July 2016

Chaired by Dr. David Pisetsky, President, the USBJI Board met June 16-17 at Rush University Medical Center, Chicago. Dr. Joel Block, Professor and Director, Division of Rheumatology, and Dr. Joshua Jacobs, Associate Provost for Research, Professor, and Chairman, Department of Orthopaedic Surgery welcomed the USBJI, and introduced a number of faculty members who presented on their research, including Dr. Kharma Foucher, now at the University of Illinois in Chicago, a member of the USBJI’s Young Investigator Initiative. Following these presentations the first day was spent in a strategic discussion on the results of the Board’s recently completed Self-Assessment Survey, USBJI’s Burden of Musculoskeletal Disease in the United States (BMUS) publication, and how to vitalize membership. The Board also viewed the video the USBJI was about to release in connection with its Fit to a T public education program on bone health and osteoporosis (now released – www.fit2t.org) The second day was the regular annual and business meeting of the Board.

Strategic Discussion Planning Meeting
 
Board members provided critical analyses of selected chapters in BMUS, and discussed improved branding, web presence, citations in scholarly articles, and reviewed a draft suite of tools on Management of Knee OA based in part on data in BMUS. An important discussion item centered on whether BMUS content should be extended beyond the current information on prevalence, societal and economic cost to cover the benefits of care including treatment outcomes data, and if so, if this should be part of BMUS or separate. The conclusion was that the USBJI needs to present this information, but it should be handled as a separate document or publication.
 
The Board reviewed the progress being made to improve recognition of members and supporters on www.usbji.org. The Home page now includes the logos of all members and supporters on a revolving panel, and About Us and Members and Friends now includes an acknowledgements page displaying the logos and names of all providing financial support. Similar improvements will now be made to recognition of support and involvement in programs. The Board discussed adding abstracts of the best recently published papers on musculoskeletal topics to the website, and in the USBJI Newsletter including a patient case with a panel offering solutions. A proposal to hold mini-workshops at the annual meetings of member organizations was discussed.
 
Board Meeting
 
Treasurers Report: The 2015 audited statements were presented showing a loss for the year. The Treasurer also presented results for January to March 2016 as well as very preliminary results for January to the beginning of June which show the USBJI with revenues slightly ahead of budget and expenses below. He noted however that while this is encouraging there is much work to do to ensure the organization is sustainable.
 
Board elections: see USBJI Board Elections 2016 below.

Musculoskeletal Conference: The USBJI is exploring the organization of a conference jointly with the American College for Sports Medicine. The conference would offer CME credits, and likely take place over a weekend in the Fall 2017. A program committee is being formed. The program may be directed to educating healthcare professionals who see patients with musculoskeletal disorders but who are not musculoskeletal specialists. It might include presentations or posters by participants in the USBJI Young Investigator Initiative.
 
Burden of Musculoskeletal Diseases in the United States (BMUS): The Executive Summary has been published and distributed to Congressional legislators in DC and their health affairs staff, editorials based on BMUS are slated to appear in a number of publications, and work on the next round of updates has begun. www.boneandjointburden.org
 
Chronic Osteoarthritis Managements Initiative (COAMI): The COAMI chairs believe organizing a liaison OA coordinator pilot project at a US clinic is the next stage, probably on the basis of a successful model from another country. However funding for this is an issue, and this is not the kind of project the USBJI takes on. It would probably be better suited to an academic institution or specialty organization. The OA Action Alliance’s interest to include the provider side of OA management in its work, previously COAMI’s area of activity, was questioned and needs clarification.
 
Public Education Programs: As noted above the Fit to a T video has been produced (www.fit2t.org). Its aim is to broaden the audience for the core educational content of the program, to raise interest the program and in live sessions, and to use it as an introduction to live sessions.  Videos are in production with the same aims for the Experts in Arthritis program.
 
