CLEAR Center Pilot and Feasibility Award Program

Dr. Mia S. Hagen is an Assistant Professor within the University of Washington’s Department of Orthopaedics and Sports Medicine, the Surgical Director of the Sports Medicine Center at Husky Stadium, serves as a team physician for the University of Washington Husky Athletics, and one of the three recipients of the 2020-2021 CLEAR Center Pilot & Feasibility Awards.

Dr. Hagen’s project uses a randomized controlled trial to test the cited benefits of postoperative hip bracing on short term patient reported pain scores, validated hip-specific pain scores, and physical exam findings of hip flexor tendonitis. Dr. Hagen and her team have completed subject recruitment for this study and are awaiting final follow up which should be complete in November 2023. They will then perform data analysis and submit the findings to the national sports medicine conference and high impact journal.

Hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS) involves reshaping of the osseous sources of impingement (“osteoplasty”) and repair of impingement-associated labral tears. The diagnoses of FAIS and the incidence of hip arthroscopy have both increased dramatically in the last 20 years in the US. Despite the increasing incidence of hip arthroscopy in the US, on a recent review Dr. Hagen and her team found few evidence based studies on postoperative care. A particular area of debate is the use of postoperative hip braces, which can be relatively expensive.

Dr. Jonah Hebert-Davies is an Assistant Professor in the University of Washington Department of Orthopaedics and Sports Medicine and one of two recipients of the 2019-2020 CLEAR Center Pilot & Feasibility Awards.

Dr. Hebert-Davies’ Pilot & Feasibility Award project addressed the the feasibility of performing a large-scale trial to address post traumatic decreased range of motion in patients with proximal humerus fractures.

Shoulder stiffness is a common complication of proxmial humerus fractures and has the potential to seriously impact daily function. Standard treatment includes physical therapy, home exercise, and “watchful waiting” to see if symptoms improve with time. In this study, Dr. Hebert-Davies and his team examined whether or not steroid injections are a viable treatment option for this type of injury. This study conducted pilot work to determine the feasibility of conducting a large scale multi-centered randomized trial to evaluate the viability of steroid injections as a treatment option for shoulder stiffness following proximal humerus fracture.

Patients participating in this study were randomized to receive an ultrasound-guided intra-articular injection with lidocaine or an ultrasound-guided intra-articular cortisone injection. The team examined clinical and functional outcomes at multiple timepoints to determine the feasibility of studying this treatment on a larger scale.

The final data collection suggests the potential to expand the size of the study for future research.

Dr. Scott Telfer is a Research Assistant Professor in the University of Washington Department of Orthopaedics and Sports Medicine and was one of two recipients of the inaugural CLEAR Center Pilot & Feasibility Awards.

Dr. Telfer’s project involved a cross-sectional study designed to test the acceptability of blood flow restriction training for those undergoing rehabilitation from ACL reconstruction surgery. It also investigated the biomechanical effects of the blood flow restriction training rehabilitation technique.

Rehabilitation after surgical reconstruction of the ACL aims to re-establish the function of the knee. Effectively building muscle strength requires exercises with high resistance loads, but the joint stress and risk of further injury make these types of activities inappropriate and unsafe for those rehabilitating after ACL reconstruction surgery. Personalized blood flow restriction training is a technique where the blood flow to the muscles being exercised is controlled by a pressure cuff to a predefined level, and has been shown to increase strength while exercising with significantly lower loads. Dr. Telfer’s CLEAR Pilot & Feasibility project compared 2 groups of 20 participants each: one group of individuals underwent rehabilitation after ACL reconstruction, and the second group was an age-, weight-, and sex-matched control group. Both groups completed personalized blood flow restriction training and had their movements and muscle activation monitored. Participants were also asked to complete post-exercise surveys rating the difficulty and discomfort associated with each exercise they performed.

Publication

Telfer S, Calhoun J, Bigham JJ, Mand S, Gellert JM, Hagen MS, Kweon CY, Gee AO. Biomechanical Effects of Blood Flow Restriction Training after ACL Reconstruction. Med Sci Sports Exerc. 2021 Jan;53(1):115-123. doi: 10.1249/MSS.0000000000002437. PMID: 32694365; PMCID: PMC8191295.

Dr. Michael O’Reilly is a Senior Neuroradiology Fellow in the University of Washington Department of Radiology. Dr. O’Reilly is training in diagnostic neuroradiology and interventional radiology with a focus on health services research and comparative effectiveness analysis in order to identify the most effective ways to organize, manage, finance, and deliver high quality care while improving patient safety.

Dr. O’Reilly’s study, Rates of Vertebral Augmentation for the Treatment of Osteoporotic Vertebral Compression Fractures among the Commercially Insured is a retrospective cohort analysis of patients with osteoporotic vertebral compression fractures in the IBM MarketScan® Research Database of Americans with employer-provided health insurance. For his study, Dr. O’Reilly analyzed a cohort of patients who had thoracic and lumbar osteoporotic fractures and calculcated the proportions who were treated with vertebroplasty and kyphoplasty, collectively termed vertebral augmentation. This study provided data on a notable knowledge gap regarding vertebral augmentation in younger patients, particularly with regard to kyphoplasty. Interim results of this study indicate that vertebral augmentation is highly utilized in this younger patient cohort, with rates of kyphoplasty in particular increasing in recent years.

Dr. O’Reilly will perform further analyses on this cohort of patients with osteoporotic fractures in the IBM MarketScan® Research Database that will compare healthcare utilization, including opioid use, complication rates, and spine surgeries, and costs among patients who did and did not receive vertebral augmentation.

Other projects of Dr. O’Reilly’s include a study to determine the prevalence of reported findings on lumbar spine imaging examinations performed subsequent to a patient’s index visit to their primary provider during the LIRE study, as well as a project to assess the materials available to create radiographic high-fidelity anthropomorphic phantoms using 3D printing and common and commercially available castable materials.

Publication:

Gold LS, O’Reilly MK, Heagerty PJ, Jarvik JG. Complications and healthcare utilization in commercially-insured osteoporotic vertebral compression fracture patients: a comparison of kyphoplasty versus propensity-matched controls. Spine J. 2021 Aug;21(8):1347-1354. doi: 10.1016/j.spinee.2021.03.025. Epub 2021 Mar 26. PMID: 33781968; PMCID: PMC8349787.