Background

The aim of the Bone and Joint Decade (BJD) 2000-2010 global initiative is to raise awareness of the system-wide impact of musculoskeletal (MSK) conditions. More specifically, the goals of the BJD are to: (1) raise awareness of the growing burden of MSK conditions, (2) empower patients to participate in their own care, (3) advance the understanding of MSK conditions. In late October 2005, the BJD World Network Conference was held in Ottawa, Canada where the Prof Lars Lidgren, the Chairman of the International Steering Committee reported that the issues of MSK science is now highlighted across the world. While this may be true for many developed countries, other countries such as Kuwait, who are signatories to the BJD, have not been able to gather the appropriate mix of researchers and policy/decision makers to begin the process of identifying, collecting and analyzing essential data.

The impact of MSK conditions has been reported to have significant effect on the health and wellbeing of Kuwaitis. For instance, Al-Awadhi et al (2004) reported that functional disabilities was reported in almost 40% of a sample of 7670 adults, with females experiencing more decline than males. They report that MSK is a major health concern in Kuwait, and a critical issue that deserves government attention. Others such as Malaviya et al (1999), Malaviya et al (2000) and Muirden (2005) have arrived at similar conclusions. Despite the fact that MSK conditions such as osteoarthritis and injury may have impact on the Kuwaiti population, there is little empirical investigations into the degree to which such condition affect the population. For instance, even the most essential epidemiological data regarding incidence and prevalence are unavailable, not to mention the lack of investigations into the socio-economic impacts. The BJD initiative was to stimulate countries such as Kuwait to begin the process of data collection and analysis in order to more fully appreciate the impact on society by understanding the size and severity of the problem, identify the risk factors, and design cost-effective interventions (i.e. treatment and prevention) to address this important issue.

In light of the lack of analysis, the primary goal of this collaborative grant is to assemble multidisciplinary Canadian and Kuwaiti researchers in order to conduct a 'gap' analysis and environmental assessment which will identify critical steps necessary to begin the process of meeting BJD goals before the end of 2010. The secondary objective is to use the results of the ‘gap’ analysis and environmental assessment to design a full research proposal that will be submitted to the primary Kuwaiti health research granting agency, the Kuwait Foundation for the Advancement of Science, in late 2006. Ultimately the aim of the project is to identify the required steps to ensure that Kuwait has the opportunity to participate fully in this global initiative. Based on current knowledge, there is a remarkable lack of epidemiological data (i.e. incidence/prevalence rates) regarding MSK conditions in Kuwait. Moreover, there is little infrastructure to systematically collect data to be used to address the BJD goals.

Preliminary work has already taken place to identify the key researchers in this research. One of the collaborators in this research (E. Hamdan) is the Kuwaiti representative to the BJD, and has identified senior level Kuwaiti researchers who are willing to work on an international team to conduct the ‘gap’ analysis and environmental assessment regarding the status of data in Kuwait that can be sued to meet BJD goals. A “gap” analysis is a process of determining the variance between where Kuwait should be relative to other countries, from where it is currently, regarding BJD goals. The environmental assessment allows from the triangulation of all available resources that can be used to inform the gap analysis, but also to identify all available data sources.

The research plan will be to send the Canadian researcher team to Kuwait on 2 separate occasions, each lasting approximately 1 week. In the first visit (March/April 2006), the Canadian and Kuwaiti teams will work together to discuss the expected outcomes of the research project, and conduct the ‘gap’ analysis and environmental analysis. The second visit will take place 6 months later (September/October 2006), where the goal will be to finalize the full research proposal and host a conference that will widen the scope of local interest, and serve to disseminate the information collated to write the full proposal.

