879 Participants Needed

Physical Therapy for Osteoarthritis

(TeMPO Trial)

Recruiting at 3 trial locations
JN
FS
Overseen ByFaith Selzer, PhD
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Brigham and Women's Hospital
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

Knee osteoarthritis is a disabling problem affecting over 15 million adults in the United States. Many people who have knee arthritis also experience painful meniscal tears. There are a number of different treatments that can be used to manage meniscal tears in the presence of knee arthritis. Treatments include surgically removing the damaged part of the meniscus; strengthening exercises to improve pain and function; manual therapy including massage and mobilization; acupuncture; and others. The combination of surgery and exercise therapy was long thought to be the best treatment. However, recent studies have shown that surgery followed by physical therapy is no more effective than physical therapy by itself.While physical therapy alone has been shown to result in similar pain relief as arthroscopic surgery, researchers have not yet done studies to determine what type of physical therapy is best for people with knee arthritis and meniscal tears. In the "TeMPO" Trial, we will be comparing 4 different, non-operative physical therapy regimens in order to gain a better understanding of how physical therapy works and what regimen will best reduce pain and improve function in persons with meniscal tear and osteoarthritis. The four arms in this randomized trial will contain different combinations of therapeutic treatments including in-clinic therapist-supervised exercise, in-clinic topical therapies, and exercises to be completed at home. Subjects in three of the arms will also receive motivational SMS (text) messages intended to improve adherence to the home exercise regimen.TeMPO is designed as a randomized controlled trial. Participants will be assigned randomly to one of the four arms. All arms include therapies that have been previously shown to work in clinical settings. One arm also contains some placebo treatments. The placebo treatments will help us to understand what aspects of physical therapy actually make people feel better.Our hypothesis is that subjects in the arm that includes in-clinic physical therapy and a home exercise regimen will experience more pain relief than subjects in each of the other arms. Also, we expect that subjects in the arm that receives the home exercise regimen and SMS messages will experience more pain relief than subjects in the arm that receives home exercise without the SMS messages.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you are using strong opioids daily or have had intra-articular therapy in the last 4 weeks, you may not be eligible to participate.

Is physical therapy for osteoarthritis safe?

Topical treatments for osteoarthritis, like topical NSAIDs, are generally considered safe, especially for older adults, as they have fewer risks compared to oral NSAIDs. Exercise programs, when supervised and cleared by a doctor, are also safe for elderly individuals, even those with limited mobility or chronic illnesses.12345

How is the TeMPO Home Exercise Program treatment different from other treatments for osteoarthritis?

The TeMPO Home Exercise Program is unique because it allows patients to perform physical therapy exercises at home, which can be more convenient and cost-effective compared to traditional office-based physical therapy sessions. This approach is particularly beneficial for older adults or those living in remote areas, as it reduces the need for travel and professional supervision while still being as effective as in-person therapy.678910

What data supports the effectiveness of this treatment for osteoarthritis?

Research shows that both in-clinic and home-based exercise programs can help reduce pain and improve function in people with knee osteoarthritis. Additionally, physical therapist-led exercise interventions have been found to enhance these benefits.611121314

Who Is on the Research Team?

CW

Chuck Washabaugh, PhD

Principal Investigator

National Institute for Arthritis, Musculoskeletal and Skin Diseases (NIAMS, NIH)

Are You a Good Fit for This Trial?

This trial is for adults aged 45-85 with knee pain from a meniscal tear and osteoarthritis, confirmed by MRI or X-ray. Candidates must have had knee pain for at least 21 days if it's due to injury. Exclusions include inflammatory arthritis, recent knee surgery, pregnancy, MRI contraindications, strong opioid use, recent joint therapy, nursing home residents, dementia history or worker's compensation claimants.

Inclusion Criteria

Evidence on MRI of meniscal tear
Evidence of osteoarthritic changes on imaging: Cartilage damage on MRI, osteophyte or joint space narrowing on X-ray
I have had knee pain for at least 21 days due to an injury, or any duration if not from an injury.
See 2 more

Exclusion Criteria

Current claimant of worker's compensation for this condition
Contraindication to MRI
Currently resides in a nursing home
See 7 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are assigned to one of four physical therapy regimens, including home exercises, SMS messages, in-clinic topical therapy, and in-clinic exercise therapy

12 weeks
14 in-clinic sessions for some arms

Follow-up

Participants are monitored for changes in pain, function, and quality of life

3 months

Long-term Follow-up

Participants are monitored for durability of pain relief and treatment outcomes

9 months

What Are the Treatments Tested in This Trial?

