers, and two targeting patients — one each in English and Spanish.
Digital versions of the pocket guides are free to members, with nonmembers able to access them for $4.99. Printable versions are available for $9.95.

Keep in Mind …
Authors of the CPG emphasize the importance of patient preferences and safety, and note that the resource "should not be construed as including all proper methods of care or excluding methods of care reasonably directed to obtaining the same results."

APTA 2020 Winner.png

APTA's development of the Total Knee Arthroplasty Clinical Practice Guideline is a winner of the American Society of Association Executives gold Power of (A) Awards.

Spotlight Series Launch & Early Stage Investigator Workshops

ASBMR_Logo_Transparent.png

ASBMR Member Spotlight Series in 2021
Brought to you by the Diversity, Equity, and Inclusion Committee of the American Society for Bone and Mineral Research, the ASBMR Member Spotlight Series aims to highlight exciting new research in a collaborative setting. ASBMR members are comprised of a diverse collection of individuals from different backgrounds, countries, and cultures who bring a host of life experiences, values, and beliefs. Each Spotlight will feature 1-2 members presenting on a current research project over 15-20 minutes each. Following each short presentation, there is an opportunity for Q&A and discussion with the audience. To view the schedule of upcoming presentations click here.

ASBMR Early Stage Investigator (ESI) Clinical Workshop Series
This ESI series aims to engage clinical fellows/trainees in stimulating discussion around musculoskeletal topics ranging from common metabolic conditions that are complex to manage (e.g. CKD and bone), rare cases, diagnostically challenging cases, and specialized groups (e.g., early-onset osteoporosis). Each workshop will feature two cases, each presented over 30 minutes. Attendees will be encouraged to ask written questions (via a chat function) to allow a more interactive style. To view the upcoming schedule, click here.

Automated Struts

Austin Fragomen, MD; Raymond Liu, MD; Reid Nichols, MD

LLRS Logo 2019 BluFlat-WhtLinesVERT-band.jpg

The field of Limb Deformity has been fortunate to have several innovative advances in the past few years, including the revolutionary internal lengthening nails. (https://www.usbji.org/news/newsletters/october-2019 ) Automated hexapod struts are the latest development and have reimagined the patient experience with the external fixator. First a bit of history: the field started with the classic Ilizarov circular fixator, where surgeons mathematically determined frame placement and rates of angular correction staging each plane of correction separately. Modern hexapod technology (also used in flight simulators) emerged with computer assisted software and six-axis spatial motions to ensure straightening of all deformities simultaneously, substantially simplifying complex corrections and decreasing the need for frame adjustments. In the latest breakthrough, Orthospin (Misgav, Israel) has created an automated strut system with integrated computer software for hexapod systems. (Fig. 1)

ll.jpeg

What is new about the automated struts? These struts have completely reinvented the ability to manipulate hexapod frames. Standard struts require manual full or quarter millimeter turns performed in one motion by the patient. These new automated struts can break up a 1mm adjustment into 50 or more sessions per day which accomplishes several goals: it reduces pain, it improves cell growth, and it out-performs standard struts in every metric. These struts are also functional: they can get wet in the shower and can tolerate full weight bearing. The first generation Orthospin struts are available in limited lengths which dictates the ring-to-ring working distance, and the computer and battery packs are bulky adding weight to the system.

My clinical observations: patients love not having to perform adjustments as the computer does it for them. The idea of adjusting struts produces anxiety in many people. Manual adjustments most often require partner assistance to see the numbers particularly in the posterior aspect of the frame. People who live alone will embrace this new system which fosters independence. I have a patient who was deeply traumatized by her childhood external fixator experience but required further limb deformity surgery as an adult. She was willing to undergo external fixator treatment with the automatic adjustments only because she did not need to be so intimate with the frame. Post surgery she noted a significant reduction in pain compared with her prior bout. In the patients I have treated the system would automatically make minor movements of each strut once every 6 hours. Patients reported minimal to no pain during the adjustment phase of treatment which is unprecedented. The system is capable of far more subdivision of adjustments (creating less force in the leg and less pain) with the ideal number still unknown. Bone formation should be superior and tissue micro damage lessened with this system, findings which have been shown in animal models. We expect to see stronger early healing and shorter times wearing the external fixator in our Orthospin patients as we look forward to seeing clinical data to critically assess this new technology.

Help NAON Celebrate at its Upcoming 41st Annual Congress in Palm Springs, CA!

