Purpose: To determine the benefit of a behaviorally-designed incentive program and corticosteroid injections in reducing symptoms and promoting physical activity in patients with knee #osteoarthritis (KOA).
Methods: This was a pragmatic, multi-site, factorially-designed, blinded, randomized clinical trial. Participants with a clinical diagnosis of KOA and an indication for joint injection (age 40-85 years; Kellgren-Lawrence X-ray grade ≥1) were randomized to receive a behavioral incentive to promote physical #activity. They were further randomized to receive corticosteroid injections or lidocaine-only injections in a crossover design. Primary outcomes were the average daily steps measured bi-weekly over 28-weeks and change in the Knee Osteoarthritis Outcome Score (KOOS; average of 5 subdomains) measured bi-weekly between 2-12 weeks after each injection. Mixed-effects models evaluated time-averaged effects. Secondary analyses evaluated within-person changes after crossover injections.
Results: Among 221 randomized (mean age 62 years; 84% male), 204 (92.3%) completed follow-up. Participants receiving the incentive program walked 771 more steps per day (p=0.01). KOOS scores were not improved in the incentive arm. Corticosteroid injections did not result in greater improvement in KOOS scores or subdomains at any time point, nor when evaluating the time-averaged effect [B: 1.72 (95% CI: -1.08,4.52) p=0.23]. A crossover analysis among 196 participants demonstrated no benefit [B: 0.36 (95% CI: -1.17,1.90) p=0.29]. Participants were 55% accurate in guessing the order of their injections.
Conclusions and relevance: Behaviorally-designed incentive programs can promote physical activity among patients with symptomatic KOA with no effect on KOA symptoms. Corticosteroid injections, compared to lidocaine-only injections, did not show a benefit.
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