The purpose of this study is to compare an orthopaedic manual physical therapy (OMPT) approach to a corticosteroid injection approach for the management of knee osteoarthritis.

The purpose of this study is to compare a commonly offered clinical approach of a series of intra-articular steroid injections to an orthopaedic manual physical therapy (OMPT) approach consisting of manually applied passive movement and reinforcing exercise for the treatment of osteoarthritis of the knee (knee OA). A second purpose is to validate a clinical prediction rule (CPR) for patients unlikely to respond to the orthopaedic manual physical therapy approach in a pre-planned secondary analysis of data from the randomized clinical trial.

Aim 1: To see if there is a significant difference in pain and function lasting out to 1 year for patients that receive a clinical approach consisting of a series of intra-articular steroid injections compared to those that receive a clinical approach consisting of orthopaedic manual physical therapy.

Aim 2: To validate a clinical prediction rule of characteristics identified in a previous preliminary study that predicted which patients with knee OA would be unlikely to respond to OMPT.

Inclusion Criteria:

• All subjects must be eligible for care in the military health system
• Meet Altman's clinical criteria for knee OA
• Have English language skills sufficient to complete the WOMAC and GROC outcome instruments
• Be 38 years of age or older

Exclusion Criteria:

• Steroid injections or physical therapy treatment for their knee in the past 12 months
• Current or past history of rheumatoid arthritis or similar rheumatic condition
• Current or past history of gout or pseudogout of the knee
• Active infection in the knee within the past 12 months
• Other physical ailment or condition that is typically more limiting or painful than their knee OA during activities such as sitting, standing, walking, or stair climbing
• History of allergy or adverse effect to corticosteroids
• Cannot speak/read English adequately to understand and provide consent to participate in the study
• Pregnant or intending to become pregnant
• Military service members pending a medical evaluation board, physical evaluation board, equivalent discharge process, or on medical hold to determine long-term disposition. For non-military personnel, anyone that is pending or undergoing any litigation for this condition.
• Contraindication to receiving a corticosteroid injection (history of allergic or adverse reaction to steroid injection, history of multiple corticosteroid injections in that area even if not within last year, etc)
• Unable to give informed consent to participate in the study.

Any data sharing must go through a Data Sharing Agreement approved by the US Defense Health Agency

These are all available in the supplementary appendix published in the trial results with NEJM

All of this data is publicly available in open access publications and in the supplementary appendix of the version published on NEJM