This action might not be possible to undo. Are you sure you want to continue?
Massage Therapy for Osteoarthritis of the Knee
A Randomized Controlled Trial
Adam I. Perlman, MD, MPH; Alyse Sabina, MD; Anna-Leila Williams, PA-C, MPH; Valentine Yanchou Njike, MD; David L. Katz, MD, MPH
Background: Massage therapy is an attractive treatment option for osteoarthritis (OA), but its efficacy is uncertain. We conducted a randomized, controlled trial of massage therapy for OA of the knee. Methods: Sixty-eight adults with radiographically con-
firmed OA of the knee were assigned either to treatment (twice-weekly sessions of standard Swedish massage in weeks 1-4 and once-weekly sessions in weeks 5-8) or to control (delayed intervention). Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores and the visual analog scale of pain assessment. The sample provided 80% statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale, with a 2-tailed of .05.
Results: The group receiving massage therapy demonstrated significant improvements in the mean (SD)
WOMAC global scores (−17.44 [23.61] mm; P .001), pain (−18.36 [23.28]; P .001), stiffness (−16.63 [28.82] mm; P .001), and physical function domains (−17.27 [24.36] mm; P .001) and in the visual analog scale of pain assessment (−19.38 [28.16] mm; P .001), range of motion in degrees (3.57 [13.61]; P=.03), and time to walk 50 ft (15 m) in seconds (−1.77 [2.73]; P .01). Findings were unchanged in multivariable models controlling for demographic factors.
Conclusions: Massage therapy seems to be efficacious in the treatment of OA of the knee. Further study of cost effectiveness and duration of treatment effect is clearly warranted. Trial Registration: clinicaltrials.gov Identifier:
NCT00322244 Arch Intern Med. 2006;166:2533-2538 of the OA disease process is total loss of joint cartilage in the affected area and the need for joint replacement. Conventional treatments for OA include pain medication (nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors), exercises, hot and cold therapy, corticosteroid injections, and, eventually, surgery to repair the joint.8 Despite conventional treatment, OA is often progressive and frequently leads to chronic pain and disability.11 The potential toxic effects of drugs used commonly to treat OA have been especially newsworthy of late.12,13 Massage therapy may diminish symptoms and improve the course of OA by increasing local circulation to the affected joint, improving the tone of supportive musculature, enhancing joint flexibility, and relieving pain.14 Massage therapy has been evaluated and found to be effective for various painful musculoskeletal con-
Author Affiliations: Institute for Complementary and Alternative Medicine, University of Medicine and Dentistry of New Jersey, Newark (Dr Perlman); Yale Prevention Research Center, Yale University School of Medicine, Derby, Conn (Drs Sabina, Njike, and Katz and Ms Williams).
STEOARTHRITIS (OA) AFflicts as many as 21 million Americans.1,2 It is a dynamic process involving an imbalance in tissue homeostasis with cartilage, synovial fluid, subchondral bone, and other joint tissues and structures3,4 and becomes more prevalent with advancing age.5 By 2020, more than 50 million Americans will have OA,6,7 which is the most frequently reported chronic condition in the elderly population.5,8 The Centers for Disease Control and Prevention highlights OA as a chronic condition that causes more physical limitation than lung and heart disease and diabetes mellitus.9 The total cost of OA was estimated at $60 billion in 2004.10 Osteoarthritis of the hip or knee is particularly disabling because it limits ambulation, but the affliction also strikes the hands, the spine, and the feet with the same destructive joint process.5,8 The end point
(REPRINTED) ARCH INTERN MED/ VOL 166, DEC 11/25, 2006 2533
Downloaded from www.archinternmed.com on May 2, 2011 ©2006 American Medical Association. All rights reserved.
