DESCRIPTION (provided by applicant): Musculoskeletal (MSK) disorders represent a broad group of conditions with diverse etiologies that result in pain and functional impairment of bones, joints, tendons, ligaments and/or muscles. These disorders are the leading cause of work disability and the most frequent source of dependency in the elderly. In the US, over 3 million hospitalizations for MSK problems occur annually, primarily for orthopaedic surgical interventions. Rigorously designed patient oriented research studies create the basis for evidence-based practice and serve as powerful tools to bridge patient expectations, clinical care and shared decision making. Presently, the evidence base in musculoskeletal and orthopedic clinical science has large gaps. I have dedicated much of my effort in the last decade to addressing these research needs. Through the K24 Mid Career Investigator Award, I hope to continue this work through patient oriented research and, importantly, to engage the next generation of clinical scientists in rigorous studies of MSK and orthopaedic problems. The Mid-career Award in patient oriented research (K24) will enable me to dedicate a substantial portion of my time to pursue a robust program in patient oriented research in orthopedics and to mentor young clinical scientists committed to orthopaedic and musculoskeletal patient oriented research. This Award will support my mentoring and research program with the following aims: I) To develop a research training program that will prepare young clinical investigators for rigorous evaluation of frequently utilized and/or recently developed orthopaedic interventions in patients with MSK disorders. II) To further develop a comprehensive patient oriented research program in MSK disorders and orthopaedics. The overarching goals of my mentoring program include: 1) providing training in patient oriented research in orthopedics, including design and conduct of randomized clinical trials, observational studies and developing new diagnostic criteria in patients with MSK disorders; 2) increasing the number of researchers focused on patient oriented research with rigorous training in the study of MSK disorders; 3) fostering new multidisciplinary collaborations; and 4) facilitating the transition from traineeship to faculty. While the goals of the program span multiple clinical problems, I highlight two research studies in this proposal: Study 1: To conduct a randomized controlled clinical trial to determine optimal timing for withdrawal of epidural anesthesia in patients undergoing total knee replacement. Study 2: To determine the diagnostic value of clinical history for the diagnosis of symptomatic meniscal tears in the presence of knee osteoarthritis (OA). Each of these studies, coupled with a comprehensive structured mentoring program, will help to address important unanswered questions in the management of patients with MSK disorders. The program will also help the next generation of clinical scientists to develop, evaluate and implement efficient and effective treatment strategies in patients with MSK conditions.

The Mid-career Award in patient oriented research (K24) will enable me to dedicate a substantial portion of my time to pursue a robust program in patient oriented research in orthopaedics and to mentor young clinical scientists committed to orthopaedic and musculoskeletal patient oriented research. I highlight two research studies in this proposal: Study 1: To conduct a randomized controlled clinical trial to determine optimal timing for withdrawal of epidural anesthesia in patients undergoing total knee replacement. Study 2: To determine the diagnostic value of clinical history for the diagnosis of symptomatic meniscal tears in the presence of knee osteoarthritis (OA). Each of these studies, coupled with a comprehensive structured mentoring program, will help to address important unanswered questions in the management of patients with MSK disorders.