To more than 750,000 Dutch people who have knee osteoarthritis, the general advice is to stay active. But whether a 30 minute walk is optimal, or perhaps cycling twice a week, remains unclear. With a budget of 9.8 million1 the consortium2 of the LoaD project, including associate professor at Erasmus MC, Marienke van Middelkoop, hopes to be able to personalise this advice. “Our goal is to determine the optimal physical activity level for individual patients with knee osteoarthritis.”
The number of people in the Netherlands who suffer from painful and stiff joints continues to rise. In most cases, it concerns osteoarthritis in the knee. This can be caused by, among other things, ageing, being overweight, or knee injuries from the past. To date, there is no curative treatment for osteoarthritis, and these patients are currently being presented with a 'one size fits all' treatment plan.
“The only thing we can do for patients suffering from osteoarthritis”, says Van Middelkoop, “is to stabilize it for as long as possible and to ensure that the symptoms do not worsen. The best treatment for knee osteoarthritis in this case is still exercise therapy. Patients visit physiotherapists to move and strengthen the joint and surrounding muscles.”
“We also prescribe medication for fluctuating periods of pain and lifestyle advice is given when it comes to overweight patients. The very last step is a referral to an orthopedic surgeon, often involving joint replacement surgery. But such surgery is definitely not without complications.”
“But suppose a patient is already actively involved in sports:
would it still be good in this case to advise more exercise?”
From runners to tennis players
Within the eight-year LoaD project, Van Middelkoop hopes to take the first steps to deviate from this 'one size fits all' treatment plan. “We all know that exercise is good for osteoarthritis. But suppose a patient is already actively involved in sports: would it still be good in this case to advise more exercise? Or should the patient just take it easy? Maybe a different type of sport would be better?”
How much movement is optimal for the individual patient, and what exactly the movements should be are the central questions for the LoaD consortium, including Omnigen. “We want to achieve this by comparing different groups that each practice a different type of sport. Runners, walkers, cyclists, tennis players, but also a group that is not that physically active.”
The LoaD researchers will follow participants from these different groups for two years. “First we will perform the baseline measurements”, says Van Middelkoop, “and then, in two years’ time, a lot of physical examinations and blood tests will follow, MRI scans of the knee will be made at various times and participants will complete several questionnaires. We also ask participants to frequently provide feedback on their activity data, easily via their phone.”
In addition to collecting patient data, the consortium will also be involved in research on a much smaller scale. At both the cartilage and the cell level, researchers will look at the effect of the different physical loads on the joint. In addition, , they will study the influences of genetic and inflammatory components on individual physical load, aided by researchers from Omnigen.
“And then you arrive at the personalised part: how can we advise patients with knee osteoarthritis on the basis of all this information about what they should actually do about physical activity?”, Van Middelkoop wonders out loud. “We will end the project with a pilot to test what type and frequency of feedback is most effective for patients, and how our feedback is experienced by both patients and healthcare providers.”
“Above all, we want to improve the quality of life for
improve people with knee osteoarthritis”
To make this personalised feedback easily available, the LoaD consortium will also be working on an online platform during the eight-year project. Via this online platform, patients will be able to gain insight into how much exercise will be optimal for them, and also the type of activity that will suit them best. This online platform can also be made available to healthcare providers, who can share this feedback with their patients.
If the pilot proves to be a success, the LoaD consortium hopes to test the platform for effectiveness in a large study, and especially for short-term effectiveness. “Then we have to look at how cost-effective it will be: what is the improvement in quality of life among these patients relative to the costs incurred?”
But for now, the LoaD project is still in the early stages, and the researchers are ready to turn their goals into realities. “Unfortunately, we will not get rid of osteoarthritis with this project, but we mainly want to improve the quality of life for people with knee osteoarthritis. We must postpone this joint replacement surgery as long as possible by providing patients with personalised advice for their complaints.”