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Prevention and personalized treatments in knee osteoarthritis: an Initial Training Network

Final Report Summary - KNEEMO (Prevention and personalized treatments in knee osteoarthritis: an Initial Training Network)

**please find the publishable version of this summary attached as final report summary.pdf

This report describes the activity carried out in the KNEEMO Initial Training Network for knee osteoarthritis (KOA) research as agreed in the Annex I to grant agreement nr. 607510 of the European Union’s 7th Framework Programme for research, technological development and demonstration. The total number of members in the KNEEMO network was 16: eight full partners and eight associate partners. Fifteen fellows undertook 36-month Early Stage Reseacher (n=11) or 24-month Experienced Researcher (n=4) projects in five research work packages (WPs). The objective of KNEEMO was to provide a step-change in the understanding and non-pharmacological management of KOA through early identification and personalised treatments.
In the research WP2-6 to date, 31 peer-reviewed papers have been published with another 15-20 in preparation. Approximately 20% of scientific outputs from KNEEMO were the result of work involving more than one WP, developed and carried out between fellows and staff active in different WPs. In Work Package 2, analyses focused on the role of thigh muscle tissue in the incidence and progression of KOA. Nine peer-reviewed papers were published, showing that loss of specific muscle strength (i.e. strength divided by the cross-sectional area of the muscle) was a key contributor to incident KOA, and progression towards knee replacement surgery, in women. Musculoskeletal modelling formed WP 3 in KNEEMO. Highly complex data collection and analyses was carried out to develop and validate a subject-specific knee model, which was then used in analyses to assess actual knee contact force and the effects of gait adaptations, merging work with WP4 and WP6. Prevention and progression of OA, WP 4, saw work concluded and reported on in four papers concerning subgroup phenotyping in KOA. Six subgroups of ptients were identified within the wieder KOA population. Subsequent work focussed on phenotyping the biomechanical overload subgroup. Additionally, a systematic review on the role of biomechanical factors in KOA was completed, highlighting the role of muscle weakness and proprioceptive deficits in the pathogenesis and progression of KOA. In WP 5, measurements, work was completed on enabling gait analysis in the free-living environment through inertial motion sensors. The breakthrough algorithm for this form of gait analysis was published and then validated in a population of elderly patients. In a separate project, assessment of physical activity and sedentary behaviour in KOA identified the highly sedentary lifestyle of KOA patients, in particular those with a high body mass index. The final research WP was WP6 concerning interventions. Soft braces, hard braces, gait adaptations and exercise were the topics of research. Evidence for the immediate effectiveness of soft braces was found. A new hard brace prototype was designed, with a patent application submitted for elements of the design. Gait adaptations, trained through a real-time biofeedback programme, were found to be effective in reducing knee load. Systematic review of clinical trials for exercise therapy showed that there is no detrimental effect of exercise on articular cartilage.
The training programme was completed with six network-level training events taking place, one more than originally scheduled. The five scheduled training weeks (on epidemiology and burden of disease in Amsterdam; generic and transferable skills in Glasgow; biomechanics in Münster; computational modelling in Aalborg; and interventions in Odense) were complemented with a training week focussing on medical imaging in OA in Salzburg. All fellows completed secondments. The group of fellows themselves held regular Skype group meetings for peer-to-peer learning, including journal clubs, progress evaluation, planning of dissemination and outreach activity, and general peer support. Individual learning programmes were completed covering cultural, scientific and generic aspects of working as a researcher. At the time of writing, five fellows had attained their PhD qualification, with three more having the date of their oral defense confirmed. An evaluation of the training programme among the fellows was undertaken, and the anonymous responses confirmed that the fellows regarded the training programme as a highly rewarding and enhancing experience, with good development of skills relating to knowledge and intellectual abilities, personal effectiveness, research governance and organisation; and engagement, influence and impact.
To achieve impact in society, dissemination and outreach activity was frequent and diverse. At scientific and clinical conferences, KNEEMO fellows gave >100 oral and poster presentations with an estimated reach of >8,000 delegates. Online posts on various social media gained good traction, including a webinar jointly hosted by XST and ABT. KNEEMO stands were included in the expo for OARSI 2016 and OTWorld in 2015-2017. A three-page spread on KNEEMO was included in a European Research edition of Impact magazine. KNEEMO was present on Facebook, Twitter, YouTube and LinkedIn with combined >2,000 post views and >1,000 engagements and follow-ups from members of the public. Physical outreach events were held, including the KNEEMO Primary Schools outreach event in 2015. The KNEEMO Final Conference took place on Thursday 26 April 2018 in Liverpool, UK as a half-day pre-conference workshop of the OARSI congress. The KNEEMO session was attended by approximately 160 delegates from >25 countries world-wide.
Further information on KNEEMO can be found at or by contacting the network co-ordinator, Prof. Martijn Steultjens at