The combined effect of physiotherapy, intra-articular steroid injection and bracing on knee OA
Page, C. (1); Kinsella, R. (1, 2); Quek, J. (1); Murdoch, H. (1); Lim, K. (3, 4); Cowan, S. (2, 4, 5)
(1) St Vincent’s Hospital Melbourne; (2) La Trobe University; (3) Western Health; (4) University of Melbourne; (5) Clifton Hill Physiotherapy
Background: Research shows that exercise, intra-articular steroid injection (IASI) and bracing independently contribute to symptomatic improvement in people with knee Osteoarthritis (OA). Effects of combining these modalities have not been investigated. This pilot study aimed to determine (i) the feasibility of a large-scale randomised controlled trial (RCT) investigating the combined effect of IASI, physiotherapy and off-loader bracing in patients with medial compartment OA and (ii) treatment effects of the combined intervention compared to standard care (IASI and physiotherapy). Methods: Patients diagnosed with medial compartment OA (defined as ≥ 2 Kellgren-Lawrence score) were recruited from St Vincent’s Hospital Osteoarthritis Hip and Knee Service from 2015 -17. The primary study outcome was feasibility (% of eligible participants enrolled, adherence and drop-out rates). Secondary outcomes included: pain and function (Numerical Rating Score (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC)) and physical performance: strength (Powertrack™), motion (Vimove™), function (OARSI core set). Results: Twenty-two participants were randomised (intervention: n=12 (mean age 63.58 ± 12.11, BMI 30.83 ± 3.65), control: n=10 (mean age 70.00 ± 7.23, mean BMI 29.35 ±4.03). Adherence was 81% with 4 lost to follow up. Both groups responded to the intervention with significantly improved change scores at 12 weeks in pain (NRS: z = -2.69, p=0.07, r=.57), function (WOMAC: z= -3.22, p= 0.01, r=.69) and hip strength (external rotation: z=-2.20, p=0.03, r= .47 and abduction: z=2.42, p=0.02, r=.52). Between-group differences were not observed. Conclusion: The low power of this pilot study prohibited definitive conclusions being drawn. Design modifications for future research were identified, with sub-groups of patients targeted to more appropriately investigate the use of off-loader bracing as part of a multi-modal strategy in patients with symptomatic knee OA.
[pdf-embedder url=”https://opus-tjr.org.au/wp-content/uploads/2019/05/Kinsella-R_poster.pdf” title=”Kinsella R_poster”]
For more information about this abstract, please contact:
Rita Kinsella, St Vincent’s Hospital Melbourne and La Trobe University
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