Comparing Different Types of Physical Therapy for Treating People With a Meniscal Tear and Osteoarthritis

Knee osteoarthritis is a disabling problem affecting over 15 million adults in the United
States. Many people who have knee arthritis also experience painful meniscal tears. There are
a number of different treatments that can be used to manage meniscal tears in the presence of
knee arthritis. Treatments include surgically removing the damaged part of the meniscus;
strengthening exercises to improve pain and function; manual therapy including massage and
mobilization; acupuncture; and others. The combination of surgery and exercise therapy was
long thought to be the best treatment. However, recent studies have shown that surgery
followed by physical therapy is no more effective than physical therapy by itself.

While physical therapy alone has been shown to result in similar pain relief as arthroscopic
surgery, researchers have not yet done studies to determine what type of physical therapy is
best for people with knee arthritis and meniscal tears. In the "TeMPO" Trial, we will be
comparing 4 different, non-operative physical therapy regimens in order to gain a better
understanding of how physical therapy works and what regimen will best reduce pain and
improve function in persons with meniscal tear and osteoarthritis. The four arms in this
randomized trial will contain different combinations of therapeutic treatments including
in-clinic therapist-supervised exercise, in-clinic topical therapies, and exercises to be
completed at home. Subjects in three of the arms will also receive motivational SMS (text)
messages intended to improve adherence to the home exercise regimen.

TeMPO is designed as a randomized controlled trial. Participants will be assigned randomly to
one of the four arms. All arms include therapies that have been previously shown to work in
clinical settings. One arm also contains some placebo treatments. The placebo treatments will
help us to understand what aspects of physical therapy actually make people feel better.

Our hypothesis is that subjects in the arm that includes in-clinic physical therapy and a
home exercise regimen will experience more pain relief than subjects in each of the other
arms. Also, we expect that subjects in the arm that receives the home exercise regimen and
SMS messages will experience more pain relief than subjects in the arm that receives home
exercise without the SMS messages.