Between the first and second visits, the Canadian and Kuwaiti research teams will communicate via email and teleconference. The Kuwaiti research team has agreed to provide in-kind contribution by managing all the logistics of travel, accommodation, and scheduling of visits to health stakeholders in Kuwait

The intended foreign researchers

In 2000 it was announced that Kuwait would support the BJD initiative, and that the country representative would be an orthopedic surgeon. Dr. Elham Hamdan, an orthopedic surgeon at Al-Razi hospital assumed this role. However, since this announcement, and despite some initial success, there has been little movement to begin the process of scaling up and meeting BJD goals. Dr. Elham Hamdan is now the Vice President of Fawzia Sultan Rehabilitation Institute, the largest comprehensive rehabilitation facility in Kuwait, and the Coordinator for the National Action Network. She has initiated discussions regarding the BJD with Dr. Saud Al Obaidi, the Vice Dean of Academic Affairs and Chairman of the Physical Therapy Department at the University of Kuwait, and Dr. Fawsi Bouzubar, an Assistant Professor also in the Physical Therapy Department at the University of Kuwait. Both Dr. Al Obaidi and Dr. Bouzubar are physical therapist with significant musculoskeletal and orthopedic clinical and research experience.

The role of Canadian  participants in the project

The Canadian contribution in this study will be primarily based at the University of Toronto, but will include 1 co-applicant from Queen’s University. Dr. Michel D. Landry will be the principal investigator for this grant, and will oversee the operations of the grant. He has significant international development experience, has visited Kuwait, and has worked with Dr. Hamdan on other projects. Dr. Cheryl Cott is a physical therapist and a social gerontologist with extensive health services research experience. Ms. Sudha Raman is currently a Master’s student in the Department of Community Health and Epidemiology at Queen’s University and Mr. Robert Balogh is an epidemiologist and doctoral student in the Public Health Sciences at the University of Toronto. Both Ms. Raman and Mr. Balogh have extensive international health experience in countries such as Afghanistan, Bangladesh, Bosnia, and Guatemala.
Dr. Landry will be responsible for the overall operation of the grant, and will take the led on conducting the gap analysis and environmental assessment, as well as the writing of the final report. He will also ensure that the data collected and analyzed lead to a full research proposal to be submitted to the Kuwait Foundation for the Advancement of Science (KFAS). Dr. Cott, Ms. Raman and Mr. Balogh will participate in the identification, collection and analysis of data within the gap analysis and environmental scans. They will also contribute the writing of the final report, and the follow up research proposal.

Additional complementary knowledge by the foreign counterpart

Dr. Hamdan, Dr. Al Obaidi and Dr. Bouzubar are all academic investigators who are motivated to begin the process of meeting BJD goals. More precisely, they have a wealth of connections throughout Kuwait and the Gulf states, and will be able to facilitate access to data and important individuals.

The potential benefit to the health of Canadians

The understanding of other societies and the extent to which MSK conditions impact on these societies represents an important opportunity for Canadian researchers. Canada is truly a global community, and one that is welcoming of all nations. Understanding the issues that impact on the health and wellbeing in other countries represents an opportunity for Canadian researchers to import this learning to Canada. As we move towards a better understanding health status in Canada, this experience will lead to more efficient treatment, and primary/secondary/tertiary prevention programs to improve overall MSK health.

The likelihood that the subsequent stages of the project will attract funding

The likelihood of further funding of this project is excellent. The Canada-Kuwait partnership has already contacted the Kuwait Foundation for the Advancement of Science (KFAS) has already been contacted. KFAS does not provide funding for research team to begin the process of working together, however they were very interested in the BJD global initiative. They reported that they do not have specific dates to submit research proposal, and that researchers can submit proposal on an on-going basis.

Initial discussions have been very positive, and KFAS is very interested in funding research programs that include foreign partners.

References

Al-Awadhi AM. Olusi SO. Moussa M. Shehab D. Al-Zaid N. Al-Herz A. Al-Jarallah K. Musculoskeletal pain, disability and health-seeking behavior in adult Kuwaitis using a validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire. Clinical & Experimental Rheumatology. 22(2):177-83, 2004 Mar-Apr.
Malaviya AN. Al-Jarallah K. Al-Awadhi A. Shehab D. Teaching of musculoskeletal diseases to undergraduates in the Faculty of Medicine, Kuwait University. Rheumatology. 39(8):925-7, 2000 Aug.

Malaviya AN. Francis IM. Kaushik P. Ayyash EH. Musculoskeletal manifestations with panniculitis--a hospital based study on 62 patients in Kuwait. Rheumatology International. 19(1-2):51-7, 1999.

Muirden KD. Community Oriented Program for the Control of Rheumatic Diseases: studies of rheumatic diseases in the developing world. Current Opinion in Rheumatology. 17(2):153-6, 2005 Mar.