Grant: Fellowship: Bisby (Prize)

Osteoarthritis (OA) is a degenerative joint condition that afflicts 24 million North Americans. Advanced knee OA is associated with increased pain and reduced function, symptoms that persist for approximately 20% of patients even after receiving the best available treatment (i.e. Total Knee Replacement, TKR, followed by strengthening exercises). Recent research suggests that certain patients are more prone to experience increasing levels of pain as they perform physical activities. An increased understanding of the mechanisms and clinical importance of this sensitivity to physical activity may help more patients recover from TKR surgery. The proposed study aims to explore the processes underlying sensitivity to physical activity, and its value in predicting recovery. 100 people awaiting TKR and 50 healthy individuals will be tested. Testing consists of completing measures of emotional distress and disability, as well as a 20-minute physical performance task. Measures of pain intensity and different physiological processes (e.g. hormone and inflammation regulation) will be tested before and after the physical task. For participants receiving surgery, testing will be repeated at 3 and 6-months following TKR. Data analysis will focus on determining whether chronic knee arthritis is associated with increased sensitivity to physical activity, and whether this is related to individual differences in emotional distress and/or physiological function. Further analysis will determine whether levels of sensitivity predict recovery following TKR surgery. This study seeks to advance clinical practice and theory by exploring the multi-modal aspects of pain and disability. This research is expected to improve the predictive accuracy of whether patients recover following TKR, a clinical group projected to rise by more than 600% over the next 20 years. This study also stands to pave the way for innovative treatments that alleviate personal suffering associated with chronic pain