Physical Therapy vs Glucocorticoid Injection for Osteoarthritis of the Knee
Deyle et al. (2020)
The objective of this study was to compare the effectiveness of glucocorticoid (cortisone) injections and physical therapy in patients with osteoarthritis.
Both physical therapy and cortisone injections into the knee joint have been recommended for the management of knee osteoarthritis. What is unclear, however, is whether the short-term and long-term effectiveness for relieving pain and improving physical function differs between these two interventions.
This study was a 1 year randomised controlled trial. 156 people participated in the study, had a mean age of 56 years and all participants had a confirmed diagnosis of knee osteoarthritis. Participants were randomly assigned into two groups; i-physical therapy (manual therapy and exercise), and ii-cortisone injection.
Those in the physical therapy group attended 8 sessions in the first 4-6 weeks, with the option of attending three more sessions at the fourth and ninth month mark. For those in the cortisone injection group, participants had one injection at baseline and if deemed appropriate, had an additional injection at the fourth and ninth month mark.
At the 1 year mark, there was a clinically significant difference favouring the physical therapy group in both relieving pain and improving physical function. 8 participants (10.3%) in the physical therapy group failed to demonstrate a clinically important improvement from baseline. This is compared to the cortisone injection group who had 20 participants (25.6%) showing no clinically significant improvement.
- Cortisone injections have been considered best practice for people with knee osteoarthritis. Recent evidence, however, has called into question the clinical effectiveness and safety of these injections for patients with knee osteoarthritis.
- Manual therapy and exercise were superior to cortisone injections for improving pain and physical function at the 1 year mark in patients with knee osteoarthritis.
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