Additional outcome measures assessed at each visit included the VAS for pain assessment. Continuous data are WWW. the University of Medicine and Dentistry of New Jersey. Usual care included pain medications. followed by once-weekly massage sessions for weeks 5 through 8. blocked (blocks of 6) random allocation sequence. 100 mm. stiffness. significant injury to the knee within the previous 6 months. located in the Saint Barnabas Ambulatory Care Center in Livingston. and tapotement (percussion-based massage where hands strike soft tissue in a repetitive. a standard protocol incorporating specific strokes (effleurage. Participants were instructed to keep a daily medication usage diary. then crossed over to receive massage (weeks 9-16) after an initial 8-week delay. Patients with bilateral knee involvement had the more severely affected knee designated as the study knee. Livingston. to date.19 Each patient provided written informed consent prior to enrollment. and physical functional disability in patients with knee and hip OA using a series of 24 questions.05. RANDOMIZATION AND SAMPLE SIZE A research coordinator randomly assigned enrolled participants to receive either 8 weeks of massage therapy intervention (hereafter. Eligible patients were men and women with radiographically established OA of the knee who met American College of Rheumatology criteria. OUTCOME MEASUREMENTS All measurements were collected at baseline and after completion of intervention (at weeks 8 and 16) in both groups. All rights reserved. and severity) were recorded by the research coordinator during her routine weekly telephone call to each participant. arthroscopy of the knee within the previous year.22 Massage sessions were 1-hour long. exercises. 2006 2534 Downloaded from www. use of oral corticosteroids within the past 4 weeks. Exclusion criteria were the presence of rheumatoid arthritis. signs or history of kidney or liver failure. The control group continued to receive conventional medical care during the initial intervention period. DEC 11/25. turning over at roughly the halfway point. or a rash or open wound over the knee. a particular sequence of strokes was not specified. and adverse events (complaint. time in seconds to walk a 50-ft (15-m) straight path. To minimize practitioner variability of treatment. Initial (weeks 1-4) treatments were given with greater frequency (twice weekly) to build a loading dose of massage treatments. or other serious medical conditions. effleurage (gliding of hands over the skin or soft tissues). cancer.com on May 2. STUDY INTERVENTIONS Two licensed massage therapists certified by the National Certification Board for Therapeutic Massage and Bodywork provided the massage therapy. Conn.24 The WOMAC global score was computed as the unweighted mean of all 24 items. approved the study.archinternmed. and had a prerandomization score of 40 to 90 on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) pain assessment scale (0 mm indicates no pain. recurrent or active pseudogout. Griffin Hospital. The intervention was developed in conjunction with Yale Prevention Research Center (Derby. or intraarticular hyaluronate within the previous 6 months. The WOMAC is a self-administered 3-dimensional questionnaire that assesses pain. NJ. fibromyalgia.7 mm) was derived from the VAS walking pain score at 6 weeks in the acetaminophen-treated arm as reported by Geba et al. The control group continued with their usual care before starting the intervention. Volunteers were screened for eligibility over the telephone. The therapists used a standard Swedish full-body therapeutic massage technique20 and a standard protocol for the study intervention. New Haven. Newark.15. The institutional review boards of the Saint Barnabas Medical Center. system.18 Written confirmation of OA of the knee was provided by the patient’s physician. the control group) followed by the intervention using a computer-generated. METHODS man Investigation Committee of Yale University. Study personnel met with the massage therapists at regular intervals to assure compliance with the protocol. which included petrissage ´ (compression or manipulation of soft tissue between the fingers and thumb).23 The WOMAC scores were standardized by calculating the mean of the corresponding unweighted item scores in each dimension. asthma requiring use of corticosteroids. Derby. worst pain ever). petrissage. Participant recruitment involved informational letters to patients with OA at the Arthritis and Rheumatic Diseases Center at Saint Barnabas Ambulatory Care Center and institutional review board–approved fliers distributed at the Saint Barnabas Ambulatory Care Center and nearby senior living facilities and to practicing primary care physicians in the area.ARCHINTERNMED. All 24 WOMAC items are rated on a numerical rating scale (in millimeters) ranging from 0 (no symptoms/no limitation) to 100 (maximal symptoms/maximal limitation). A sample size of 66 subjects was determined to provide 80% statistical power to detect a 20-point difference between intervention and control groups at 8 weeks in the change on the WOMAC and VAS scores for walking pain. no study has specifically evaluated the effectiveness of massage therapy for OA. and the Hu- STATISTICAL ANALYSIS Descriptive statistics for each relevant variable at baseline were determined to justify parametric methods.16 However. rhythmic fashion) techniques used at the therapists’ discretion. the intervention group) or 8 weeks of usual care on a wait-list (hereafter.21. range of motion in degrees using a standard goniometric assessment as performed by a trained research assistant at the center. Demographic data and medical history were documented by the research coordinator. 2011 ©2006 American Medical Association. ´ or tapotement) was used.ditions. intra-articular knee depocorticosteroids within the previous 3 months. Conn) and conducted at the Siegler Center. Participants remained supine or prone for the full hour of treatment.COM (REPRINTED) ARCH INTERN MED/ VOL 166. or hot and cold therapy. to our knowledge.18 A negative change in WOMAC scores from baseline indicates improvement of symptoms and limitation whereas a positive change indicates deterioration of symptoms and limitation. however. The standard deviation (25. . which is a 100-mm-long visual scale on which the participant draws a line to designate their level of pain at interview. with an of . Study personnel prompted subjects for all scheduled appointments to minimize attrition.17 were at least 35 years of age. We performed a randomized. wait-list controlled trial of 8 weeks’ duration of Swedish massage therapy for OA of the knee. PARTICIPANTS Patients were recruited from January to July of 2003 from the Saint Barnabas Health Care System (the Carol and Morton Siegler Center for Integrative Medicine and the Arthritis and Rheumatic Diseases Center).