Interventions

  • In-Clinic Exercise Therapy
  • In-Clinic Topical Therapy
  • Motivational SMS Messages
  • TeMPO Home Exercise Program
Trial Overview The TeMPO Trial compares four non-surgical physical therapy regimens to see which best reduces pain and improves function in people with meniscal tears and osteoarthritis. It includes in-clinic exercises, topical therapies, home exercises and motivational texts. One group will receive placebo treatments to identify effective therapy aspects.
How Is the Trial Designed?
4Treatment groups
Experimental Treatment
Group I: 4. In-Clinic Exercise TherapyExperimental Treatment3 Interventions
Subjects in this arm will receive the TeMPO Home Exercise Program, SMS motivational messages to encourage them to adhere to the TeMPO Home Exercise Program and 14 in-clinic sessions with a trained physical therapist. The therapist will supervise the participant in a rigorous set of strengthening and stretching exercises.
Group II: 3. In-Clinic Topical TherapyExperimental Treatment3 Interventions
Subjects in this arm receive the TeMPO Home Exercise Program, motivational SMS messages to encourage them to adhere to the TeMPO Home Exercise Program, and 14 in-clinic sessions with a trained physical therapist. The therapist will apply topical therapies: ultrasound, gel, and manual therapy.
Group III: 2. Home Exercise Program + SMS MessagesExperimental Treatment2 Interventions
Subjects in this arm receive the TeMPO Home Exercise Program and motivational SMS messages to encourage them to adhere to the TeMPO Home Exercise regimen.
Group IV: 1. Home Exercise ProgramExperimental Treatment1 Intervention
The Home Exercise group receives the TeMPO Home Exercise Program (including a set of weights, a DVD showing how to complete the TeMPO exercises, and a pamphlet outlining instructions on how to complete the exercises and how often should they be done).

Find a Clinic Near You

Who Is Running the Clinical Trial?

Brigham and Women's Hospital

Lead Sponsor

Trials
1,694
Recruited
14,790,000+

State University of New York at Buffalo

Collaborator

Trials
279
Recruited
52,600+

National Institutes of Health (NIH)

Collaborator

Trials
2,896
Recruited
8,053,000+

Boston University

Collaborator

Trials
494
Recruited
9,998,000+

The Cleveland Clinic

Collaborator

Trials
1,072
Recruited
1,377,000+

University of Pittsburgh

Collaborator

Trials
1,820
Recruited
16,360,000+

University of Melbourne

Collaborator

Trials
193
Recruited
1,287,000+

Published Research Related to This Trial

Participants with knee osteoarthritis who attended more physical therapy (PT) visits showed significant improvements in overall knee function and pain, with benefits lasting up to 8 months after treatment, based on a study of 259 individuals.
In contrast, the use of an internet-based exercise training (IBET) program did not lead to significant improvements in any measured outcomes, suggesting that traditional PT may be more effective for managing knee osteoarthritis.
Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis.Pignato, M., Arbeeva, L., Schwartz, TA., et al.[2019]
A study involving 80 patients with knee osteoarthritis showed that both home exercise programs significantly improved knee range of motion, muscle strength, and overall function, as measured by various health indices.
However, patients who received guidance from a physiotherapist experienced greater improvements compared to those who followed an exercise brochure alone, highlighting the added value of professional support in home exercise therapy.
Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis.Yilmaz, M., Sahin, M., Algun, ZC.[2019]
In a randomized controlled trial involving 209 elderly participants (average age 80), a home-based exercise program was found to be generally safe, with 151 adverse events reported, affecting 47% of participants.
Despite the program's safety, 14% of the adverse events were serious, highlighting that high levels of pre-existing morbidity in this population can pose challenges to maintaining consistent exercise participation.
Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices.Hinrichs, T., Bücker, B., Wilm, S., et al.[2015]

Citations

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis. [2019]
Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. [2022]
Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis. [2019]
Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. [2022]
Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial). [2023]
Disease remission and sustained halting of radiographic progression with combination etanercept and methotrexate in patients with rheumatoid arthritis. [2022]
The NSAID dilemma: managing osteoarthritis in high-risk patients. [2013]
Evolution of topical NSAIDs in the guidelines for treatment of osteoarthritis in elderly patients. [2021]
Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices. [2015]
Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review. [2022]
Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial. [2018]
12.United Statespubmed.ncbi.nlm.nih.gov
Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series. [2020]
13.United Statespubmed.ncbi.nlm.nih.gov
Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial. [2019]
14.United Statespubmed.ncbi.nlm.nih.gov
Clinical outcomes following manual physical therapy and exercise for hip osteoarthritis: A case series. [2006]
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