A Pragmatic Trial to Determine the Benefit of Behaviorally Enhanced Exercise Incentives and Corticosteroid Injections in Osteoarthritis of the Knee Marching On for Veterans With Osteoarthritis of the Knee
NCT ID: NCT05035810
Last Updated: 2025-03-20
Study Results
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Basic Information
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ACTIVE_NOT_RECRUITING
PHASE3
221 participants
INTERVENTIONAL
2022-03-14
2025-12-31
Brief Summary
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Detailed Description
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Promoting physical activity has been shown to be helpful in reducing pain and improving function in KOA and other groups. However, promoting behavioral change in the arthritis population is a significant challenge. The group has shown that social incentives \[and gamification\] derived from concepts from the field of behavioral economics to promote behavioral change and increase physical activity can be both practical and effective in other settings. The investigators' group is studying incentives in patients with inflammatory arthritis with the goal of addressing fatigue, pain, and deficits in physical function. The incentivization of physical activity using this approach represents a novel intervention for the managing symptoms of KOA and to improving overall health.
Analgesic therapies can help KOA patients participate in exercise therapy. However, whether corticosteroid injections, a commonly used medical therapy for KOA pain, has a positive impact of physical activity is unknown and is an additional important question addressed by the current proposal. Despite widespread use, definitive data demonstrating a consistent benefit of corticosteroids are lacking. A large randomized trial recently tested the effects of repeated corticosteroids injections every 3 months for a period of 2 years on patient reported pain as well as progression of disease measured by magnetic resonance imaging (MRI). This study demonstrated no improvement in pain compared to saline injections. In addition, a small but statistically significant decline in cartilage thickness on MRI was observed, raising a concern for side effects. These recent data might suggest that corticosteroid injections result in more harm than good, and may discourage providers from performing this intervention. However, there are critical weaknesses to this study. Pain and function were only assessed at 3-month intervals, while previous trials have suggested that peak benefit is expected at 4-8 weeks. Moreover, the clinical and biologic significance decrease in cartilage thickness is unclear.
The investigators propose to fill these important knowledge gaps with an innovative and efficient pragmatic clinical trial with a factorial and crossover design. A large and definitive practical trial would lead to better understanding of the clinical effectiveness of these interventions, the meaningfulness of their combined impact, and the subgroups that are most likely to derive benefit. This clinical trial will leverage unique resources available through the Penn Center for Innovation to better capture important patient-reported outcomes in real-time through a web-based platform. The study will also test the feasibility of a crossover and factorial design to improve efficiency and reduce confounding. Each patient will receive each intervention (saline, corticosteroids) in random order over 1 year. A factorial design will be employed and will randomize participants to receive social incentives with gamification to promote increases in their physical activity. To accomplish these aims, the investigators will utilize innovative mobile applications for smart phones and wearable activity trackers through the Way-to-Health platform and assess, in real time, the impact of the intervention on patient-reported function and pain as well as physical activity. The technology will allow for the recording of outcomes as they occur, between clinic visits, thereby avoiding information bias due to poor recall. It will also provide real-time assessment of symptoms, providing granular assessments of response over time.
Aim 1: To determine whether an incentive based on behaviorally-enhanced gamification can improve physical activity among patients with KOA and reduce self-reported pain and disability. The intervention will result in sustained improvements in average daily step counts over 10 months.
Aim 2: To determine if corticosteroid injections can reduce pain and disability in patients with KOA when compared to lidocaine only. Participants will report improvements in self-reported pain and disability, and improvements in quality of life.
Conditions
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Study Design
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RANDOMIZED
FACTORIAL
TREATMENT
DOUBLE
Study Groups
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Social Incentives and Gamification, Corticosteroid AB
Participants will receive a support person and be able to interact with a web-based platform to progress through levels based on their achievement of step goals.
The participants will receive injections in A-B order (corticosteroids, then lidocaine only)
Social Incentives and Gamification to Promote Exercise
The intervention will provide social incentives and gamification to promote physical activity.
Corticosteroid Injection given in A-B order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in A-B order.
No Incentive, Corticosteroid AB
Participants will only receive reminders to sync their activity monitor.
The participants will receive injections in A-B order (corticosteroids, then lidocaine only)
Corticosteroid Injection given in A-B order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in A-B order.
No Social Incentive applied
No social incentive will be applied
Social Incentives and Gamification, Corticosteroid BA
Participants will receive a support person and be able to interact with a web-based platform to progress through levels based on their achievement of step goals.
The participants will receive injections in B-A order (lidocaine only, then corticosteroids)
Social Incentives and Gamification to Promote Exercise
The intervention will provide social incentives and gamification to promote physical activity.
Procedure: Corticosteroid Injection given in B-A order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in B-A order.
No Incentive, Corticosteroid BA
Participants will only receive reminders to sync their activity monitor.
The participants will receive injections in B-A order (lidocaine only, then corticosteroids)
No Social Incentive applied
No social incentive will be applied
Procedure: Corticosteroid Injection given in B-A order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in B-A order.
Interventions
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Social Incentives and Gamification to Promote Exercise
The intervention will provide social incentives and gamification to promote physical activity.
Corticosteroid Injection given in A-B order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in A-B order.
No Social Incentive applied
No social incentive will be applied
Procedure: Corticosteroid Injection given in B-A order
The study will compare corticosteroid injections with lidocaine to lidocaine only in a crossover design. These participants will receive the medication in B-A order.
Eligibility Criteria
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Inclusion Criteria
* Chronic knee osteoarthritis
* Indication for joint injection
* Previous joint injections for palliation
* Patient expresses interest in increasing their physical activity
* Patient is able to walk 1/2 mile per day
Exclusion Criteria
* Lack of smart phone
* Acute exacerbation of osteoarthritis or knee pain
* Comorbid condition that precludes safe exercise
40 Years
80 Years
ALL
No
Sponsors
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VA Office of Research and Development
FED
Responsible Party
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Principal Investigators
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Joshua F. Baker, MD MSCE
Role: PRINCIPAL_INVESTIGATOR
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Locations
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Washington DC VA Medical Center, Washington, DC
Washington D.C., District of Columbia, United States
Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NE
Omaha, Nebraska, United States
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, Pennsylvania, United States
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, Washington, United States
Countries
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References
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Leach W, Doherty C, Olave M, England BR, Wysham K, Kerr G, Quinones M, Ogdie A, White D, Neogi T, Scanzello CR, Baker JF. Protocol for a multi-center randomized controlled trial to evaluate the benefits of exercise incentives and corticosteroid injections in osteoarthritis of the knee (MOVE-OK). Trials. 2022 Jul 27;23(1):604. doi: 10.1186/s13063-022-06529-w.
Gillcrist RL, Doherty CR, Olave M, Bonilla J, England BR, Wysham K, Quinones M, Scanzello CR, Ogdie A, White DK, Neogi T, Baker JF. A Remote Behaviorally Designed Intervention to Promote Physical Activity in Patients With Knee Osteoarthritis: Results of a Pilot Randomized Clinical Trial. J Clin Rheumatol. 2024 Dec 1;30(8):336-339. doi: 10.1097/RHU.0000000000002148. Epub 2024 Oct 16.
Provided Documents
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Document Type: Informed Consent Form
Other Identifiers
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RX003644-01A1
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
F3644-R
Identifier Type: -
Identifier Source: org_study_id
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