The serious decrease in the number of osteoporotic patients taking prescribed medication was discussed, primarily brought about, it is believed, because of publicity about possible adverse effects. Fit to a T addresses this issue with general guidelines which presenters may present. 
 
iGIANT: The federal initiative to raise awareness about sex and gender differences recently held a webinar at which Dr. Templeton presented on musculoskeletal health differences, using content from BMUS. She has also presented on this topic to the American Medical Women’s Association. The association has as a priority to change perceptions that women’s health is mostly about reproductive health.
 
Pediatric Specialty Group: The group’s valuable accomplishments around obesity and World PB&J Day were lauded. New leadership and members are to be appointed to ensure multi-specialty involvement. Representatives are sought for juvenile idiopathic arthritis.
 
Project 100/1000: 300 people have signed up for the Community of Musculoskeletal Educators. Progress is being made on the Pediatric Musculoskeletal Competence Test.
 
Young Investigators Initiative (YII): Participants continue to report the program as having been instrumental in enabling them to become funded investigators. As the average age at which investigators obtain their first major funding has risen from age 38 to age 45, the program is very much needed. The USBJI would like to see more member societies taking advantage of the program. It would also like to see more participants engaged in other USBJI programs and seeking leadership positions within the organization.
 
American Medical Association – Musculoskeletal Caucus: The Board would like to know who each member’s representative is.

Thanks to Retiring Members: Dr. Pisetsky thanked retiring Board members, Dr. Paul Caskey, Dr. Beatrice Edwards, Dr. Ellen Raney, Ms. Barbara Sack, and Dr. Peter Trafton. He especially thanked Dr. Trafton for his dedication and contribution as USBJI Treasurer in addition to his Board duties.

At the USBJI Board meeting, hosted by Rush University Medical Center, Chicago, June 16-17, 2016, several Rush faculty members presented on their research. In addition Dr. Kharma Foucher, now with the University of Illinois at Chicago, and a participant in the USBJI Young Investigator Initiative gave a presentation on her research. As follows are summaries of some of the presentations. An article by Dr. Foucher is presented separately in this newsletter, here.
 
Welcome and Introductions
 
Dr. Joshua Jacobs, Associate Provost for Research, Professor, and Chairman of the Department of Orthopaedic Surgery provided a brief outline of the history of Rush, including mentioning that the medical school, chartered two days before the City of Chicago was incorporated, is named after Benjamin Rush, MD, a physician and signer of the Declaration of Independence.
 
Dr. Joel Block, Professor and Director of the Division of Rheumatology, explained that the Rush Arthritis and Orthopaedics Institute was the brainchild of Klaus Keuttner, PhD, and over the years has expanded to include departments of rheumatology, orthopaedic surgery, anatomy and cell biology, biochemistry, microbiology and immunology, pediatrics, and physical medicine and rehabilitation. It is now referred to as Musculoskeletal Medicine at Rush. There are 26 core faculty, and the facilities are located at Rush University Medical Center, and Cook County Hospital. Research is organized by pre-clinical, clinical, and outcomes.
 
Investigating the mechanisms of osteoarthritis pain
Rachel E. Miller, PhD
Assistant Professor of Medicine and Biochemistry
 
Osteoarthritis is the most common form of arthritis, and pain is the primary symptom, yet limited treatment options exist for managing osteoarthritis pain. Therefore, we are using a mouse model of osteoarthritis in order to better understand the sources of osteoarthritis pain and to try to identify novel analgesic targets. Our previous work has shown that after destabilization of the medial meniscus (DMM) surgery, mice develop slowly progressive joint damage concurrent with the following pain-related behaviors: hindpaw mechanical allodynia, knee hyperalgesia and locomotive deficits. Persistent pain develops after week 8 in this model. Here, we utilized a new method for imaging intracellular calcium responses by dorsal root ganglion (DRG) sensory neurons in vivo, while physical stimuli are applied to the hindlimb, in order to determine how neuronal responses change 8 weeks after DMM surgery. At this time point, DMM mice had increased numbers of DRG neurons responding to a noxious pinch of the hindpaw as well as to a non-noxious pinch of the knee compared to mice that had undergone sham surgery, which correlates well with the pain behavior readouts. Future work will be directed at using this technique to probe which molecular pathways mediate this neuronal hypersensitivity. More information on our lab’s efforts may be found at our website: www.annemariemalfait.com
 