Approximately 82 (39%) of those screened were ineligible. and physical functional disability: −17. PARTICIPANTS Of 210 candidates screened. however.15 [22. No.19 [24.6 (13.27 [24.001. P .com on May 2. The greatest improvement from baseline in the intervention group was observed in pain (−23.8) 55.77‡ 34 Allocated to Intervention Group Massage Therapy for 8 Weeks 23 Followed Up at 8 Weeks Usual Care for 8 Weeks 15 Followed Up at 16 Weeks 34 Allocated to Control Group Usual Care for 8 Weeks 30 Followed Up at 8 Weeks Massage Therapy for 8 Weeks 18 Followed Up at 16 Weeks Characteristic Age.001).ARCHINTERNMED.82] mm) vs the control group (40. and the clinical assessment for range of motion between the treatment groups were measured using repeated measures analysis of variance.56 [15. the mean (SD) WOMAC pain score was higher (P = . body mass index.3) Control (n = 34) 66.10 (18.84. P . mm Pain Stiffness Functionality Global VAS pain score. At the 16-week assessment.50 Abbreviations: BMI.08 [17.6 (8. The combined effect of independent variables (demographics. P .19 [24. The mean (SD) WOMAC global scores improved significantly from baseline (−17. Significant improvement was observed in all domains (pain: −18. 68 subjects participated (34 subjects per group) (Figure). EFFICACY RESULTS The mean (SD) WOMAC global score improved significantly from baseline value (−21. P=. pooled study sample are thus available and are shown in Table 2. †P values were obtained from 2-tailed t test.11 .6 (20.02 . P . Changes in WOMAC and VAS scores. Analysis followed an intention to treat design (ie. and physical functional disability) (Table 2). 2006 2535 Downloaded from www.9) 62. All rights reserved.007.05. The paired t test was used to examine the change in scores from baseline to follow-up examination.15 [22.9 (17. P = .59 . and investigators’ baseline assessment for range of motion) and treatment assignment on WOMAC and VAS scores. Participant flowchart.2 (19.3) 28.68 Subjects Table 1.58] mm. stiffness. The 95% confidence intervals were determined for changes from baseline. A similar pattern was observed in the VAS and the clinical assessment for range of motion.02) in the intervention group (52.001) followed by stiffness (−21.01] mm) at baseline. Findings persisted after controlling for demographic and baseline clinical values.82] mm. Cary.1 (7. SAS Institute. No.0) 52. VAS.7) 8 (23) 26 (76) 29 (85) 5 (14) 52.001. s .36] mm. *Values are presented as mean (SD) except where noted.28] mm. Improvements observed in the intervention group differed significantly from the control group (pain: −23.8) 60. visual analog scale. P . NC). (%) White Other WOMAC score.16] mm.002.23 .50] mm vs −0.8 (18.6) 47.36 [23.69 [20. global. VAS.0 (6. presented as mean (SD) in the text and tables.60 [26.001.2 (21.4) 15. time to walk 50 ft (15 m).2.99] mm.001) and physical function (−20. body mass index (calculated as weight in kilograms divided by height in meters squared).4 (11. Within-group intervention effects for the entire.0) 115. Significance for the 2-tailed t test was set at P . and the clinical assessment for range of motion was assessed with multivariable models using analysis of variance. P . the last value carried forward).7) 16. 2011 ©2006 American Medical Association.03. (%) Male Female Race. time to walk 50 ft (15 m).2 (11.13 . and range of motion scores at baseline did not differ between groups.001). P .11 . The control group in this trial received the intervention after an initial delay of 8 weeks and thus became a second intervention group during weeks 9 to 16 (Figure). respectively).60 [26. P .001).46] mm vs −4. physical functional disability: −20.8) 54.34 (18. DEC 11/25.29 [24.50 [22. baseline WOMAC and VAS scores.50] mm.001) of the WOMAC score.61]. functionality.44 [23. Comparing the improvements observed in the intervention group at week WWW. and 3. mm Range of motion. P .3) 109. The WOMAC findings were validated with the VAS findings and the clinical assessment for range of motion using correlation coefficients.85] mm.9) 67.61] mm.37] mm.001. improvements seen in the intervention group (massage intervention ceased at 8 weeks) largely persisted (Table 3).3) 29. No significant change was observed in the control group from baseline in any of the domains.6 (19.1 (18.3 (21. ‡P values obtained from 2 test.99] mm vs −4. y BMI Sex.38 [28. P . Demographic and Baseline Characteristics by Treatment Group* Intervention (n = 34) 70.6) 7 (20) 27 (79) 29 (85) 5 (14) 40.4) 49.02 [16. P=.12 .COM (REPRINTED) ARCH INTERN MED/ VOL 166. Western Ontario and McMaster Universities Osteoarthritis Index. as did the score in each domain (pain.8 (16. WOMAC. stiffness: −16.archinternmed.99‡ Figure.46] mm.001).001). Data were analyzed using SAS statistical software (version 8.40 . and global score: −21. The change observed in VAS was highly correlated to the change in the WOMAC global score (r =0. P . .7 (5. degree Time to walk 50 ft (15 m).63 [28.57 [13. P .10 [18.6) P Value† . The VAS and range of motion scores also improved significantly from baseline (−19.18] mm.30] mm. The study groups were comparable at baseline (Table 1). and 60 (28%) were unable to complete screening or were uninterested.30] mm vs −3. RESULTS . The stiffness.50 [22. stiffness: −21.
