Exploring Massage Benefits for Arthritis of the Knee for VA Healthcare Users

The goal of this supplement is to enroll n=25 VA healthcare users with knee OA into the
initial 8-week EMBARK massage program in order to collect preliminary data on the
feasibility, acceptability and efficacy of massage in this patient group, in preparation for
a larger grant submission to evaluate the effectiveness of massage for knee OA in the VA
healthcare system. All veterans enrolled under this supplement will complete the initial
8-week massage protocol, since this will allow us the maximum opportunity to assess the
feasibility and gather preliminary efficacy data. Veterans with symptomatic knee OA will be
recruited from the Durham VA Medical Center, and the remaining study activities will be
completed at the Duke site of the EMBARK study.

Inclusion Criteria:

1. Be a veteran enrolled in care at the Durham VA Medical Center.

2. 35 years of age or greater.

3. Written confirmation of OA of the knee as provided by the participant's physician.

4. Radiographically-established OA of the knee.

5. Pre-randomization score in a specified range on the Visual Analog Pain Scale (0 - 100
mm scale).

6. Receiving care for diagnosed OA of the knee under the care of a board-certified
primary care physician, with or without involvement of a board-certified
rheumatologist.

7. Patients with bilateral knee involvement will have the more severely affected knee
designated as the study knee.

8. American College of Rheumatology defined OA of the knee; specifically:

a. Knee pain b. Satisfaction of at least three of the following six criteria: i. Age
greater than 50 years ii. Stiffness < 30 minutes iii. Crepitus iv. Bony Tenderness v.
Bony enlargement vi. No palpable warmth

Exclusion Criteria:

1. Presence of rheumatoid arthritis, fibromyalgia, recurrent or active pseudo gout.

2. Presence of cancer or other decompensated medical conditions that limit the ability
to participate fully in all interventions, assessments, and follow-up visits.

3. Signs or history of kidney or liver failure.

4. Presence of asthma requiring the use of corticosteroid treatment.

5. Use of oral corticosteroids within the past four weeks.

6. Use of intra-articular knee depo-corticosteroids with the past three months.

7. Use of intra-articular hyaluronate with the past six months.

8. Arthroscopic surgery of the knee within the past year.

9. Significant injury to the knee within the past six months.

10. Presence of a rash or open wound over the knee.

11. Unable to satisfy the treatment and follow-up requirements.

12. Unable to provide written informed consent.

13. Currently receiving massage therapy on a regular basis (at least twice a month).

14. Knee replacement of study knee (ok if the knee not being studied has been replaced).

15. History of participating in the EMBARK Phase I (2004) or II (2009) studies.