A Comparison of Manual Physical Therapy and Corticosteroid Injections for Knee Osteoarthritis

The purpose of this study is to compare a commonly offered clinical approach of a series of intra-articular steroid injections to an orthopaedic manual physical therapy (OMPT) approach consisting of manually applied passive movement and reinforcing exercise for the treatment of osteoarthritis of the knee (knee OA). A second purpose is to validate a clinical prediction rule (CPR) for patients unlikely to respond to the orthopaedic manual physical therapy approach in a pre-planned secondary analysis of data from the randomized clinical trial.

Aim 1: To see if there is a significant difference in pain and function lasting out to 1 year for patients that receive a clinical approach consisting of a series of intra-articular steroid injections compared to those that receive a clinical approach consisting of orthopaedic manual physical therapy.

Aim 2: To validate a clinical prediction rule of characteristics identified in a previous preliminary study that predicted which patients with knee OA would be unlikely to respond to OMPT.

Inclusion criteria

• All subjects must be eligible for care in the military health system
• Meet Altman's clinical criteria for knee OA
• Have English language skills sufficient to complete the WOMAC and GROC outcome instruments
• Be 38 years of age or older

Exclusion criteria

• Steroid injections or physical therapy treatment for their knee in the past 12 months
• Current or past history of rheumatoid arthritis or similar rheumatic condition
• Current or past history of gout or pseudogout of the knee
• Active infection in the knee within the past 12 months
• Other physical ailment or condition that is typically more limiting or painful than their knee OA during activities such as sitting, standing, walking, or stair climbing
• History of allergy or adverse effect to corticosteroids
• Cannot speak/read English adequately to understand and provide consent to participate in the study
• Pregnant or intending to become pregnant
• Military service members pending a medical evaluation board, physical evaluation board, equivalent discharge process, or on medical hold to determine long-term disposition. For non-military personnel, anyone that is pending or undergoing any litigation for this condition.
• Contraindication to receiving a corticosteroid injection (history of allergic or adverse reaction to steroid injection, history of multiple corticosteroid injections in that area even if not within last year, etc)
• Unable to give informed consent to participate in the study.