NAON Logo_2.crop_.jpg

NAON remains committed to ensuring that we as a community come together to learn, share research and drive forward the practice of orthopaedic nursing.

With that commitment in mind, we are pleased to share that, presently, the NAON 41st Annual Congress, scheduled for May 22-25, 2021, in Palm Springs, California will continue as planned and that registration for the in-person event is now open!

We encourage you to register and make plans to join us this May for the best in orthopaedic education, presented by leaders and experts within orthopaedic nursing. Register by the extended early registration deadline of March 19 to take advantage of the best rates.

We also recognize that many may not be able or want to travel for an in-person event in May. Which is why NAON is also excited to offer a virtual Congress attendance option, Lights, Camera, Congress: A Virtual Experience, featuring select presentations and live speaker Q&As that will take place in June 2021 following the in-person event.

For more information and to register for either event, please visit: www.orthonurse.org/congress

NAON Executive Board approves 2021 strategic plan
The NAON Executive Board has approved it’s new strategic plan which will focus on:

Attracting non-member orthopaedic nurses
Attracting ortho allied health professionals
Educating patients and caregivers
Diversity, Equity & Inclusion

To view the full plan, visit: www.orthonurse.org/page/aboutus

NAON is excited to announce that we have joined Healthy Nurse, Healthy Nation™ as a Champion partner.
On May 1, 2017, the ANA Enterprise launched the Healthy Nurse, Healthy Nation Grand Challenge, a national movement designed to transform the health of the nation by improving the health of the nation’s 4 million registered nurses.

The Grand Challenge:

Broadly connects and engages individual nurses, employers of nurses, state nurses organizations, and specialty nurse associations to take action within five domains: physical activity, rest, nutrition, quality of life, and safety
Provides a web platform to inspire action, cultivate friendly competition, provide content and resources to users, gather data, and serve to connect registered nurses with each other, with employers and organizations through blogs, discussion boards, mini-challenges, and more!

In a number of significant indicators, nurses are less healthy than the average American. Nurses are often overweight, have higher levels of stress, and get less sleep. Because health care delivery requires 24/7 support, the demands of shift work challenges the health of nurses. In addition, hazards such as workplace violence and musculoskeletal injuries are contributing factors to poorer health.

As the largest group of health care workers, nurses are critical to America’s healthcare system. Nurses protect, promote, and optimize the health of their patients by preventing illness and injury, facilitating healing, and alleviating suffering. Their well-being is fundamental to the health of our nation.

To learn more about this initiative, visit: www.healthynursehealthynation.org/

New NIH Research Grants Honor Legacy of Former NIAMS Director Stephen I. Katz, M.D., Ph.D.

Robert H. Carter, M.D. Acting Director National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health

November 16, 2020

Dear Colleagues,

We at NIAMS are excited as we look forward to the arrival of Lindsey Criswell as the new Director but our thoughts also turn back to memories of our previous Director, Steve Katz. He was a unique voice who guided the NIAMS as director for more than two decades and who spent his career mentoring the next generations of researchers. With this in mind, I am pleased to share news of new awards that give the NIH a unique way to encourage the scientists of tomorrow.

The Stephen I. Katz Early Stage Investigator Research Project Grant (R01 Clinical Trial Not Allowed) and the Stephen I. Katz Early Stage Investigator Research Project Grant (R01 Basic Experimental Studies with Humans Required) are now accepting applications.

While Steve was internationally known for his contributions to the field of dermatology, he also saw great value in looking beyond the borders of any single area of research. The new awards are infused with this spirit of intellectual exploration. The purpose of these R01 Research Project Grants is to support early-stage investigators (ESIs) who wish to propose research projects in a new direction for which preliminary data do not exist. The change in research direction could involve, for example, a new approach, methodology, technique, discipline, therapeutic target, and/or new paradigm.

NIH Director Francis S. Collins, M.D., Ph.D., a close colleague of Steve’s, said, “I can’t think of a better way to commemorate Steve’s tireless dedication to empowering the scientists of tomorrow than through these awards. We hope the recipients of these awards will help generate bold new ideas to help move medical research forward in unexpected ways.”

If Steve were with us today, he would be first in line for a chance to read the incoming applications. I know he would be proud to see his legacy live on through these awards that foster innovative new directions from our next generation of scientists.

I encourage you to apply, and to share the announcements with interested colleagues.

Robert H. Carter, M.D.
Acting Director
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health

We've Got Your Back!

