1. Research Priorities for Osteoarthritis of the Knee Chard JA, Tallon D, Dieppe PA.

2. What Biases Exist in Research Output? “Agenda” biases –Researcher interests –Vested interests –Funding –Culture Reporting biases –Publication –Language –Citation –Funding Research biases –Study design –Inclusion criteria –Statistical analysis

3. Objectives To contrast available evidence with consumer requirements for knee osteoarthritis

4. Who Are Consumers? Consumers includes patients, health professionals and managers

5. Methods Systematic review of available research Convening of focus groups of consumers Undertaking questionnaire survey of consumer Results of review and consumer opinions compared

6. Review Search designed to identify research on osteoarthritis of the knee Search strategy applied to electronic databases, bibliographies, and survey of experts (undertaken in 1998) Inclusion/exclusion criteria applied to studies Summary data extracted from studies

7. Identified studies Total number of studies identified Studies fitting a priori selection criteria (all languages) Studies collected and reviewed (English language only) 5237 1292 930

8. Review Results InterventionTotal studies (column %) RCTs (% of total studies) Positive outcome (% of total) Alternative & complementary49 (5.3)29 (59)43 (87.8) Drug (injected)89 (9.6)50 (56)87 (97.8) Drug (oral)461 (49.6)330 (71.5)447 (97.0) Education33 (3.5)14 (42.4)29 (87.9) Physiotherapy & exercise60 (6.4)24 (40)55 (91.7) Surgery238 (25.6)13 (6)215 (90.3) TOTAL930 (100)460 (49.5)874 (94)

9. Pearson X 2 = 4.9, 1 df, p=0.027 Conclusion compared by funding source

10. Focus Group Methodology User groups identified and meetings convened (undertaken in 1998) –Rheumatologists [5 attended], general practitioners [3 attended], physiotherapists [5 attended], and patients [7 attended], Surgeons [failed] Asked for opinion on research needs for osteoarthritis of the knee Group discussion tape-recorded and transcribed verbatim Data analysis using qualitative software

11. Focus Groups Results Specialist –Wanted more time with patients –Didn’t want any more drug trials Physiotherapists –Wanted funding for research –Didn’t want poor quality research General Practitioners –Wanted education for patients –Didn’t want drug trials Patients –Wanted information on disease –Wanted physiotherapy –Didn’t want side-effects of drugs

12. Patient Survey Methodology Patients with osteoarthritis of the knee identified through existing study (undertaken in 1998) Survey mailed to patients (n=120; 112 responses) Survey asked about: –experience of treatments for osteoarthritis of the knee –experience of osteoarthritis –research priorities for osteoarthritis of the knee Responses entered on Excel worksheet and analysed

13. Research Priorities of Patients Treatment Priority1st-5 th (n = 258) (%)1st choice (n = 67) (%) Knee replacement16.335.8 Education and advice15.120.9 Physical therapy14.03.0 Tablets11.24.5 Injections in the knee9.34.5 Complementary therapy7.86.0 Removal of fluid/ debris7.80.0 Aids and adaptations6.20.0 No treatment at all0.81.5 Other priority11.623.9

14. Conclusion (1) Research dominated by drug trials and observational surgical studies Consumers want more research in non- pharmaceutical areas

15. Conclusion (2) Mismatch between evidence being gathered and evidence required by consumers Likely to be due to commercial and researcher interests

16. Publications Chard JA, Tallon D, Dieppe PA. Epidemiology of research into interventions for the treatment of osteoarthritis of the knee joint. Ann Rheum Dis 2000;59:414-418. Tallon D, Chard JA, Dieppe PA. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care & Research 2000;13:312-319. Tallon D, Chard JA, Dieppe PA. Relation between agendas of the research community and the research consumer. Lancet 2000;355:2037-2040.