Hands-on approach
Reproduced from Issue 108 of Arthritis Today
For the first time, arc has awarded a Postdoctoral Fellowship
to a physiotherapist. Dr Mike Hurley explains the importance of
his research into knee osteoarthritis.
FOR a grant of getting on for half a million pounds, Dr Mike Hurley has precious little of the hi-tech, state-of-the-art, expensive equipment vital to most researchers.
In fact the most complicated bit of kit to be included in his £428,000 Postdoctoral Fellowship is an exercise bike. Not to mention the odd chair and wooden block.
It might be low-tech but the grant is of high importance to the thousands of people who suffer the constant pain of knee osteoarthritis.
The fact that arc has taken the unprecedented step of awarding a prestigious five-year Postdoctoral Fellowship to a physiotherapist – added to the fact that it's double the amount of any previous award – is evidence of the significance of Dr Hurley's project.
In a nutshell, his community-based research will investigate the effectiveness of a rehabilitation package which involves exercise of the leg muscles, self-help advice and coping strategies. He will compare this approach to that of a typical GP, who generally prescribe non-steroidal anti-inflammatory drugs (NSAIDs). If the rehabilitation package is proven to be successful, Dr Hurley hopes it could become available throughout the country.
"One of the things we are trying to do is to give patients a quick dose of simple exercise, and see if we can help them continue to increase their physical activity once they have completed the course," explained Dr Hurley, who is based in the physiotherapy division at King's College, London, and works at Dulwich Hospital.
"We don't expect older people to start going to the gym; we encourage them to walk to the shops more to get the paper, or stroll around the park, rather than take part in formal exercise. People can't be expected to rely on big expensive bits of equipment; the most we will be using will be an exercise bike, or a block they can step on and off. The exercise is within everyone's capabilities."
The premise of Dr Hurley's research is that weakness in the quadricep muscles at the front of the thigh causes the knee joint to move abnormally, leading to pain. In other words, for some people with knee pain/osteoarthritis, the original fault may lie in the leg muscle rather than in the knee joint.
"As people get older their muscles get weaker – it's normal and happens to everybody. They also tend to ease off their physical activity, which can exacerbate the muscle weakness. These two things in combination can lead to episodes of mild knee pain, which inhibits the person's activities and worries them, so they reduce their activities further. This leads to more weakness, exposing the joint to abnormal movement and increasing pain."
The 450 people aged 50 and over whom Dr Hurley is recruiting will take part in 12 half-hour exercise sessions – including strength, balance and co-ordination exercises using a bike and other unsophisticated equipment – for six weeks under the supervision of a research worker. They will then be followed up for a two-and-a-half year period once the exercise programme has been completed.
As well as the exercise, they will be given plenty of sensible self-help advice such as keeping their weight down, combating depression if the pain is bad, and how to use heat and ice packs.
"It's difficult because we are trying to give people lifestyle changes, but our experience is that once they start to feel the benefits of exercise, they become willing to help themselves; they don't like relying on tablets," said Dr Hurley. "The only way these patients will be helped in the long-term is by encouragement and reinforcement, so the follow-up sessions are obviously important."
Patients will be treated either on an individual basis, or in a group, although in the long-term the importance of keeping down costs will probably mean that most patients are seen collectively. "If we can get this project going, then working in a group could be the best way of making it as cheap as possible, which is what we need if we're going to get the regime widely implemented," he added.
Dr Hurley is optimistic about the research and its wider practical application for patients with osteoarthritis of the knee.
"We are not saying that we can get rid of people's knee pain completely," he said. "But we are trying to show that people can work within whatever pain they have got – and function better. There doesn't have to be inexorable decline into decrepitude, but you can manage the condition yourself."