37].23 (19.44 to 2.82) P Value‡ .86 0. All rights reserved.99 to −13.06 (14.19 Variable WOMAC score. 1 reported increased discomfort and refused to return for the 8-week assessment.03 (7. d .01 (14.64 to 0. P=. s Abbreviations: CI.73) 3.35 to −12.14) −1. Change in Outcome Measures from Baseline at 8 and 16 Weeks* At 8-wk Follow-up† Intervention Group (n = 34) −23.17 to −1.02). d =[ I(intervention at 8 weeks) – C control at 8 weeks]/pooled SD (ie. and time to This study suggests that massage therapy using the Swedish technique is safe and effective for reducing pain and improving function in patients with symptomatic OA of the knee.01 to 3.18 (30.44 to 1.45) (3.92) Intervention Group at 16-wk Follow-up (n = 34) −18. 2006 2536 Downloaded from www.09) (−2.59 (25.14) −5. COMMENT Abbreviations: CI.20 to −12.61) (0.30) (−31.20) (−6.72) −16.29 (24.51 (22. mm Pain Stiffness Functionality Global VAS pain score. ‡P values are for baseline to 8-week and 16-week measurement differences within-group paired t test.27 (24.96) (−3.001 . our findings are a conservative estimate of the magnitude of treatment effect.50) (−28.003 .36 (23. mm Pain Stiffness Functionality Global VAS pain score.09 to 0.74 0.97 (21.44 (23.48) (−22.001 .32 to 5. mm Range of motion.10 .29 to −7. mm Range of motion.73 to 0.50) P Value‡ .56 (15.001 .08 (17.73) −19.28) (−23.85) (−10.97) −13. P =.97) −1.21 to 3.23 [19.89) 0. WOMAC global score (−17.14) −5.37) (−10. 2011 ©2006 American Medical Association. WWW.15) (−24.08 to −10.001 .97) −1.17 to 5.20) (−6.57) 3.52 [22.59 .02 (16. P = .17 to −11. The 95% CI is for the measured change from baseline to follow-up assessment.44 to 1.08 [17.18) (−12.001 . 16 (ie.12 to −4.15 (21.06) −4.73 to 4.51] mm vs −3.24 (4.004 .63 (28.001 . residual mean (SD) differences in pain (−18.37 to −10. Data are given as mean (SD) (95% CI). †For P .50 (22.27 to −5. degree Time to walk 50 ft (15 m).44) P Value‡ .002 .24) (−26.05 .15 (22. visual analog scale. Western Ontario and McMaster Universities Osteoarthritis Index. WOMAC.72 to −0. Effect size.58) (−9.COM (REPRINTED) ARCH INTERN MED/ VOL 166.02) −17. These effects are greater than those observed by Witt et al28 in a large acupuncture trial of similar design.27 to 6. at the end of their nonintervention period) revealed significant.ARCHINTERNMED.58] mm.005).63) −2.02 (16.65 to −13.87 (5.28 (3.28) (−23.18) (−12.001 Control Group (n = 34) −3. function (−17.24 (4. Massage has previously shown promise for other musculoskeletal conditions such as rheumatoid arthritis and fibromyalgia.99) (−31. P=.05 [20. intervention plus control at 8 weeks).79 0. Western Ontario and McMaster Universities Osteoarthritis Index.25-27 Our results are concordant with these prior findings. ranging from 0.07] mm.05 (20.004 .82) (−23.27) (−24.2) −17.08 (17.32 to 5. difference between the intervention group at the 8-week follow-up and the control group at the 8-week follow-up by repeated measures analysis of variance.009 . To our knowledge.52 (21.97 (21. .97) (−31.71) −21. DEC 11/25.77 (2.96] seconds vs 0.001 . Losses to follow-up.001 .99 .02 [16.62) −0.73 to −5. randomized trial assessing the efficacy of massage for OA. *Pooled analysis: the intervention group at the 8-week follow-up plus the control group at the 16-week follow-up.02 to −6.61 to −9.06) −4.13) (−22.001 .15 . s Subjects were instructed to report adverse events to the massage therapist.02 to −12.001 .77 0.85] mm. The 95% CI is for the measured change from baseline to follow-up assessment.80 0. effect size) at the 8-week assessment in the