Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial
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Current treatment options for knee osteoarthritis have limited effectiveness and potentially adverse side effects. Massage may offer a safe and effective complement to the management of knee osteoarthritis.
Examine effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care.
Multisite RCT assessing the efficacy of massage compared to light-touch and usual care in adults with knee osteoarthritis, with assessments at baseline and weeks 8, 16, 24, 36, and 52. Subjects in massage or light-touch groups received eight weekly treatments, then were randomized to biweekly intervention or usual care to week 52. The original usual care group continued to week 24. Analysis was performed on an intention-to-treat basis.
Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments.
Sixty minutes of protocolized full-body massage or light-touch.
Primary: Western Ontario and McMaster Universities Arthritis Index. Secondary: visual analog pain scale, PROMIS Pain Interference, knee range of motion, and timed 50-ft walk.
At 8 weeks, massage significantly improved WOMAC Global scores compared to light-touch (− 8.16, 95% CI = − 13.50 to − 2.81) and usual care (− 9.55, 95% CI = − 14.66 to − 4.45). Additionally, massage improved pain, stiffness, and physical function WOMAC subscale scores compared to light-touch (p < 0.001; p = 0.04; p = 0.02, respectively) and usual care (p < 0.001; p = 0.002; p = 0.002; respectively). At 52 weeks, the omnibus test of any group difference in the change in WOMAC Global from baseline to 52 weeks was not significant (p = 0.707, df = 3), indicating no significant difference in change across groups. Adverse events were minimal.
Efficacy of symptom relief and safety of weekly massage make it an attractive short-term treatment option for knee osteoarthritis. Longer-term biweekly dose maintained improvement, but did not provide additional benefit beyond usual care post 8-week treatment.
KEY WORDSmassage osteoarthritis arthritis knee pain musculoskeletal pain
The team acknowledges the positive impacts and contributions of Ather Ali, ND, MPH, MHS, to their lives, with deep gratitude, love, and respect. We also thank Mary Carola (Rutgers), Michelle Pinto-Evans (Yale), and Gina Smith, MA (Yale), for coordinating study participants and entering data; Kim Turk, Kelly Cross, and Myra Blackwell (Duke); Lee Stang, Carol Nakagawara, Paula Jelly, and Susan Kmon (Yale); and Denise Ostopo-Gliozzi, Mariella Silva, and J. J. Long (Rutgers) for providing massage and light-touch interventions; Michael Patterson, PhD, DO, for developing the LT bodywork intervention; and the study subjects for their participation.
This study and publication were made possible by grant number R01AT004623 from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.
Compliance with Ethical Standards
All study materials were approved by the Institutional Review Boards of participating sites.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH.
- 3.Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2010-2012. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; November 8, 2013.Google Scholar
- 6.Fisher N, Pendergast D. Reduced muscle function in patients with osteoarthritis. Scand J Rehab Med. 1997;29:213–221.Google Scholar
- 12.Messier S, Loeser R, Hoover J, Semble E, Wise C. Osteoarthritis of the knee: effects on gait, strength, and flexibility. Arch Phys Med Rehabil. 1992;73:29–36.Google Scholar
- 14.National Center for Complementary and Alternative Medicine. NCCAM backgrounder: massage therapy: an introduction. Vol NCCAM Publication No. D3272010.Google Scholar
- 15.Barnes PM, Bloom B, Nahin RL, Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep. 2008(12):1–23.Google Scholar
- 16.Perlman A, Meng C. Rheumatology. In: Leskowitz E, ed. Complementary and alternative medicine in rehabilitation. St. Louis: Harcourt Heath Sciences; 2003:352–362.Google Scholar
- 17.Perlman A, Spierer M. Osteoarthritis. In: Rakel D, ed. Integrative medicine. Orlando: W.B. Saunders Co.; 2003:414–422.Google Scholar
- 18.Perlman A, Weisman R. Own your own health - the best of alternative and conventional medicine: pain Deerfield Beach: Health Communications, Inc.; 2006.Google Scholar
- 20.Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Rep. 2015(79):1–16.Google Scholar
- 23.Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29(8):1039–1049.CrossRefGoogle Scholar
- 25.Bellamy N, Buchanan W, Goldsmith C, Campbell J, Stitt L. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.Google Scholar
- 26.Bellamy N. The WOMAC knee and hip osteoarthritis indices: development, validation, globalization and influence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol. 2005;23(5 suppl 39):S148-S153.Google Scholar
- 28.Anagnostis C, Mayer TG, Gatchel RJ, Proctor TJ. The million visual analog scale: its utility for predicting tertiary rehabilitation outcomes. Spine. 2003;28(10):1051–1060.Google Scholar
- 30.Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Care Res 2001;45:384–391.CrossRefGoogle Scholar
- 44.Szalavitz M. Study: taking just a little too much tylenol each time can be deadly. Pain. 2011. http://healthland.time.com/2011/11/23/study-taking-just-a-little-too-much-tylenol-each-time-can-be-deadly/. Accessed 11/5/18