Physical Therapy More Effective than Steroid Injections for Osteoarthritis of the Knee

Both steroid joint injections and manual (physical) therapy shown to confer clinical benefit with respect to osteoarthritis of the knee. A randomized controlled trial published recently in the New England Journal of Medicine assessing intra-articular injections of corticosteroids with physical therapy, comparing short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies in individuals with osteoarthritis of the knee.

Methods: The investigators 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: They 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 one year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively. These findings favored physical therapy over the glucocorticoid injections, and changes in secondary outcomes were in the also favored physical therapy. One of the 78 patients receiving the glucocorticoid injection fainted while receiving that treatment.

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 intra-articular glucocorticoid injection.

See the Study Here: N Engl J Med. 2020 Apr 9;382(15):1420-1429. doi: 10.1056/NEJMoa1905877