Rachel E. Miller¹, Shingo Ishihara¹, Yu Shin Kim², Xinzhong Dong², Richard J. Miller³, Anne-Marie Malfait^1
1Department of Internal Medicine (Rheumatology), Rush University Medical Center; Chicago, Illinois
²Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland
³Department of Pharmacology, Northwestern University, Chicago, Illinois
 
Footwear in Osteoarthritis
Dr. Najia Shakoor, MD
Professor of Medicine

Osteoarthritis (OA) is the most common arthritic condition.  As of yet, there is no intervention known to alter the natural history and progression of the disease. OA of the lower extremity is mediated, at least in part, through aberrant loads transmitted across the joint during walking. Nearly two-thirds of all knee OA affects the medial knee compartment, not coincidentally the compartment that bears most of the load during ambulation.   Quantification and assessment of knee loads through gait analysis has demonstrated that in knee OA, elevated medial joint loads are directly associated with radiographic severity, disease progression, and pain.  Therefore, there has been interest in biomechanical interventions targeted at decreasing knee loads with hopes of thereby improving pain and delaying disease progression.  These have included orthotic shoe inserts, knee braces and more recently, footwear.  Early footwear studies have shown that walking barefoot significantly reduced medial knee loads compared to wearing conventional shoes.  Subsequent studies have suggested that flat flexible footwear may be better than more supportive footwear in decreasing knee loads and longer term use of flexible footwear appears to be beneficial in providing sustained and fairly large reductions in medial knee loads as well as possibly improvement in symptoms. 
 
Bio-Psychosocial Model of Care for Lupus
Meenakshi Jolly, MD, MS
Associate Professor, Departments of Medicine and Behavioral Sciences, 
Director, Rush Lupus Clinic 
Associate Program Director, Rheumatology Fellowship Program
http://www.lupuspro.com
 
Lupus affects all domains of quality of life of the patient, and patients affected by this disease are young and women. Not only do patients suffer from joint pains, arthritis, avascular necrosis of joints/bones, osteoporosis and fractures, but muscles may develop inflammation, and tendons may experience laxity and ruptures. Other organs of the body including skin, kidneys, blood etc. may also get involved. Patients frequently may develop anxiety, stress, depression, pain, fatigue and poor body image. Currently no cures are available and medications that suppress the immune system are used, including prednisone, to control the inflammation and thus damage. Frequently these medications have serious side effects. No major advances in treatment of lupus have occurred. Using a multidisciplinary model of care that includes takes into account patients concerns and their view point seriously (e.g. use of patient reported questionnaires-LupusPRO) and a biopsycho-social model of care may be the answer to address their disease and concerns. A team that involves a primary care physician, rheumatologist and a  psychologist may be needed to evaluate and comprehensively treat the patient. Based on the patients symptoms and complaints this team may involve an orthopedician, physical and occupational therapy, pain experts, social workers and other specialists. At Rush Lupus Program, we are engaged in promoting this model of patient centric care for Lupus.
 