NSHF.png

News from the National Spine Health Foundation

National Spine Dec Pic.JPG

The National Spine Health Foundation is a nonprofit organization dedicated to improving spinal health care through education, research, and patient advocacy. Our vision is to give hope and to improve the lives of those with neck and back issues. Our goal is to educate Americans about the treatment and prevention of neck and back disorders. Our research initiatives are data-driven, focused on educating patients on treatments that work, reducing the need for invasive treatments, and improving surgical outcomes. We aim to prove that more efficient and less invasive alternatives to traditional treatments exist, often resulting in faster recovery times and improved quality of life. Our network of national spine specialists others contribute to our Spine Health Journal, a patient-centered, research-driven publication produced by the Foundation. new research

SpineOnline® is a nationwide, multi-centered technology project to prove the effectiveness of spinal treatment options. Through SpineOnline®, we have compiled the definitive collection of provider and patient reported treatment outcomes. This unique approach allows us to uniformly collect information about spine treatments and their applications and prove which treatments are the most effective and result in the best possible patient outcomes.

This year we have developed collaborations with many non-profit organizations that focus on specific spine and neck issues. These collaborations include arthritis, osteoporosis, physical therapy, chronic pain, sports medicine, and cancer. With the support of these non-profits, we have developed patient education programs on specific topics that showcase the latest developments in research, diagnosis, and treatments for spine and neck issues.

In addition, this year we have invited eighteen of the best and brightest spine surgeons from around the U.S to be on our Medical and Scientific Board. This board brings cutting edge expertise on spine issues to share with patients across the US. https://spinehealth.org/the-medical-scientific-board.

We advocate for government policy efforts that provide access to all patients to critical spine health information. We support funding research that leads to new treatment protocols and alternatives to opioid pain relief for individuals with spinal issues and injuries. We have joined a number of coalitions like, USBJI, to raise awareness of important policy issues. In addition, a Congressional Record Statement was submitted on our behalf “Recognizing October as National Spine Health Awareness Month”. (October 2, 2020 by Congressman Connolly). The Foundation’s CEO has been invited to join the FDA’s Patient Engagement Committee providing an opportunity for input on important FDA decisions.

The COVID pandemic has been a challenge to our Foundation’s commitment to reach patients and obtain resources to further that reach. With the public and private health care system focused on the pandemic, now more than ever access to patient education is needed on spinal health issues. We also strive to make our patient education materials and messaging sensitive to the current pandemic environment and specific needs of patients during this difficult time.

We would like to expand our partnerships with USBJI members since we know that the journey to spinal health is not one that can be made alone. We invite patients, policy makers, and health care providers to access the educational resources of the National Spine Health Foundation website and share it with others who may benefit from its content. spinehealth.org

$425,000 in New Grant Funding from OREF Now Available!

OREF_New_RFA_Announcement_LI.png

$425,000 in new grant funding from OREF now available!
Orthopaedic Research and Education Foundation (OREF) grant applications are now available for research funding on injectable biologics for knee osteoarthritis (OA) and several resident opportunities. Grants from $5,000 to $50,000 are available to eligible applicants. Apply today! (links to grants and awards)

Applications for the following grants are due February 21, 2021.

OREF Injectable Orthobiologics Knee Osteoarthritis Research Grant provides $50,000 in funding for investigator-initiated research proposals focused on the broad area of injectable orthobiologics for the treatment of knee osteoarthritis
Resident Clinician Scientist Training Grant provides $20,000 in funding to prepare residents for a career with research as a major component.
OREF/JRGOS Resident Research Project Grant provides $5,000 in funding to resident investigators conducting research in the area of health disparities and diversity in the orthopaedic surgery field.
Resident Research Project Grant—RD1 provides $5,000 in funding to residents who are interested in research. These grants are offered several times throughout the year, but you may submit only one application per grant year. Please apply during the time frame that most closely aligns with your research rotation in the labs

We look forward to receiving applications and learning about the exciting research being proposed! Have questions about the OREF grants program? Visit www.oref.org/grants or contact the OREF Grants Team at grants@oref.org.

At Last…Moving TMJ into the 21st Century!

TMJ.jpeg

The National Academies of Sciences, Engineering, and Medicine recently released a Consensus Study Report titled Temporomandibular Disorders: Priorities for Research and Care (2020). The Report was prepared by the Committee on Temporomandibular Disorders (TMDs): From Research Discoveries to Clinical Treatment, which was Chaired by Enriqueta C. Bond, President, Emeritus Burroughs Wellcome Fund & QE Philanthropic Advisors and Co-Chaired by Sean Mackey, Chief, Division of Pain Medicine, Stanford University Medical Center. Activities of this Committee and the preparation of the Report were supported by the Office of the Director, National Institutes of Health (NIH) and the National Institute of Dental and Craniofacial Research, NIH.

