“This will not change management because it’s not an either/or situation” and doctors should be taking an integrated approach, he tells Reuters Health in a telephone interview.
Una Makris, MD, an osteoarthritis investigator at the Dallas VA Medical Center, who was also not involved in the study, also said it won’t change her practice. But the study does show that having “booster” sessions with a doctor or therapist can be important for success.
The researchers treated 156 volunteers—all active-duty or retired service members and their families with an average age of 56—at the Madigan Army Medical Center in Tacoma, Wash., or at Brooke. The research team included experts in orthopedics, rheumatology and physical therapy.
The volunteers in the injection group could receive up to three injections during the year of the study. Physical therapy, done in as many as 14 sessions, included finding ways to move the joint, and stretch and strengthen muscles without invoking pain.
All of that professional contact can be a key to doing well, says Dr. Karp. The problem is, “usually once the study is over, patients lose the effect, because they stop doing the exercises at home” and may not have as much support.
Although only 10% of patients in the physical therapy group did not show significant improvement after one year, the same was true for 26% of the volunteers who got cortisone injections.
There was little difference in annual cost of therapy. It was $2,113 for injections versus $2,131 for physical therapy.
“I’m hopeful this will push the pendulum in the direction where patients are offered low-risk strategies rather than being pushed down a pipeline that eventually leads to only one thing—total joint replacement,” Dr. Deyle says.
References
- Deyle GD, Allen CS, Allison SC, et al. Physical therapy vs. glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020 Apr 9;382(15):1420–1429.
- Bennell KL, Hunter DJ. Physical therapy before the needle for osteoarthritis of the knee. N Engl J Med. 2020 Apr 9;382(15):1470–1471.
