Physical Therapy Superior to Steroid Injection for Knee OA Save
Treatment options for painful knee osteoarthritis (OA) are numerous, but comparative outcomes are seldom available. A NEJM report shows that physical therapy is superior to intraarticular glucocorticoids injections assessing the outcomes 12 months after the intervention.
This randomized clinical trial to compared physical therapy against glucocorticoid injection in knee OA patients in the U.S. Military Health system. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year.
A total of 156 patients (age of 56 years) were enrolled. The mean (±SD) WOMAC scores at baseline and 12 mos are shown below.
| Baseline | 12 months | |
| PT | 107.1±42.4 | 37.0±30.7 |
| IA Steroid | 108.8±47.1 | 55.8±53.8 |
These findings show more sustained benefits (less pain and functional disability) whenn osteoarthritis of the knee is managed with physical therapy (compared to intraarticular glucocorticoid injection).
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Intuitively we have known this to be true and am not surprised by the report but it has been the rare patient that will attend PT. So infrequent has it been that when they agree to try or, shamefully, they suggest it, I am taken off guard. In an attempt to convince them of the ultimate cost-benefit, I ask that they go for an assessment and review with the therapist the value of an at home program with periodic reassessments.
Disclosures
The author has no conflicts of interest to disclose related to this subject
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