Easing pain and cost for arthritis sufferers

Associate Prof Haxby Abbott. Photo by Gregor Richardson.
Associate Prof Haxby Abbott. Photo by Gregor Richardson.
Associate Prof Haxby Abbott in June 2012, during a Latin American motorcycle tour,  at Patapampa...
Associate Prof Haxby Abbott in June 2012, during a Latin American motorcycle tour, at Patapampa Pass, Peru, which, at an altitude of about 4900m, is one of the highest paved roads in the world. Photo supplied.

Otago has a rich history of establishing firsts, leading the way in many fields. University of Otago researchers are attracting international attention, with some granted millions of dollars for cutting-edge projects. So what are they up to? Reporter John Gibb does his own research on the researchers.

Award-winning University of Otago researcher Associate Prof Haxby Abbott is quick to point out that osteoarthritis is ''not only a pain in the hip, but also a pain in the hip pocket''.

Prof Abbott, of the university surgical sciences department orthopaedics section, is keen to reduce the painful burden of osteoarthritis, the most common form of arthritis, on New Zealanders.

And he is also keen to promote integrated physiotherapy services as a key part of the solution.

He noted that osteoarthritis had been estimated to cost New Zealand $2 billion a year in 2010, including more than $550 million in health treatment-related costs.

''This involves not only a pain in the hip, but also a pain in the hip pocket, costing our society a great deal of money, but also imposing a big burden on individuals and their families,'' he said.

Prof Abbott, who has an Otago University doctorate in physiotherapy, is also eager to promote the message that manual therapy and exercise therapy, co-ordinated by physiotherapists, can greatly improve outcomes for many patients with osteoarthritis.

This includes reducing pain and increasing mobility.

''The results of our trials show very strongly that appropriate physical exercise, specifically exercise therapy prescribed and supervised by a physiotherapist, can improve outcomes significantly.

''The old myth, still believed by many, that exercise would only make osteoarthritis worse, has been well and truly proven false.

''It's too early yet in our patients to see if it will delay the need for surgery, but two studies from Scandinavia show that at six or seven years follow-up, exercise therapy did indeed delay the need for joint replacement surgery.

''We lose a lot of working, earning and saving power from those older adults who reduce or drop out of work because of osteoarthritis pain, and it may well be highly cost-effective to reduce hospital and surgical costs by intervening early with effective non-surgical therapies,'' he said.

A recent randomised clinical trial involved 207 Dunedin patients with painful osteoarthritis in knee and hip joints over one year, and used three protocols of treatment provided by physiotherapists, as well as the usual care provided by their GP.

This study, led by Prof Abbott, of the Centre for Musculoskeletal Outcomes Research, found that manual therapy or regular physical exercise programmes could significantly improve the lives of many people with painful osteoarthritis.

And the programmes were cost effective.

Half the patients treated with manual therapy, and 40% of those treated with exercise therapy were significantly better a year later both in terms of pain and ability to perform everyday activities.

And his vision of helping many more people with osteoarthritis to significantly improve their health and mobility and to provide more integrated physiotherapy services is proving increasingly influential.

An innovative ''Joint Clinic'' which Prof Abbott has helped establish at Dunedin Hospital in 2012 to serve patients with hip or knee osteoarthritis, has proved a successful pilot project.

And this ''alternative model of care'', backed by $200,000 in funding from the National Health Board, could be adopted as a model elsewhere in the New Zealand health system.

Sandra Kirby, chief executive of Arthritis New Zealand, said the research undertaken by Prof Abbott was ''world leading''.

And his work with the ''Joint Clinic''provided a positive model for other DHBs to follow, she said.

Prof Haxby's research has also been honoured with a series of academic awards, including the prestigious Sir Charles Hercus Health Research Fellowship from the Health Research Council in 2010.

And this year he and microbiologist Dr Peter Fineran were jointly awarded Otago University's Carl Smith Medal and Rowheath Trust Award, recognising outstanding research performance.

Prof Abbott said he had done his postgraduate training in the United States under Dr Stanley Paris, ''an expat New Zealander originally from Dunedin''.

''He has been a huge influence on my clinical background, and gave a really compelling perspective on hip osteoarthritis that struck me quite strongly, and it stuck with me through my research training,'' he said.

Prof Abbott decided that, after graduating, he would focus on non-surgical treatments for osteoarthritis.

That was because the condition was ''really is underappreciated as a cause of pain and disability despite being so common, and potentially beneficial treatments are underused and not well studied''.

''We managed to get a clinic set up in the hospital specifically for the heavy burden of osteoarthritis patients referred there, but I think better co-ordination and management of the disease earlier on is where great gains can be made.''

Born in Ashburton, Prof Abbott grew up on a sheep and crop farm in Mid Canterbury, by the mouth of the Rangitata River.

He drove trucks, tractors and other machinery for summer holiday work before graduating as a physiotherapist.

And what does he do to relax?''Read, and lie in the sun, but my children always find me and jump on me.''

He and his wife Sarah like to take their children on bike rides.

''I listen to music, roast coffee beans. Walking. Simple things in the fresh air.

''Our two children are still only 2 and 5, so there's been less time for former pleasures like biking, running and skiing occasionally.''

 

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