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Cathy Chapple has a long standing interest in the treatment of knee osteoarthritis (OA).

physio_Cathy Chapple cropped 2018She had many years of experience working as a physiotherapist in the public sector, treating patients with chronic conditions such as OA.

This expertise proved useful when she undertook her PhD working on a Health Research Council funded Management of Osteoarthritis clinical trial under the supervision of Associate Professor Haxby Abbott. Subsequent and similar research work included the set-up of the physiotherapist-led Joint Clinic at Dunedin Hospital, which aimed to relieve pressure on orthopaedic clinics and to improve patient care.

Her research interest in knee osteoarthritis continues. Cathy's approach recognises osteoarthritis to be a chronic disease that requires long-term management. The ultimate goal is to develop a research programme that will provide evidence to support a range of treatment options for people with knee osteoarthritis. Such treatments should be clinically effective and available at reasonable cost. Clarity is needed about the best way of delivering that care in terms of the dose of treatment.  New and appealing technologies such as exergaming may also encourage patients to stick with useful exercise programmes for longer periods.

Cathy finds her research a rewarding and challenging experience:

“Being able to conduct research which has a tangible outcome for patients is exciting. Also assisting physiotherapists in their clinical decision-making by providing high quality evidence is very satisfying. The constant search for funding in a competitive environment means you need to develop resilience, but working alongside other researchers in the School of Physiotherapy means there is plenty of support on offer to celebrate the successes, and to commiserate if you miss out.”

She believes in thinking outside the box in order to provide a range of treatment options and her ability to problem-solve helps with the logistics of research. When she was unable to purchase Wii Fit units for her exergaming project through retail outlets in New Zealand, Cathy took to the news and, in an example of community-engaged research, sourced the gear she needed from elsewhere.

Cathy and her team's current projects

Frequency of Manual Therapy for knee OA

There is a lack of evidence about the optimal frequency of treatment sessions for osteoarthritis.

While studies show that manual therapy for managing knee osteoarthritis is effective, many questions about optimal treatment dose and frequency remain unanswered.

In the absence of a scientific rationale, clinical decisions may be based upon convention, convenience, or cost considerations. The project aims first to identify the factors that physiotherapists consider important when making decisions about treatment frequency.

The team's work also investigates in a feasibility study, how the frequency of manual therapy treatment influences the outcome for patients with knee OA.

Cathy will be presenting the preliminary results of this study at the NZMPA Conference, 19-20 August 2018 in Rotorua. "Same time next week? What is the optimal frequency of manual therapy for people with knee osteoarthritis?"

Preliminary results from the feasibility study are encouraging, and provide more data about the benefit of manual therapy (MT) for people with knee osteoarthritis.

Funded: NZMPA and a University of Otago Research Grant

Exergaming for knee instability and strength

Instability of the knee is a common feature of knee OA, and prevalent in up to 65% of patients studied.

Instability is described as buckling, shifting or the giving-way of the knee during normal daily activities. Knee instability affects the quality of life in older adults by reducing participation in usual activities, which stem from the loss of confidence and an increased fear of falling. Decreased muscle strength contributes to knee instability and falls risk, but such risk is potentially modifiable by exercise therapy. Well-designed randomised controlled trials (RCT) are needed to investigate if increasing muscle strength reduces knee instability in people with knee OA and decreases falls risk and functional decline.

Funded: Arthritis NZ and MPPT

In associated research, Cathy's PhD candidate Donald Manlapaz is looking at falls risk, and  balance in patients with knee osteoarthritis. He hopes to investigate the use of the Wii Fit™ gaming system as an intervention for these patients.

Funded: Mark Steptoe Memorial Trust

You can read more about Cathy and her research here.

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