- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03835910
A Pragmatic Trial To Determine the Benefit of Exercise Incentives and Corticosteroid Injections in Osteoarthritis of the Knee (MOVE-OK)
A Pragmatic Trial to Determine the Benefit of Exercise Incentives and Corticosteroid Injections for Osteoarthritis of the Knee
Study Overview
Status
Conditions
Detailed Description
Knee osteoarthritis (KOA) is one of the most prevalent and disabling conditions among Veterans and accounts for high morbidity and high costs for the VA. Management of KOA is challenging as there are few consistently effective treatments other than joint replacement. Importantly, chronic reductions in physical activity in patients with KOA may worsen pain, physical function, and exacerbate the metabolic consequences of obesity. Moreover, the greater mortality observed in symptomatic knee OA populations is likely mediated through its effect on physical activity. The current proposal aims to derive preliminary data to support a large pragmatic trial testing the impact of interventions geared towards improving physical activity and function in KOA patients.
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 of 32-40 patients 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. The investigative team includes early career investigators with experience conducting similar trials using this infrastructure. Results will provide preliminary data to power a large, feasible, and low-cost pragmatic multi-site trial that would lead to practical implementation. The specific aims of the study are:
Aim 1: To determine the feasibility of recruitment and retention of Veterans with osteoarthritis of the knee (KOA) in a practical trial using an innovative online trial platform incorporating mobile activity monitors. The investigators expect to recruit and retain 32 Veterans within 1 year.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Veterans in VA Rheumatology or Orthopedic clinics
- 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:
- Intra-articular hardware or other contraindication to joint injection
- Lack of smart phone
- Acute exacerbation of osteoarthritis or knee pain
- Unable or unwilling to identify a social sponsor
- Comorbid condition that precludes safe exercise
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 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) |
The intervention will provide social incentives and gamification to promote physical activity.
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.
|
Active Comparator: 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) |
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 will be applied
|
Experimental: 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) |
The intervention will provide social incentives and gamification to promote physical activity.
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.
|
Active Comparator: 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 will be applied
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.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percent change from baseline in weekly average steps per day
Time Frame: Measured weekly over 3-10 months
|
Steps measured by a wearable activity monitor
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Measured weekly over 3-10 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Knee Injury and Osteoarthritis Outcome Score (KOOS)
Time Frame: Measured bi-weekly over 3-10 months
|
KOOS assessed by survey at 2 week intervals.
KOOS scores range from 0 to 100 with 0 representing worse knee problems and 100 representing no knee problems.
|
Measured bi-weekly over 3-10 months
|
Change in PROMIS pain intensity score
Time Frame: Measured bi-weekly over 3-10 months
|
Assessed by survey at 2 week intervals.
Scores range from 3-15 and are converted to T-Scores.
A high score represents greater pain.
|
Measured bi-weekly over 3-10 months
|
Change in PROMIS Fatigue
Time Frame: Measured every 4 weeks over 3-10 months
|
Assessed by survey at 4 week intervals
|
Measured every 4 weeks over 3-10 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Joshua F. Baker, MD MSCE, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- F3157-P
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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