This report was informed by input from TMJ patients, several workshops and open scientific sessions, a commissioned paper on the prevalence, impact, and costs of treatment for TMDs, and expert advice from a wide range of biomedical researchers, health-care providers, and professional school educators. It describes the current state of TMD research and care, lists detailed recommendations, and outlines priorities for the research community. The Report describes eleven recommendations covering four broad areas:

Expanding and sustaining multidisciplinary research;
Improving quality of health care for TMJ patients;
Improving health care professional education; and
Raising awareness and reducing stigma of TMDs.

Building and Sustaining Multidisciplinary Research

The Report calls for the creation of a national collaborative research consortium for TMDs that will coordinate basic, translational, and clinical research. Included in this initiative are a strengthening of population and public health-based research and clinical research that will drive patient-centered and evidence-based interventions. The Report pinpointed additional research priorities including biomechanics of the joint, regenerative medicine, and the use of artificial intelligence and novel bioinformatics approaches to identify patterns in genomic and proteomic data.

Improving Access and Quality of Health Care for TMJ Patients

The second area of emphasis is the improvement of patient assessment and risk stratification to advance care that emphasizes patient-centeredness and a coordinated, multidisciplinary, interprofessional treatment approach. Diagnostic tools to identify TMJ patients who are likely to transition from localized symptoms to a high-impact chronic pain condition are a high priority. There is an important need for the development and dissemination of evidence-based clinical practice guidelines and quality metrics. A major recommendation in this area is to develop centers of excellence for Temporomandibular Disorders. These centers will:

Evaluate and treat patients,
Contribute to the research base for TMDs, and
Serve as resource centers in training and continuing education for physicians, dentists, physical therapists, and other health care specialists and professionals.

Improve Education and Training for Health Care Professionals

The third area of emphasis is the improvement in education and training for health care professionals on TMDs. The Report recommends that this improvement in education should be continuous and started early in professional training by strengthening undergraduate, graduate, pre- and postdoctoral, residency, and continuing education curricula in pain management, and TMD care and importantly ensure interprofessional and multidisciplinary training opportunities.

Raise Awareness, Improve Patient and Public Education and Reduce Stigma

The fourth area of emphasis is to raise awareness, improve education and reduce stigma of TMDs. The Report focuses on patient and public awareness about TMDs. Evidence-based communications and patient-focused tools related to TMDs should be strengthened and widely disseminated through multiple avenues for all health literacy levels and in multiple languages to improve the resources available to patients and families, and reduce the stigma related to TMDs.

A Turning Point in TMD Research and Care

The recommendations of this report represent a decisive turning point in TMD research and care. For too long, TMDs have been thought of as merely orofacial conditions involving the structures of the jaw joint and face. Consequently, the treatment of TMD patients has been siloed in dentistry and oral and maxillofacial surgery. Treatment outcomes for TMD patients have been less than satisfactory and, in some cases, detrimental to their health and quality of life. Recent biomedical research on TMDs is pointing in new directions. It is no longer appropriate to think of chronic TMDs as localized orofacial pain conditions, but rather as multi-system disorders involving multiple, comorbid chronic pain conditions and other overlapping non-pain comorbidities. There is a need for immediate action to increase new research, develop science-based treatments, and guarantee additional funding support for TMDs.

Accordingly, research on TMDs needs to be expanded with multi-disciplinary, collaborative approaches. A national consortium should be established to oversee and coordinate efforts. Likewise, new patient-centered TMD treatments need to be designed and implemented by a group of interprofessional health care providers including medical, dental, bioengineering, allied professionals, and other disciplines sitting at the same table with patients. Similarly, these new treatments should be administered in a collaborative and coordinated manner by an interprofessional team of health care providers with measurable outcomes that are meaningful, beneficial, and will improve the quality of life for TMD patients. Centers of excellence for TMD treatment and management should coordinate these efforts. Educational and training opportunities need to be expanded and existing programs updated. These efforts must lay the groundwork for interprofessional, collaborative patient-centered care.

The recommendations and research priorities found in this NAM Report will drive the fields of TMD research and treatments forward on a new course of collaborative discovery that leads to multidisciplinary, evidence-based treatment approaches. Working together with patients, health care professionals will improve the lives of patients suffering from TMDs.