Dr. Roll is a former USBJI Young Investigator Initiative (USBJI/YII) participant and is an assistant professor in the Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy at the University of Southern California. Dr. Roll directs the Musculoskeletal Sonography & Occupational Performance (MSOP) research laboratory, which evaluates the use of musculoskeletal sonography as a tool for advancing the prevention, assessment, and rehabilitation of musculoskeletal disorders, particularly within the upper extremity. (From left: Mark Hardison, MS, OTR/L and Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA)

 Workplace Screening
Dental hygiene students report a significant increase in pain and discomfort in their wrists and hands due to novel, intensive exposure to repetitive and forceful hand activities involved in learning the processes of teeth cleaning. This research project is collecting data from students every 4-5 months throughout their two-year training program. Using this longitudinal design, we are evaluating the relationship of various task exposures to structural changes in the tendons and nerves at the wrist measured with sonographic imaging, physiological changes in the nerve measured with nerve conduction studies, and participant reports of symptoms and functional abilities. study is focused on detection of early signs of pathology in the wrist and hand. We aim to evaluate the earliest signs of tissue changes noted on the sonographic images that may predict the development of carpal tunnel syndrome in workers. These predictive models will inform the development of screening techniques and the identification of thresholds to trigger preventive interventions. This study is funded by a 4-year, $2.3M R01 from the Centers for Disease Control (CDC), National Institute for Occupational Safety and Health (NIOSH).
 
Enhancing Rehabilitation
In addition to developing workplace screening for musculoskeletal disorders, we are evaluating other methods for integrating the practice of sonography and physical rehabilitation. Research activities include: development and validation of musculoskeletal sonography training protocols for non-physician rehabilitation providers, exploration of the usefulness of imaging in the clinical reasoning process, and effectiveness of sonography as a tool for patient education and biofeedback to increase patient engagement and improve functional outcomes.
 
Challenges and Supports
Tightened funding paylines and increased competition are some of the biggest challenges facing new investigators. I attribute my success in obtaining an R01 in this environment to the mentorship and peer-review opportunities I received through the USBJI/YII program. Specifically, the guidance for formatting a specific aims page and other writing tips during the first session, the mock peer review and advice on revising my application during the second session, and the connection to a luminary researcher in my field to provide continued mentoring throughout the process were paramount to my success. In addition to USBJI, obtaining a K12-award from the Rehabilitation Research Career Development Program (NICHD/NIH) provided protected time that allowed me to gather preliminary data and develop my grant writing skills, and the Training in Grantsmanship for Rehabilitation Researchers workshop provided additional content specific mentoring that helped to guide my work. These training opportunities are vital to support the growth of the next generation of career scientists in bone, joint, and musculoskeletal disorder research.
 
 For more information regarding the work of the MSOP laboratory, please e-mail me at: sroll@usc.edu.
 

To demonstrate the connection between weak bones, the risk of breaks and osteoporosis in an enlightened and attractive format, a new 6-minute animated video has been released focusing on the core messages of Fit to a T, a public education program on bone health and osteoporosis offered by the U.S. Bone and Joint Initiative. The USBJI invites you to watch the video (www.fit2t.org) and share it with your patients, colleagues, family and friends.
 
Sylvia in a succinct and easy-to-understand story covers the basics of bone health, risk factors, myths, and how to strengthen bones and avoid fractures. Having unexpectedly broken a bone during a fall and discovering she has osteoporosis, she now worries her children are likely at heightened risk. She introduces her Dad - yes, a man - who broke his hip because of his weakened bones, and who may not be able to return to the interests and lifestyle he used to enjoy. Thinking he doesn’t need his medications any more, Sylvia tries to persuade him otherwise, fearful if he doesn’t continue them this will lead to further fractures. And neither her break, nor that of her Dad, had to happen. Her story line, and that of millions of Americans, could have been altered.   
 
Fit to a T has been presented to more than 700 audiences over the last 10 ½ years in live one-hour programs in communities across the nation, to educate the public about bone health and osteoporosis. Thanks to the expert guidance provided by the Fit to a T Advisory Committee, the participation of professional society and community organization program partners, and financial support, the program has been remarkably successful and sustainable. The video introduces a new and exciting element to aid in educating the public about bone health and osteoporosis – and expand the audience for the core messages contained in Fit to a T.
 
