Preventing Osteoarthritis (OA) After a Sport or Activity Related Injury

SOAR 2.0: A Proof-of-Concept Study

Scientific Study title:

Assessing the Efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis

 

Study Start Date:

September 2021

 

Study End Date:

February 2023

 

Why Did We Do This Research?

In Canada, about 700,000 youth hurt their knee every year while playing sports. Half of them go on to develop knee osteoarthritis (OA) by the age of 40. The risk for knee osteoarthritis is greater for those that develop knee muscle weakness, or become physically inactive, and gain weight after their knee injury. Despite knowing this, the treatment of knee injuries tends to focus on returning to playing sports, with little effort spent on osteoarthritis prevention. With a team of patients and healthcare providers, we developed a new digital (online) education and exercise-based program to help boost recovery from a knee injury and reduce the risk for osteoarthritis. The SOAR or – Stop OsteoARthritis program aims to improve user’s ability to self-manage their knee health through education, personalized exercise, activity tracking, and weekly action planning. This research is a key step forward in changing how we treat knee injuries in Canada.

 

What Did We Do?

The second step in testing the SOAR program was to assess if the program could improve health outcomes reported to be important to participants at increased risk of knee osteoarthritis after a sport-related knee injury. This included things like knee muscle strength, physical activity, self-management of knee health, self-efficacy, quality of life, and kinesiophobia (fear of pain or injury due to movement). We recruited 54 people aged 16-35 who had experienced a sport-related knee injury anywhere between 1-4 years ago. Participants were split randomly into two groups. One group received a 9-week SOAR program right away, while the other group received a 9-week SOAR program after a 9-week wait.

As a part of this trial, we also looked at how social support affects people’s participation in exercise therapy by conducting interviews with 15 participants.

Two patient partners with lived experience of knee trauma and three physiotherapists helped with the study procedures.

The SOAR program included:

    1. A 2-hour Knee Camp where participants attended a virtual group education session, one-on-one knee exam and one-on-one exercise therapy and physical activity goal setting guided by a physiotherapist.
    2. Weekly personalized exercise and activity program built from participants goals to do at home alongside activity tracking (Fitbit) and an exercise log.
    3. Weekly one-on-one physiotherapist-guided counselling sessions to modify and add exercise-therapy and physical activity goals, and problem solve around any barriers participants might be experiencing.

 

What Did We Find?

We had 49 out of 54 people complete the study (91% of the original group we recruited). On average, the participants were 27 years old and had been dealing with their knee injuries for about 2.4 years.

The majority of participants completed the required study tasks, and physiotherapists rated participants’ commitment to the program as very high. During the 9-week treatment period, participants completed most of their exercise therapy (92%) and physical activity goals (84%). Despite high adherence, the SOAR Program did not result in meaningful improvements to knee strength, knee-related quality of life and self-efficacy, or physical activity levels in this highly active sample of participants. However, we did find that people who went through the program felt they were better at managing their knee health on their own and had greater improvements in kinesiophobia compared to those who had not completed the program. The program was also safe.

The interviews revealed three key themes related to the role of social support in fostering exercise participation. Themes included:

  • the importance of treating participants as a whole person, not just focusing on their physical needs
  • the value of a collaborative partnership between a clinician (physiotherapist) and participant, and
  • the need for ongoing support

The interview findings suggest that tailored social support strategies can enhance exercise adherence and long-term management of knee health after injury and have implications for improving physiotherapist-patient interactions.

What Are the Next Steps?

This study has helped researchers develop the next study in the SOAR research program, which is a full-scale clinical trial to assess whether the SOAR program can prevent post-traumatic osteoarthritis (symptoms and magnetic resonance imaging
changes) after an Anterior Cruciate Ligament (ACL) tear. You can read more about SOAR 3.0 here.

If you have experienced an Anterior Cruciate Ligament (ACL) tear and had reconstruction surgery, and are interested in participating in this clinical trial please reach out to the SOAR team and check to see if you are eligible here.

 

Do You Have Questions?

Please feel free to contact us at soar@arthritisresearch.ca.

Research Team

Principal Investigators:

Jackie L. Whittaker, PT, PhD, Research Scientist, Arthritis Research Canada (University of British Columbia)

Co-investigators:

Michael Hunt, PT PhD (University of British Columbia)

Amber Mosewich, PhD (University of Alberta)

Linda Li, PT, PhD, Senior Scientist, Arthritis Research Canada (University of British Columbia)

Ewa Roos, PT, PhD (University of Southern Denmark)

Hui Xie, PhD, Research Scientist, Arthritis Research Canada (Simon Fraser University)

Alison Hoens, PT, KB, Knowledge Broker, Arthritis Research Canada (University of British Columbia)

Linda Truong, PhD, Alumni Research Trainee, Arthritis Research Canada (University of British Columbia)

Justin Losciale, PhD Student, Research Trainee, Arthritis Research Canada (University of British Columbia)

Christina Le, PhD, Alumni Research Trainee, Arthritis Research Canada

(University of Alberta)

Trish Silvester-Lee, Patient Partner, Arthritis Research Canada, Arthritis Patient Advisory Board member

Maxi Miciak PT, PhD, Patient Partner

Andrea Pajkic, Patient Partner

 

Who Funded This Research?

This project was supported by:

  1. The Arthritis Society STARS Career Development Award – Preventing Osteoarthritis after a Sport-Related Knee Injury

Dr. Whittaker is supported by a Michael Smith Foundation for Health Research Scholar Award (2020-2025) and Arthritis Society STARS Career Development Award (2019-2022).

SOAR 3.0 is supported by a Strategic Operating Grant from the Arthritis Society and two Priority Announcements from the Canadian Institutes of Health Research Institute of Gender and Health (CIHR-IGH) and Sports Canada.

 

Related Publications:

  • Losciale JM, Truong LK, Zhang K, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Xie H, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM, Whittaker JL. Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis. Osteoarthritis Cartilage. 2024 Aug;32(8):1001-1012. doi: 10.1016/j.joca.2024.04.003. Epub 2024 Apr 12. PMID: 38615974
  • Truong LK, Mosewich AD, Miciak M, Losciale JM, Li LC, Whittaker JL. Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries. Physiother Theory Pract. 2024 Feb 19:1-14. doi: 10.1080/09593985.2024.2315520. Epub ahead of print. PMID: 38374585.
  • Whittaker JL, Truong LK, Losciale JM, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich A, Hunt MA, Li LC, Roos EM. Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial. BMC Musculoskelet Disord. 2022 Jan 25;23(1):85. doi: 10.1186/s12891-022-05019-z. PMID: 35078446; PMCID: PMC8790851.