300 Participants Needed

Non-Surgical Management for Knee Osteoarthritis

Recruiting at 2 trial locations
ML
RM
BH
Overseen ByBrian Hatler, DPT
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment DoD/VA CPG Core Set for knee osteoarthritis?

The DoD/VA Clinical Practice Guidelines for non-surgical management of knee osteoarthritis recommend treatments like physical therapy, patient education, and weight control, which are supported by high-quality guidelines as effective non-drug interventions for managing osteoarthritis.12345

Is the non-surgical management of knee osteoarthritis safe for humans?

The 2020 guidelines from the US Department of Veterans Affairs and Department of Defense for non-surgical management of knee osteoarthritis include recommendations on diagnosis, self-management, physical therapy, medications, and other treatments, suggesting a focus on safe practices. While specific safety data isn't detailed, the guidelines are based on a systematic review of evidence, indicating a consideration of safety in their development.12567

How is the DoD/VA CPG Core Set treatment for knee osteoarthritis different from other treatments?

The DoD/VA CPG Core Set treatment for knee osteoarthritis is unique because it combines a comprehensive set of guidelines developed by the Department of Defense and Veterans Administration, focusing on non-surgical management, including self-management, physical therapy, and complementary health approaches, which are tailored specifically for veterans and military personnel.358910

What is the purpose of this trial?

This study will compare two different treatment approaches for the management of knee osteoarthritis (OA). All subjects will receive a standardized approach consistent with the core set of recommendation from the Department of Defense (DoD) and Veterans Administration (VA) Clinical Practice Guidelines for Non-Surgical Management of Knee Osteoarthritis. Follow-up will occur over a 1 year period.

Research Team

DI

Daniel Rhon, PhD

Principal Investigator

Brooke Army Medical Center

Eligibility Criteria

This trial is for TRICARE beneficiaries aged 18-60 with knee pain and a diagnosis of knee osteoarthritis, who can attend treatment sessions over a month. It's not for those who've had recent invasive knee treatments, consulted a surgeon in the past year, or have conditions like severe neurologic disorders or systemic diseases that could explain their knee pain.

Inclusion Criteria

I can attend treatment sessions for 4 weeks.
I have seen or will see a doctor for knee pain within 3 months.
Satisfies American College of Rheumatology (ACR) clinical criteria for diagnosis of knee OA for at least one knee
See 4 more

Exclusion Criteria

My knee pain is not due to conditions like arthritis, gout, or injury.
Anyone leaving military service for other than regular retirement, pending a medical evaluation board, discharge from the military for medical reasons, or pending or undergoing any litigation for an injury
I have had knee surgery or injections in the past year.
See 5 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a standardized approach consistent with the core set of recommendations from the DoD and VA Clinical Practice Guidelines for Non-Surgical Management of Knee Osteoarthritis, with or without additional physical therapy

1 year

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 year

Treatment Details

Interventions

  • DoD/VA CPG Core Set
  • DoD/VA CPG Core Set + PT
Trial Overview The study compares two non-surgical treatments for managing knee osteoarthritis over one year. Everyone gets standard care based on DoD/VA guidelines; some also get additional physical therapy (PT). The goal is to see if adding PT improves outcomes.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: DoD/VA CPG Core Set + PTExperimental Treatment2 Interventions
In addition to DoD/VA clinical practice guidelines, patients will be referred to physical therapy (PT). Physical therapy will consist of evidence-based interventions that can be provided by a PT (exercise, manual therapy, education).
Group II: DoD/VA CPG Core SetActive Control1 Intervention
The standard core set of interventions recommended by the DoD/VA clinical practice guidelines for non-surgical management of knee OA.

DoD/VA CPG Core Set is already approved in United States for the following indications:

🇺🇸
Approved in United States as DoD/VA CPG Core Set for:
  • Non-Surgical Management of Knee Osteoarthritis

Find a Clinic Near You

Who Is Running the Clinical Trial?

Brooke Army Medical Center

Lead Sponsor

Trials
134
Recruited
28,100+

University of Utah

Collaborator

Trials
1,169
Recruited
1,623,000+

Findings from Research

Out of 20 clinical practice guidelines (CPGs) for osteoarthritis management, 11 were rated as high quality, emphasizing the importance of patient-centered care that includes exercise, education, and weight loss when appropriate.
For patients with disabling osteoarthritis that hasn't improved with nonsurgical treatments, nonsteroidal anti-inflammatory drugs and surgical options are recommended, along with the use of hand orthoses for those with hand osteoarthritis.
Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines.Conley, B., Bunzli, S., Bullen, J., et al.[2023]
A survey of 822 Italian physiotherapists revealed that while there is a good understanding of osteoarthritis clinical practice guidelines (CPGs), with consensus on 13 out of 24 statements, adherence to these guidelines is lacking.
Only 25% of physiotherapists were classified as 'Delivering' the recommended interventions for osteoarthritis, indicating a significant evidence-to-practice gap that could lead to suboptimal patient care.
Italian physiotherapists' knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study.Battista, S., Salvioli, S., Millotti, S., et al.[2022]
In a review of 1096 visits for knee osteoarthritis, adherence to the American Academy of Orthopaedic Surgeons' guidelines was only 65% for new patients and decreased to 40% for returning patients, indicating a need for better compliance with established treatment protocols.
The most common interventions were intra-articular injections and physical therapy, but the use of hyaluronic acid injections was notably expensive and contradicted by strong evidence against its effectiveness, highlighting the importance of aligning treatment choices with clinical guidelines.
Adherence to the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for Nonoperative Management of Knee Osteoarthritis.Meiyappan, KP., Cote, MP., Bozic, KJ., et al.[2022]

References

Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. [2023]
Italian physiotherapists' knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study. [2022]
Adherence to the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for Nonoperative Management of Knee Osteoarthritis. [2022]
A systematic critical appraisal for non-pharmacological management of osteoarthritis using the appraisal of guidelines research and evaluation II instrument. [2022]
Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. [2021]
Physical Therapy Management of Nontraumatic Shoulder Problems Lacks High-Quality Clinical Practice Guidelines: A Systematic Review With Quality Assessment Using the AGREE II Checklist. [2021]
Clinical practice guidelines: their use, misuse, and future directions. [2022]
Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of the hip and knee: a descriptive overview of published guidelines. [2020]
The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty? [2022]
Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis. [2022]
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