James P. Waddell, M.D., FRCSC
Coordinator, Canadian National Action Network
for the Bone and Joint Decade

The Canadian National Action Network has decided upon five priorities for the second half of the Decade:

1. Develop and implement a wait list strategy to improve access to hip and knee surgery.
2. Develop and implement an osteoporosis strategy to enhance the level and consistency of osteoporosis care in Canada.
3. Develop and implement a musculoskeletal education strategy to enhance the training of health professionals.
4. Train new clincial investigators with an interest in MSK research.
5. Optimize patient involvment in the Bone and Joint Decade.

In November 2006, we will finalize consensus relating to a strategic outline for addressing wait times for hip and knee surgeries in Canada. In preparation for the meeting, these orthopaedic opinion leaders will identify key government representatives in their local communities. They will liaise with those government decision-makers, informing them of our intention to build knowledge networks across the country consisting of health providers, government and patient representatives.

Once the consensus outline document is finalized, we will invite other stakeholders (government, health and patient representatives) to join in a workshop to determine the optimal method of implementing the Wait List Strategy.

2. Osteoporosis Strategy:
The Ministry of Health and Long-term Care (MOHLTC) is moving ahead on the implementation of the Ontario Osteoporosis Strategy. The third element, of five in the $5 Million (annual) Plan, includes introducing Osteoporosis Screening Coordinators into some of Ontario's fracture clinics, in order to facilitate the identification of patients who present with fragility fractures (hip, proximal humerus, wrist, vertebra) and who may have underlying osteoporosis. This group of patients, aged 50 or over, whose fractures occur with minimal trauma is in a very high risk group for future hip and other fractures. If properly identified and treated, the risk of future fractures can be substantially reduced.

The task of the coordinator will be to identify and educate patients, refer back to the family physician or in some cases to a specialist, recommend evidence- and guideline-based treatments and to report information on their activities.

The MOHLTC has contracted Osteoporosis Canada to implement this element (and other elements, including public education) of the Osteoporosis Strategy. The MOHLTC has also contracted with the Ontario Orthopaedic Association to provide support in the hospitals selected for coordinators. The task of the orthopaedic "champion" in each hospital will be to liaise between the coordinator and the orthopaedic staff, and to facilitate the activities of the coordinator in the fracture clinic.

Dr. Steven Richie, a Past-President of the OOA who is in active community orthopaedic practice, has been contracted by MOHTLC to serve as the OOA Osteoporosis Consultant and to organize the activities of the orthopaedic champions.

3. Musculoskeletal (MSK) Education Strategy:
A Bone and Joint Decade Undergraduate Curriculum Group (BJDUCG) established CORE curriculum recommendations for MSK conditions targeted for undergraduate medical school education. A study was done in Canada to determine the level of agreement of the BJDUCG recommendations among physicians and surgeons in Canada representing all sixteen accredited academic institutions, 77 postgraduate educational programmes that represent six disciplines in medicine (Family Medicine, Emergency Medicine, Physical Medicine and Rehabilitation, Rheumatology, Orthopaedic Surgery and Sports Medicine). A validated Multidisciplinary CORE Curriculum for Musculoskeletal health was the product of this study.

Our vision is to improve medical education of health care providers by developing one multidisciplinary educational tool pertaining to MSK health that would ultimately improve the delivery of health care and awareness of MSK conditions to all Canadians.

Our mission is to create an MSK web site located on one central server in Canada with emphasis on 1) Patients and the need to provide them with information about MSK conditions and screening examinations.; 2) Current health care providers to provide them with current evidence that supports decisions on how they manage patients and; 3) Future health care providers by creating interactive learning modules that will enhance and augment clinical encounters. These modules would be located on one central server, accessible to all physicians and surgeons in Canada, be multidisciplinary, available 24/7 for nation-wide implementation and possibly beyond.

4. Training New MSK Investigators:
In collaboration with USBJD, Canada hosted the fourth Young Investigators' Workshop in Vancouver, British Columbia, in September 2006.

The objective of these workshops is to train young clinical investigators in the field of MSK health and disease to develop and defend research proposals so as to enhance their success at securing funding. This is achieved through a combination of formal training and mentorship from experienced clinical investigators.

The expected outcome is that more North American MSK researchers will be successful in securing research funds. As our population ages, there is a greater prevalence of MSK conditions and greater need for related research. To obtain a higher allocation for MSK funded research we need a higher number of grant applications being submitted, and scoring in the top percentile. In addition we need more emphasis on translational research, hence the focus on clinical investigators.

Since the experienced researchers will remain involved as ongoing mentors, the likelihood of success is increased. New investigators will be able to consolidate the learnings from the workshop, as they develop their proposals under the direction of the experienced investigators. This builds on the principles of adult learning that suggest that repetition and practice are key to internalizing new learning.

5. Optimize Patient Involvement in BJD:
Anne Dooley, President of the Canadian Arthritis Patient Alliance (CAPA) is a key member of the BJD Canada team. She provides a strategic link to patients and families affected by arthritis. CAPA has selected Colleen Maloney, one of their members, to represent Canada at the BJD Conference in Durban, South Africa in 2006. Laurie Proulx, is Canada's representative to BJD Pals, an interactive web link for patients with MSK conditions around the world.

In late May, BJD was represented at the BC Kinesiologist Conference by two CAPA members, Colleen Maloney and Delia Cooper. In a joint presentation they spoke of the role patients play in health care and how consumers support the International Goals of the Bone and Joint Decade. Both BJD and CAPA were pleased to meet the request made by the Kinesiologists in order to further understanding about BJD and its goals, the opportunities it presents to young researchers, and the many activities and collaborations of arthritis consumers to help make these goals a reality.

For instance, consumers raise awareness of the growing burden of MSK disorders on society by speaking of the cost to the economy in terms of health care, lost productivity and taxes. Patients helped develop and launch the Canadian Standards for Arthritis Prevention and Care unveiled in April 2006, and have been instrumental in delivering Arthritis 101 in provincial legislatures to help policy makers understand the importance of implementing the standards as part of an arthritis chronic disease strategy.

Consumer groups help empower patients to participate in their own care by helping to develop and launch the Arthritis Bill of Rights (January 2002), and through representation at health policy decision-making tables as these decisions affect patient lives and health. Collaboration in education is key to working to help empower patients. Cost-effective prevention and treatment can be assisted by timely access to accurate diagnosis and treatment that can slow disability and in many instances prevent it. Patient Partners in Arthritis provides education to medical students, residents, Family Practitioners and allied health professionals on the identification of arthritis through an MSK exam. Arthritis Self-Management Programmes and Chronic Pain Workshops are delivered by patients, and consumers contribute to the debate on access to medications through involvement in coalitions and participation at conferences.

Consumers support research to improve prevention and treatment and promote understanding of MSK disorders. Patients act in a variety of roles from helping to set the research agenda, to participation as advisers and collaborators on research projects, project assessment, and assisting in the dissemination of information gained from research, through newsletters, web sites, and educational programmes.