Clinician Article
Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.
PMID: 32268027
-
Family Medicine (FM)/General Practice (GP)Relevance - 7/7
Newsworthiness - 6/7 -
General Internal Medicine-Primary Care(US)Relevance - 7/7
Newsworthiness - 6/7 -
Physical Medicine and RehabilitationRelevance - 7/7
Newsworthiness - 5/7 -
Internal MedicineRelevance - 6/7
Newsworthiness - 5/7 -
RheumatologyRelevance - 6/7
Newsworthiness - 5/7
Abstract
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.).
Clinical Comments
Family Medicine (FM)/General Practice (GP)
The evidence is slowly moving us away from routine intra-articular corticosteroid injection for knee osteoarthritis, but note the short-term improvement in WOMAC scoring for knee injections, which is attractive to many of our patients. In a perfect world, physical therapy would be inexpensive and easy to access. For many of our patients, this is not the case. In the post-COVID-19 world, will "hands on" physical therapy be acceptable still? Finally, this study evaluated these interventions as separate, rather than complementary. Nonetheless, this is a study worthy of our attention.
General Internal Medicine-Primary Care(US)
This trial is relatively small, the patients were not blinded and there was no sham injection, so patient expectation of benefit may have affected their perceived benefit from the intervention.
General Internal Medicine-Primary Care(US)
This is very relevant for primary care and determines where someone with knee pain is referred.
Internal Medicine
I don`t think most people think steroids have a long-term effect.
Internal Medicine
Insurance companies pay for injections, but they are often extremely stingy with physical therapy. This limits the number of sessions and large co-payments are requested. This study provides compelling reason to pay for PT and avoid the complications of injections. I suspect that PT may be more enduring than injections if patients continue the exercises. It would have been interesting to have a group that received both injections and PT.
Internal Medicine
This is right up a primary care physician`s alley and is a top 10 common complaint encountered. Getting patients to comply with an active therapy as opposed to a passive therapy is the challenge.
Physical Medicine and Rehabilitation
Physical therapy demonstrated greater improvement in the WOMAC and functional tasks over one year than intra-articular steroid injections in patients with symptomatic and radiologically demonstrated knee osteoarthritis.
Register for free access to all Professional content
RegisterOur Content
About
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.
