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.