Physical Therapy Versus Glucocorticoid Injection for Osteoarthritis of the Knee

Physical therapy produces better outcomes at one year than corticosteroid injections in patients with osteoarthritis of the knee. James W. Mold, MD, MPH

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Background: Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain.

Methods: We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year.

Results: We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection.

Conclusions: Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection. (ClinicalTrials.gov number, NCT01427153.).

Author/s:

Deyle, GD, Allen, CS, Allison, SC, Gill, NW, Hando, BR, Petersen, EJ, Dusenberry, DI, Rhon, DI

The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study

Jeffrey Wilson — Wed, 01 May 2019 20:18:15 +0000

Date Added:

May 1, 2019

Journal/Publication:

BMC Musculoskeletal Disorders

Publisher:

BioMed Central

Publication Date:

April 9, 2019

Issue:

Volume:

URL:

The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1186/s12891-019-2521-4

Keywords

osteoarthritis

physical therapy

health education

PMID (1):

30967131

MeSH

In this admittedly imperfect study, older osteoarthritis patients receiving 8 hours of physical therapy, periodic telephone support, and health education had significantly less pain and more function at 3 months than control patients receiving standard care. James W. Mold, MD, MPH

BACKGROUND:

Knee osteoarthritis (KOA) is common in elderly people, causes pain, loss of physical functioning, and disability. This was a two-arm, superiority, quasi-experimental trial. The aim of this study was to evaluate the effectiveness of a home-based exercise intervention (HBEI) to reduce KOA symptoms and improve the physical functioning of elderly patients.

METHODS:

A total of 171 elderly patients (60 years of age or older) with KOA were recruited from four community centers. Patients from two community centers were randomly assigned to the intervention group (IG) and the other two centers were randomly assigned to the control group (CG). Participants in the IG received a 12-week HBEI (including four 2-h sessions supervised by a physiotherapist and fortnightly telephone support) combined with health education, while patients in the CG only received health education. The participants and physiotherapists were aware of the group assignment and alternative treatment components, but the study's hypotheses were not disclosed to the participants. Pain intensity, joint stiffness, lower-limb muscle strength, balance, mobility, and quality of life were measured before and after the intervention by the same blinded assessor.

RESULTS:

A total of 171 patients (IG: n = 84, CG: n = 87) were enrolled. Data were obtained from 141 patients with an average age of 68 (range, 60-86 years) who completed the 12-week study (IG: n = 71, CG: n = 70). No significant group differences were found in any outcome measures at baseline. At week 12, the pretest/posttest changes 3significant between-group differences in decreases in pain intensity (- 1.60 (CI, - 2.75 to - 0.58)) and stiffness (- 0.79 (CI, - 1.37 to - 0.21)), with the IG exhibiting significantly larger improvements on both measures than the CG. The IG also showed significantly greater improvements on all the secondary outcomes than the CG did.

CONCLUSIONS:

HBEI may be effective for relieving KOA symptoms, increasing the physical functioning, and improving quality of life in community-dwelling KOA elderly patients. A large randomized controlled trial with long-term follow-up is needed to confirm these findings.

Author/s:

Chen, Hongbo, Zheng, Xiaoyan, Huang, Hongjie, Liu, Congying, Wan, Qiaoqin, Shang, Shaomei