Pavlos Bobos: Finding the Formula

A Pragmatic Trial that Tests the Best Exercises to Reduce the Pain of Knee Osteoarthritis

Pavlos-bobos

Dr. Pavlos Bobos was very active growing up, participating in a variety of sports, including martial arts, soccer, basketball, running, volleyball, and tennis. Today, he’s an Assistant Professor in musculoskeletal health at the School of Physical Therapy at Western University, where he conducts research focused on identifying the most effective exercises or combinations of exercises to restore mobility and reduce the crippling pain of knee osteoarthritis.

In early 2024, he joined the Health Data Research Network Canada (HDRN Canada) Pragmatic Trials Training Program, an experience that, as he puts it, allowed him to “move his research out of idealized settings into real-world care.”

From Training to Rehabilitation

Driven by a passion for injury treatment and rehabilitation, Dr. Bobos first pursued a BSc in the Biology of Exercise, followed by a BSc in Physical Therapy in his home country, Greece.

“With my degree in biology of exercise, I learned how to train a healthy person, but I had a gap in knowledge of how to treat an injured person. That's why I decided to study physical therapy as a second degree.”

His interest eventually turned toward research, leading him to Canada to pursue graduate studies. “When I finished my undergrad studies, I wanted a master's with more hands-on skills, so I came to Canada, where I earned my Master's in Rehabilitation Sciences. As I progressed, I became more interested in research, which led to formal training in Clinical Epidemiology. I subsequently completed my PhD and Postdoctoral Studies. The truth is, I wanted to be involved in academia.”

Managing the Symptoms of Knee Osteoarthritis

The protocol Dr. Bobos is developing will test exercise interventions to reduce pain intensity and improve physical function in people with knee osteoarthritis, which is a degenerative disease marked by progressive loss of articular cartilage.

“This disease is progressive, so it gets worse with time, and, currently, there’s no cure for it. People develop this disease due to many factors, including aging and many other comorbidities. Unfortunately, the number of people developing this disease is increasing. However, even if there’s no treatment for this disease, we can still manage the symptoms and alleviate pain while improving physical function, enabling people to have a better quality of life,” he explains.

To address this gap in clinical practice knowledge, Dr. Bobos conducted a large network meta-analysis, currently under review, that aims to identify which exercise modalities are driving the benefits. He explains:

“So, if one exercise program combines strength and flexibility, we want to know which components really make the difference. Once we identify the top two exercise interventions, we can then design a new trial that tests that specific combination.”

Patients as Partners

Dr. Bobos’ protocol, currently under development, is designed to test the most promising exercise interventions in a real-world setting rather than a highly controlled laboratory.

“I am designing this as a pragmatic trial, so it needs to be run in real-world community settings with routine care workflows so that the results can actually be generalized to the people who need them. By recruiting through community organizations rather than lab clinics, we capture diverse participants who often don’t show up in tightly controlled trials, making the findings more usable for clinicians and decision-makers.”

By engaging directly with communities, the study intentionally includes people whose voices are often absent from clinic-based trials. In addition to participation, they serve as patient partners in the research, with funds from the Schulich School of Medicine and Dentistry at Western University.

“Patient partners are fantastic because they live with this disease and know what matters. Alongside my students, we are launching surveys to understand the barriers and facilitators of rehabilitation, so we can implement the most effective exercise components efficiently. We are also developing supporting resources. Schulich is funding patient recruitment and ensuring participants are compensated for their time.”

With the support of the HDRN Canada pragmatic trials training program, which is coordinated by Schulich and funded by the Canadian Institutes of Health Research (CIHR) and is an initiative of the Health Data Research Network Canada (HDRN Canada), Dr. Bobos is enabled to transform his research interests into a pragmatic trial.

“I’m receiving specialty training on how to do real-world evaluation and how to routinely collect data across different settings, which is exactly what I needed. Thanks to the program, I now have the basic knowledge around how to test exercise-delivered interventions, maximize external validity, outcome selections, and other elements of trial design that make it more pragmatic.”

** The HDRN Canada pragmatic trials training program is coordinated and hosted by the Schulich School of Medicine & Dentistry and is an initiative by Health Data Research Network (HDRN) Canada. It has been funded with $3.48 million from the Canadian Institutes of Health Research (CIHR). Read more.