Consider scheduling a live session of Fit to a T in your community. A ready-made PowerPoint slide set is available to you along with handout materials and organizational support. There is no charge. To learn more or to register your interest in presenting or scheduling a session in your community, visit www.fit2t.org or email usbji@affinity-strategies.com.
 
Follow Us:
Twitter: https://twitter.com/USBJIF2T
Facebook: https://www.facebook.com/Fit-to-a-T-916613155131628/

What people are saying about the Fit to a T video

 “… a truly brilliant video – enjoyable to watch and easy to understand. It has already been shared many times by colleagues here…”
Claire Severgnini, Chief Executive
National Osteoporosis Society, UK
 
“…it is excellent.”
Ann Elderkin, Executive Director
American Society for Bone and Mineral Research
 
“… Is a great new piece.”
David Lee, Executive Director
National Alliance for Bone Health
 
“This is AWESOME!”
Erin Ransford, Manager, Research Advocacy
American Academy of Orthopaedic Surgeons
 

For the first time, two primary medical specialties are joining forces to create a clinical data registry. Together, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the American Association of Neurological Surgeons (AANS) are creating a Spine Patient Registry, which will support the collection and submission of quality data specific to spine patients and track these patients’ outcomes over time.

According to the Centers for Disease Control, back pain is one of the most common health complaints, affecting more than one in four adults every year, and a popular reason for physician visits. The specialties of physical medicine and rehabilitation and neurosurgery serve a large portion of spine patients in the United States. The registry will follow both surgical and nonsurgical patients longitudinally, and collectively, the data has the ability to advance the understanding of this ever-growing patient population while demonstrating the quality and value of treatments.

“PM&R physicians practicing spine medicine currently represent the largest segment of our specialty and Academy membership,” commented Gregory M. Worsowicz, MD, MBA, president of AAPM&R.  “Their work is critical for improving the health of the spine patient population as well as for the future of our specialty.  Through this registry and data we seek to demonstrate the clinical expertise and impact PM&R physicians have on the lives of these patients.  This unique collaboration with AANS also showcases a key to the physiatric approach to medicine: team-based care.”

“We are exceedingly excited about the potential of this joint registry.  Physiatrists and neurosurgeons are natural partners in caring for patients suffering spine disorders throughout the continuum of care.  Through this registry and for the first time we will have a meaningful database with patient reported outcomes that will allow us to understand which patients respond to medications, which ones respond to physical therapy, which ones respond to percutaneous treatments, and, finally, which ones are best served by surgery.  While we normally try all conservative options up-front, we may be able to predict which patients are destined to fail those interventions and we can go directly to some form of percutaneous or open surgical procedure to hopefully eliminate suffering quicker.  As the database matures we will be able to communicate very directly with the patient and say ‘we can predict that this treatment for you has an 85% chance of improving quality of life.’  This knowledge will be empowering to physicians as well as patients.  We look forward to a long and productive relationship with our colleagues from the AAPM&R,” added AANS President, H. Hunt Batjer, MD, FAANS.

The objectives for the Spine Patient Registry also closely align to health care’s shift towards value-based payments. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) established new mandates that will have a direct effect on the physician quality reporting programs. Payment adjustments are scheduled to be implemented in 2019 tied to a 2017 performance period. AAPM&R and the AANS are diligently preparing the registry for utilization for the 2017 reporting period. Physicians who participate in the registry will meet reporting requirements while having the capacity to advance quality improvement and research needs.

About AAPM&R

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) is the national medical specialty organization representing more than 9,000 physicians who are specialists in physical medicine and rehabilitation (PM&R). PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. Physiatrists utilize cutting‐edge as well as time‐tested treatments to maximize function and quality of life. To learn more, visit www.aapmr.org.

About AANS

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 9,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves. To learn more, visit www.aans.org.

For more information:
Meagen Arensdorff
Director of Marketing, AAPM&R
847.737.6092 | marensdorff@aapmr.org

Alice Kelsey
Associate Executive Director, AANS
847.378.0517 | aik@aans.org