Be Part of the Solution

The TMJ Association (TMJA) has been a member of the Bone and Joint Initiative since its onset. The TMJA is in the early stages of developing various working groups to address the recommendations of the National Academy of Medicine report on TMDs and would welcome participation by members of the U.S. Bone and Joint Initiative.

Movement is Life USBJI Report 2020

MIL Logo.png

Movement is Life (MIL) continued to advance health equity in 2020 despite the challenges of the COVID-19 pandemic. Given the precautions of the pandemic, our national caucus was moved from November 2020 to May 2021. We are still excited for this event in the spring.

In lieu of our in-person caucus, we launched the first in our Virtual Health Equity Symposia Series on November 12^th with keynote presenter Danies Dawes Director, JD, author of “The Political Determinants of Health” and “150 Years of ObamaCare” and faculty at the Satcher Health Leadership Institute, Morehouse School of Medicine. The political determinants of health represent the initial improper conduct that is subsequently manifested in bushels of poisonous fruit that we see currently in the form of social determinants of health and health inequities. These political determinants of health create, perpetuate, and exacerbate systemic barriers for Black, Indigenous, Latinx, and other communities of color. With over 650 registrants, this event was a huge success as we elevate the message of health equity. Stay tuned for 2 more MIL Virtual Symposia in this series in early 2021.

On the legislative front, we continue to work with other legislators to reintroduce in Congress the “Equity in Medicare and Medicaid Treatment Act,” originally proposed by the late great Rep. John Lewis. We worked extensively with Congressman Lewis’s office on the development of this bill which will require that new Medicare and Medicaid payment models not negatively impact health equity and health access. We are encouraged by the current interest in this important legislation.

Sharing our critical message of health equity has increased through our Health Disparities Podcasts. We have now recorded over 70 incredibly powerful podcasts! Topics have been broad and range from the impact of the pandemic on underserved communities to the challenges of effective vaccination policies.

We continue to plan for additional MIL Operation Change programs post-pandemic. In 5 programs to date, over 200 women have made significant improvement in their health with a 35% reduction in knee pain and 18% improvement in walking speed. We are extremely enthusiastic about the potential of this program to impact women in both urban and rural America.

Recognizing the need to provide immediate support to clinicians and patients to promote health equity, our innovative Shared Decision Making tool for knee pain is now available for use by any provider at no charge. This is the only personalized shared decision making tool ---- it incorporates the patient’s gender, race, ethnicity, BMI, HTN, Diabetes, educational level, knee pain level and functional level. The tool projects a likely outcome for that patient of various treatment pathways for knee pain and also shows the “do nothing” option. If you are interested in learning more about this tool, please email Dr. Vani Sabesan at sabes001@gmail.com. We are happy to schedule a demo with you!

Finally as an organization MIL contributes to the peer review literature with a number of articles on disparities and health equity. Dr. Mary O’Connor, Chair of MIL, authors a quarterly Column in Clinical Orthopaedics and Related Research entitled, “Equity 360: Gender, Race and Ethnicity”, Dr. Sabesan is editing a series of articles in AAOS Now. Drs. Daniel Wiznia and Mary O’Connor will lead a series in JAAOS on preoperataive optimization in THA/TKA to help address disparities, and Journal of Arthroplasty recently published research on a survey of surgeon perception of risk for THA/TKA patients lead by Dr. Adolph Yates and several MIL steering committee members.

We are proud to be a member of the USBJI and welcome members to contact us directly if they would like to learn more about our programs and efforts. We can be reached at sabes001@gmail.com or bacot@movementislifecaucus.com Happy and Safe Holidays to all!

Acknowledgements

The USBJI thanks the following for their support of USBJI programs during 2020.

2020 Acknowledgments.JPG

Resource links

Burden of MSK Disorders/Impact: www.boneandjointburden.org
Experts in Arthritis patient/public education: www.ControlArthritis.org
Fit to a T (fracture prevention/bone health/osteoporosis) patient/public education: www.fit2t.org
Grant Mentoring and Career Development for MSK researchers: www.usbji.org/programs/yii
Movement is Life (Disparities): www.movementislifecaucus.com
OA Action Alliance: www.oaation.unc.edu
Secondary Fracture Prevention Initiative: www.secondaryfractures.org
United States Bone and Joint Initiative (USBJI): www.usbji.org

You are here

December 2020

In This Issue

Calendar of Events

AOSSM-AANA Combined 2021 Annual Meeting brings expanded education offerings to the sports medicine and arthroscopy communities