Congratulations Dr Stephanie Filbay for receiving an NHMRC Investigator Grant

Dr Stephanie Filbay’s innovative research seeks to improve the lives of people living with knee injury and osteoarthritis. Dr Filbay and her team will develop and evaluate a unique intervention to engage people with knee osteoarthritis in personalised, fulfilling forms of physical activity. She will also develop a decision aid to educate people with Anterior Cruciate Ligament (ACL) injury about evidence-based management options, so they can make an informed decision about surgical or non-surgical management approaches.

 Dr Filbay’s PhD Graduation Ceremony at the University of Queensland Dr Filbay completed her PhD on long-term outcomes of ACL injury, at the University of Queensland in 2016. Dr Filbay was awarded fellowships to pursue her research overseas, at the University of Southern Denmark, Link√∂ping University and The University of Oxford. During the past four years she led a research program at the University of Oxford investigating the psychological and physical health implications of musculoskeletal injury, including the long-term outcomes of anterior cruciate ligament injury.

Relocating from the UK during these challenging times, we offer Dr Filbay our support and a warm welcome back to Australia as an NHMRC Emerging Leadership Fellow and a member of the University of Melbourne’s CHESM team.

Welcome to the University of Melbourne’s CHESM team and congratulations for receiving the NHMRC Investigator Grant. Could you talk us through the research projects you have planned for the Grant?

Over 5 million Australians suffer sport-related injuries per year, and knee injury is the most common. In fact, Australia has the highest rate of serious knee injury in the world. This is concerning, considering one in two people will develop knee osteoarthritis within 10 years of injury. This results in young and middle-aged adults developing knee osteoarthritis, which can stop them participating in sport and daily activities, cause chronic pain, and have a negative impact on their quality of life.  Since there is no cure for osteoarthritis, improving quality of life through effective osteoarthritis management is very important. The NHMRC Investigator Grant will provide the opportunity to develop and evaluate an innovative treatment to improve outcomes for people living with knee osteoarthritis.Photo of Dr Filbay attending a colleague dinner at the University of Oxford

Effective management of knee injury also plays an important role in reducing the burden of knee osteoarthritis, since poor management of knee injury increases the risk of developing osteoarthritis. Australia has the highest rate of ACL injury in the world and more than 90% of people are surgically treated, despite evidence recommending rehabilitation as the first-line treatment in most cases. Misconceptions about the best treatment for knee injury are common, and surgery is often perceived as the best available treatment. I plan on developing and evaluating a decision aid to inform people with ACL injury of the evidence surrounding the surgical and non-surgical treatment options. I hope that this will improve long-term outcomes and treatment satisfaction, and reduce costs associated with an over-utilisation of surgical treatment.

Can you tell me more about the intervention you are developing to improve quality of life in people with knee osteoarthritis? How does it differ from other knee osteoarthritis interventions?

Physical activity in people with knee osteoarthritis can improve pain, quality of life, and reduce adiposity which is associated with more severe osteoarthritis symptoms. However, 70% of young and middle-aged adults with knee osteoarthritis are not physically active and a majority are overweight or obese. Current exercise interventions are typically non-personalised, home or gym-based, and do not meet the needs of young and middle-aged adults with osteoarthritis. Younger adults with osteoarthritis desire participation in different forms of activity than is typical in an older osteoarthritis population. Therefore, they would benefit from a personalised approach to identify specific forms of physical activity that meet their needs and interests.

Photo of Dr Filbay meeting colleagues at the Norwegian School of Sport Sciences We plan on developing an intervention that provides personalised activity recommendations and uses behaviour change techniques, to engage inactive people with knee osteoarthritis in satisfying forms of physical activity. We hope that the personalised nature of this intervention will improve adherence and facilitate ongoing physical activity participation across the lifespan. Increasing physical activity may provide a cost-effective means of improving quality of life and managing osteoarthritis symptoms.

You mentioned that people who develop knee osteoarthritis after a knee injury may have physical activity needs that are not met through available osteoarthritis treatments, can you provide an example?

My research in people with ACL injury found that people often fit into one of two groups; those who enjoy recreational exercise (like going to the gym, yoga, hiking or running), and those who prefer to be active through competitive sport. After a sport-related ACL injury, 50% of people do not return to sport. People who do not enjoy other forms of exercise risk becoming inactive and gaining weight, which increases their risk of osteoarthritis and can have a negative impact on mental health. For these individuals, finding an alternative to competitive sport that meets their personal needs and preferences, can be the key to maintaining a fulfilling and active life after knee injury.Photo of landscape shot of Dr Filbay’s morning cycle to work at the University of Southern Denmark

A participant in our qualitative study demonstrated the importance of finding a fulfilling form of physical activity after knee injury. Lucy1 was an elite gymnast who ruptured her ACL and didn’t return to gymnastics after ACL surgery due to fear of re-injury. She hated recreational exercise and felt that she could no longer take part in competitive sport because of her knee. So, she became inactive, gained a lot of weight, and developed depression. She spent many years like this before ‘‘hitting rock bottom.’’ She was then introduced to the sport of Olympic powerlifting. This was an activity that met her needs; it satisfied her thirst for competition and had a low risk of reinjuring her knee. Speaking about finding a form of physical activity that met her needs improved her knee pain and symptoms and transformed her quality of life, she stated: ‘’I’ve gone from what I feel like 10% quality of life, to 100% quality of life, for me, being active is everything.’’

Why are you interested in knee injury and osteoarthritis research?

I’ve always played competitive sport and I’ve had a lot of sports injuries, which led me towards the physiotherapy profession. I was an 18-year-old physiotherapy student when I first ruptured my ACL. I experienced first-hand what it’s like to have ACL surgery and not be able to participate in the activities that you love. When I eventually returned to sport, I re-tore the ACL graft, and had revision ACL surgery. After going through surgery and a lengthy period of rehabilitation, I tore it a third time. Twelve years after my first ACL injury, I have developed knee osteoarthritis, and face the challenge of managing this condition for the rest of my life. Despite knee pain and swelling, I still play competitive sport. For me, sport participation has always played an important role in leading a fulfilling life. However, the time will come when my knee prevents me from doing the activities that I want to do – a problem that many people who develop osteoarthritis after sports injury are faced with.

Dr Filbay’s knee after her second ACL surgery My experience as a physiotherapist managing knee injuries and osteoarthritis, as a researcher studying knee injuries and osteoarthritis, and as a patient who had knee injuries and developed osteoarthritis; provides me with unique insight to design interventions aimed at improving the quality of life of people living with these conditions.

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