Dr Jillian Eyles APAM is a physiotherapist and a clinical researcher at the Kolling Institute in Sydney. 

Jillian is leading a project – along with colleague Professor David Hunter, a rheumatologist – that aims to reduce low-value care for knee osteoarthritis (OA). 

Dr Jillian Eyles APAM

They were recently awarded $2.6 million by the Medical Research Future Fund (MRFF) for this work. 

‘We want to support health professionals in Australia to deliver high-value care and we want to provide consumers with the right information, so they know to ask for evidence-based treatments for their knee OA,’ says Jillian. 

‘We are particularly interested in looking in detail at arthroscopic knee procedures, which often don’t benefit people with knee OA; in fact, they may even hasten its progression. 

'Over 20,000 knee arthroscopic procedures are carried out every year in Australia for people over 50 with knee OA, which is a very high number given the limited application of the procedure. 

‘Physios often lead the management of knee OA and frequently make recommendations for treatment options, working closely with GPs and surgeons. 

'We got together with key interest holders including physios, GPs and orthopaedic surgeons, along with health insurers, Arthritis Australia and consumers, and talked about how we could tackle this at a high level in Australia and bring down the rate of arthroscopic procedures for knee OA.’ 

The project will employ geospatial mapping to identify geographical areas of Australia with a high proportion of people undergoing knee arthroscopic procedures for knee OA. 

The next step will involve randomising the top 20 per cent of sites into two groups (intervention and control) before conducting co-design workshops with clinicians and local consumers in the intervention group to develop and implement strategies to reduce unnecessary arthroscopic knee procedures. 

‘On our team we have physios, GPs, surgeons and representatives from professional groups including the APA, the Australian Orthopaedic Association, the Australian Knee Society and the Royal Australian College of General Practitioners. 

'We’ll be working closely with our partners to reach our intended audiences. 

‘We’ll use the Australian Commission on Safety and Quality in Health Care’s Osteoarthritis of the Knee Clinical Care Standard to guide us regarding high-value care; we know that compared to surgery, it’s much safer and just as effective to use physiotherapy, exercise and weight management to look after your joints.’ 

The research team will return to the intervention areas at 12 and 24 months to evaluate what worked and what didn’t and to determine the best ways of disseminating the information to various communities to help translate evidence into practice for knee OA management. 

Associate Professor Adam Culvenor APAM is a physiotherapist and the head of the Knee Injury Group at the La Trobe Sport and Exercise Medicine Research Centre. 

His research project, the KOBRA trial, is testing the clinical effectiveness and cost-effectiveness of a low-cost intervention for post-traumatic knee OA, using a slim-fit knee brace. 

It recently received an MRFF grant of $2.7 million. 

‘For young people post ACL injury and reconstruction, about twothirds get back to their sport and do relatively well with post-surgery physio rehab,’ says Adam. 

Associate Professor Adam Culvenor APAM

‘However, the other third don’t do so well; they experience persistent pain and rapidly develop post-traumatic OA, further impairing quality of life. 

'These are the people who are most at risk of physical inactivity, weight gain and chronic pain. 

'Currently, there’s no evidence to provide any guidelines for how these patients should be treated. 

'That’s what has prompted this trial.’ 

The KOBRA trial will involve the recruitment and randomisation of approximately 300 patients who have undergone ACL reconstruction at least one year prior and are experiencing posttraumatic knee OA symptoms. 

The control group will receive usual care, while the intervention group will receive a low-cost, low-burden knee brace as well as a fitting consultation with a physiotherapist. 

Wearing the brace can aid people’s biomechanics by helping them load their knee differently, improve their self-confidence, lower their fear of being injured and increase physical activity. 

‘Some of the preliminary evidence from others and from our pilot work shows that the brace can change gait and higher demand task (ie, hopping) biomechanics. 

'We hypothesise that the brace will also help with fear of re-injury and lack of confidence, which is a big issue for these patients, and that, in turn, will reduce their symptoms and allow them to be more physically active when they wear the brace, getting their life back on track in terms of their knee health.’ 

Following the initial phase of the trial, the researchers will follow up with the intervention group at four and 12 months to assess how much they are wearing the brace as well as their physical activity, pain symptoms, function and quality of life and an MRI scan of the knee to assess cartilage health. 

‘We’re interested to see whether knee biomechanics improve and whether that has a subsequent effect on knee load and health of knee cartilage. 

'Can we improve or prevent the rapid deterioration of knee cartilage in this group, who are at high risk of getting arthritis at a young age? 

'We are aiming to improve people’s pain, symptoms and quality of life and to prevent and/or slow the progression of post-traumatic osteoarthritis.’ 

The researchers will be recruiting for interested participants through hospitals, surgeries and community sites in Melbourne, Sydney and Adelaide at a later date.