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Massage therapy more effective in treating knee OA than usual care
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July 2013
Massage therapy more effective in treating knee OA than usual care
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial
PLoS One. 2012;7(2):e30248. doi: 10.1371/journal.pone.0030248. Epub 2012 Feb 8Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
125 patients were randomized to evaluate the efficacy of massage therapy in treating knee osteoarthritis (OA). Patients received one of four 8-week programs of Swedish massage regimen (30 or 60 min weekly or biweekly) or a Usual Care control. The results at 8 weeks revealed that the 60-minute massage groups displayed significantly better improvements than the control group in the WOMAC subscales of pain and functionality, as well as the VAS pain scale. However, no significant differences were observed in range of motion.
Publication Funding Details
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Funding:
Non-Industry funded
Sponsor:
National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health.
Conflicts:
Other
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
4/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Currently, about 27 million Americans are affected by osteoarthritis (OA), a progressive degenerative disease of the joints. While massage therapy could be an effective option to manage OA pain, there are relatively few studies that examine the efficacy of this treatment. Therefore, this study aimed to identify a dose and treatment regimen of an 8-week Swedish massage therapy for knee OA that would be both optimal (provide greatest effectiveness) and practical (minimize patient cost and inconvenience).
What was the principal research question?
Did a Swedish massage regimen provide better clinical outcomes for the treatment of knee OA than Usual Care control, assessed at 24 weeks?
Study Characteristics
-
Population:
125 patients (at least 35 years of age) with radiographically-diagnosed OA of the knee.
Intervention:
Group 1: Patients received 30 minutes of massage weekly for eight weeks.
Group 2: Patients received 30 minutes of massage twice weekly for the initial four weeks, and once weekly for the remaining four weeks.
Group 3: Patients received 60 minutes of massage weekly for eight weeks.
Group 4: Patients received 60 minutes of massage twice weekly for the initial four weeks, and once weekly for the remaining four weeks.
Comparison:
Usual Care group (control): Patients continued with their current treatment without the addition of massage therapy.
Outcomes:
The primary outcome measure involved the change in the Western Ontario and McMaster Universities Arthritis Index (WOMAC-Global). Secondary measures included: pain that was measured through a visual analog scale (VAS), a validated mechanical scale used to measure pain sensation intensity evoked by nociceptive stimuli, joint flexibility (range of motion (ROM) allowed at the knee during flexion using a double-armed goniometer), and time to walk 50 feet (15 m) on a level surface within the clinic facilities.
Methods:
RCT
Time:
24 weeks (assessed at baseline, 8 weeks, 16 weeks, and 24 weeks post-baseline).
What were the important findings?
- WOMAC Global score displayed a significant improvement (24.0 points, 95% CI range: 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI range: 0.1-12.8) after 8 weeks; no statistically significant differences were observed between massage groups at this time point.
- For the WOMAC pain subscale, all massage groups produced significant improvement (P < 0.05) from baseline at weeks 8, 16, and 24 for the three highest doses of massage (groups 2, 3, and 4), while no improvement was seen in the Usual Care at any time point (P > 0.05).
- According to the VAS scale, pain perception improved significantly (31.2-39.8 points, 95% CI range: 22.9-48.1 points) in both 60-minute dose groups (groups 3 and 4) compared to Usual Care at 8 weeks, although there were no significant differences between groups 3 and 4.
- Decreased pain perception was observed in all treatment groups at all time points compared to baseline.
- While every group (except group 1 at week 8) displayed decreased time to walk 50 feet at all times, there were no significant differences between the groups at any time point (P > 0.05).
- No significant between-group differences were observed in range of motion after 8 weeks; however, all massage groups changed in the positive direction.
What should I remember most?
This study demonstrated that there was more improvement in the WOMAC Global scores with greater total dose (minutes) of massage. At 8 weeks 16 and 24, every massage group displayed significant improvements in WOMAC Global scores compared to baseline, a change unseen in the Usual Care group.
How will this affect the care of my patients?
This study established an optimal dose of 60-minute Swedish massage therapy (once weekly in 8 weeks) regimen for OA of the knee. While this type of intervention is difficult to conclusively prove its efficacy, physicians may be inclined to prescribe massage therapy as a possible conservative treatment for patients with painful OA.
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