Research Report 2018

A man in an operating room

Dr. Gillian Hawker |Senior Scientist and Rheumatologist

Tackling barriers to effective osteoarthritis care

Osteoarthritis (OA) is the most common type of arthritis affecting Canadians. As one of the top three rapidly increasing and debilitating conditions worldwide, Dr. Gillian Hawker research is focused on advancing evidence-based healthcare for people with OA to improve outcomes. Her experience as a rheumatologist has helped her identify barriers and facilitators to timely and effective OA care. These include societal beliefs about OA as a ‘normal part of aging’, healthcare provider knowledge of OA and confidence with joint examination, attitudes about pain medication and the high prevalence of co-morbidities, which can complicate OA treatment. 

Despite the number of effective treatments available for OA, the condition is often underdiagnosed and undertreated. Dr. Hawker and her team have conducted numerous studies to document the downstream effects of OA pain on sleep, fatigue, disability, depression and changes in pain perception. These findings led to the development and validation of a new OA pain measure, which has been translated into almost two dozen languages and is used worldwide. Dr. Hawker’s research found that when OA pain is inadequately controlled, people often avoid physical activities that exacerbate their symptoms. Her research found that developing OA in the knee and hip was the number one contributor to difficulty walking which is critical for patients’ mobility and independence as they age. OA-related walking difficulty also increased risks for serious cardiovascular events, diabetes complications, and developing diabetes, and that having a knee or hip joint replacement may reduce these risks.

Dr. Hawker’s research has also advanced the appropriate use of hip and knee joint replacement surgery, including shedding light on the relative importance of clinical need for surgery, patients’ preferences, and additional factors in determining whether or not surgery is offered or received. For example, they showed that among men and women with similar OA severity, women were less likely to be offered surgery. Preliminary joint replacement appropriateness criteria have now been developed to address these barriers and are being validated in a study funded by the Canadian Institutes of Health Research.