August 2003 Bulletin

AAOS introduces new Unified Research Agenda

OREF, COMSS and ORS lend support

Six leading research priorities: Osteoarthritis, spinal disorders, osteoporosis and bone quality, major limb trauma, soft-tissue injuries and childhood musculoskeletal disorders

By Carolyn Rogers, with Joshua J. Jacobs, MD, and Marilyn Weisberg, MPH

With the establishment of the "Unified Research Agenda" (URA)–a new, unified advocacy strategy–the AAOS and other leaders in the orthopaedic research community seek to enhance the quality and quantity of musculoskeletal research by increasing the size of the musculoskeletal research funding "pie."

"The goal of this project is to provide a resource to members of the orthopaedic research community who are involved in fund raising and advocacy efforts," says Joshua J. Jacobs, MD, chair of the AAOS Council on Research and Scientific Affairs, which drafted the Unified Research Agenda.

The aim is to increase the funding allocated to musculoskeletal research, he adds, not to de-emphasize or take away from current research.

"Rewarding the best research will always be important," Dr. Jacobs says.

Six research priorities

"The Unified Research Agenda will help us to identify the ‘burning questions' in research," explains Mathias Bostrom, MD, chair of the Council's URA Project Team.

To that end, the document identifies six leading research priorities:

These priority areas are recognized for their heavy burden to society, their importance to orthopaedic surgeons and patients, and their alignment with the priorities of the Bone and Joint Decade (BJD). They provide common ground for individual researchers and for organizations such as AAOS, the Council of Musculoskeletal Specialty Societies (COMSS) and the Orthopaedic Research and Education Foundation (OREF) to use when talking to policymakers and legislators, patient advocacy groups, foundations, and other potential donors about the musculoskeletal conditions with the greatest burden to society.

Directions for future research

For each of the six priority areas, the agenda document provides information on the burden of disease as well as a wide-ranging list of "Directions for Future Research." (View complete listing.)

"The intent is to be broad and inclusive of the wide array of musculoskeletal research topics while having sufficient specificity to stimulate the interest of policy makers and philanthropic sources," Dr. Jacobs explains.

Evolution of the URA

The URA was drafted earlier this year by the Council's URA Project Team, which included Dr. Jacobs; the chairman, Dr. Bostrom; Marc F. Swiontkowski, MD; Peter C. Amadio, MD; Jay R. Lieberman, MD; Peter J. Mandell, MD; and Marilyn Weisberg, MPH, director, department of research and scientific affairs.

The document also has had broad input from the organizations currently seated on the Council, including OREF, COMSS, and the Orthopaedic Research Society (ORS).

The draft was submitted to the Council for approval and then to the AAOS Board in June 2003. To date, it's also been presented to the COMSS Board, the OREF Board, the ORS Board, and the Board of the U.S. BJD's National Action Network.

Research Committee Panel Studies

One of the key resources used in creating the URA was Future Directions in Musculoskeletal Research: A Summary Report of the AAOS Research Committee Panel Studies, also recently approved by the Council and the AAOS Board of Directors. The Panel Studies have been a project of the AAOS Research Committee since 1999, under the current and past chairmen, Dr. Swiontkowski and Gary E. Friedlaender, MD. (View related article) Each of the 17 panels addressed a unique area in orthopaedic research, including its clinical significance and scope, recent advances and future directions.

OREF involved in "early stages"

OREF has been involved in the evolution of this agenda from its early stages, reports Gene Wurth, president of OREF.

"I've been pleased to represent OREF in these discussions," Wurth says. "Learning what others think are the most important areas of research has validated what we've done for nearly 50 years, since we have supported research in most of those areas in the past."

The agenda not only demonstrates the type of collaboration possible between the Academy and OREF, it also can be helpful to OREF in its fund-raising efforts.

"We know that many of our grants are aligned with the future directions of orthopaedic inquiry," Wurth says. "That demonstrates our credibility and our value to the specialty. It also helps us to identify possible collaborations with the AAOS, specialty societies and other orthopaedic organizations. The agenda will help us match important research areas with the interests of some of our individual and corporate donors, and helps us plan our future fund-raising efforts."

Because the nature of orthopaedic medicine is changing rapidly, all practitioners–as well their patients–stand to benefit from advances in research in the next few years, he says. "The development of the Unified Research Agenda is an example of ways the AAOS and OREF can have a direct impact on the day-to-day practice of orthopaedics."

Furthering the goals of the BJD

"All of the COMSS societies support the goals of the Bone and Joint Decade," says Dr. Amadio, who helped develop the URA on behalf of COMSS. "The Unified Research Agenda links directly to priorities already identified by the BJD, and thus is a critical feature aligning all of the orthopaedic research community with the Decade agenda."

The goals of the BJD, Dr. Amadio explains, are to:

"If we are to reach these goals, it's important that we speak with one voice in setting priorities for action, including research," he says. "By working together, and with the support of the full BJD community, including not only other medical professionals but also patient advocacy groups, industry and government, we have the best chance of achieving the BJD goals."

Why push for more musculoskeletal research?

As the BJD initiative has made clear, musculoskeletal conditions have an enormous impact on our society. In the United States alone, for example:

These figures are projected to increase sharply due to the predicted doubling of the number of people over age 50 by the year 2020. In spite of these statistics, current orthopaedic research expenditures are estimated to total only about $92 million per year. Of that amount, just $16 million is devoted to clinical research.

Why do we need research priorities?

Sen. William H. Frist, MD, answers this question in his article, "Federal Funding for Biomedical Research: Commitment and Benefits" (Journal of the American Medical Association, April 3, 2002):

"First, an improved process is needed for establishing goals and research priorities based on scientific data and health analysis, including moving beyond input measures and anecdotal evidence to develop new metrics to measure scientific advances and their causal relationship to improved health outcomes.

"Second, an improved public dialogue is needed on every level. Improvements in the research priority-setting process will be effective only if accompanied by clear communication between policy makers and stakeholders on the priorities and their justifications.

"Third, there is a great need for improved collaboration across government agencies, between public and private sectors, and among scientific disciplines."

URA: "A living document"

The Unified Research Agenda is not intended to be a static document. The suggestions of COMSS, OREF and ORS have already been integrated into the agenda, and as the Council on Research moves forward, additional organizations in the musculoskeletal research community may weigh in as well.

"We want this to be a living document and, as such, it will change over time," Weisberg explains. "As we continue to share it with organizations in the musculoskeletal research community, we hope that they will support it as well. This is what we mean when we say, ‘unified.'"

View the URA online

View the URA document in its entirety in PDF format.

Joshua J. Jacobs, MD, is chair of the Council on Research and Scientific Affairs.

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