Background

Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain.

Methods

We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year.

Results

We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection.

Conclusions

Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection. (ClinicalTrials.gov number, NCT01427153.)

VISUAL ABSTRACT
Physical Therapy vs. Glucocorticoid Injection for Knee Osteoarthritis

中文翻译：

---

物理疗法与糖皮质激素注射液治疗膝骨关节炎

背景

物理治疗和糖皮质激素的关节内注射均已显示出对膝骨关节炎的临床益处。这两种疗法在缓解疼痛和改善身体机能上的短期和长期效果是否不同尚不确定。

方法

我们进行了一项随机试验，以比较美国军事卫生系统在初级保健机构中使用物理疗法与糖皮质激素注射的情况。将一只或两只膝盖的骨关节炎患者以1：1的比例随机分配以接受糖皮质激素注射或接受物理治疗。主要结果是西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）在1年时的总分（分数范围从0到240，分数越高表明疼痛，功能和僵硬程度越严重）。次要结果是完成替代步骤测试所需的时间，完成定时并执行测试所需的时间以及全球变更等级量表的分数，均在1年时评估。

结果

我们纳入了156例平均年龄为56岁的患者。每组78例。两组的基线特征（包括疼痛的严重程度和残疾程度）相似。糖皮质激素注射组的基线WOMAC平均值（±SD）为108.8±47.1，物理治疗组为107.1±42.4。在1年时，平均得分分别为55.8±53.8和37.0±30.7（组间平均差异为18.8分； 95％置信区间为5.0至32.6），这一发现有利于物理疗法。次要结果的变化与主要结果的方向相同。一名患者在接受糖皮质激素注射时晕倒。

结论

与接受关节内糖皮质激素注射的患者相比，接受物理治疗的膝关节骨关节炎患者在1年时疼痛和功能障碍更少。（ClinicalTrials.gov编号，NCT01427153。）

视觉抽象
物理疗法与糖皮质激素注射治疗膝骨关节炎