WOMAC scale were large.5) 7.06 (14.50 At 16-wk Follow-up Control Group (n = 34) −13.65) −17.38) −1.38 (28. shown in the Figure.19) −20.41) (−2. VAS score (−17. WOMAC.03 .61 0.16 to −10.15 to 11.32 .29 (24. Thus.15] vs −5.04 (26.46) (−28.02) −11.56 [15.16 to −11.69) −4. Using intention-to-treat analysis and carrying forward baseline values likely biased our results toward the null.90) walk 50 ft (15 m) (−2.05.57 to −9.08 .51) (−26.37) −17.15) −14.15 [21. VAS.97 [21.004).67 .73 (24.31 .21 to 3.81) (−1.92) P Effect Value‡ Size.78) (−5.38) −1.02 Variable WOMAC score.61) (−0.88] mm vs −4. In this study.81) (−1. The treatment effects observed were stronger when limited to only those subjects returning for follow-up. confidence interval.69) −4.archinternmed. VAS.19) −16.005 .32) −22.81] seconds.09 to 0.86) −0. confidence interval. Comparison Between Improvements Observed in the Intervention and Control Groups* Control Group at 8-wk Follow-up (n = 34) −3.03 .57 (13.88) (−24.07 (−9.87 to 8.74) −17.Table 2.15 (11.19 (24.002).02) (−23.89) 0.56 (15.60 (26.001 .001 .01 to 3.14) 0. SAFETY P Value . the magnitude of the treatment effects (ie.99 to −12.64 0.98 Pooled Analysis Total for Both Groups (n = 68) −18.36) (−23.com on May 2.73 to 4.85) (−10.66 to -0.27] mm vs −1.16) (−26.66 (30.07) (−9. Table 3.28 [3.52 (22.18 to 0.88 (13. P .66) −15.67 to −14.73 to 0.24 [4. 8 weeks after the intervention was completed) with the control group at week 8 (ie.49) (−21.002 .009).86 (Table 2).61) (−23. are reflective of the real-world experience with an elderly population with impaired mobility. degree Time to walk 50 ft (15 m).73) (−2. this is the first prospective. *Data are given as mean (SD) (95% CI).65) −21. visual analog scale.37) (−10.58) (−9.
Saltzman C. 9. Accepted for Publication: September 1. and this will need to be elucidated in subsequent studies. Although Hawthorne effect29. Curr Opin Rheumatol. Williams. demographic homogeneity may limit generalizability.ARCHINTERNMED. 2004. Kato T.42:1-9. I: pathophysiology. United States 2005 with chartbook on trends in the health of Americans. 11. 2. Praemer A. in individuals older than 50 years. However. Ill: American Academy of Orthopaedic Surgeons. 1998. We used Swedish massage because it is one of the more common and readily accessible or practiced techniques in the United States. Nakamura H. This did result in increased contact with study personnel for the intervention group during the 8-week intervention. and most of the subjects in the intervention and control groups were white women. 2005. 2006. Brown T. Correspondence: Adam I. 2000. MLIS. et al. MPH. Bias toward a null effect is more probable. although higher body weights may contribute to a slightly higher prevalence in black persons. 2006. Arthritis Rheum. and therefore longer studies will be needed. Di Cesare PE. It seems unlikely that the massage intervention would have caused participants to increase their medication in such a way as to lead to significant improvement in pain and function compared with the control group. Xiang Y. NCTMB.archinternmed.31-34 Many patients are already adding or trying massage as a therapy for OA. Sabina. Massage therapy seems to be well tolerated by people with painful OA of the knee. Disease-modifying therapies for osteoarthritis: current status.40 Establishing massage as a therapy for OA would provide an additional option to the current approaches. Nevitt MC. First-line treatment for osteoarthritis.13.16:604-608. Saimbert. Fajardo M. and material support: Perlman. Osteoarthritis: epidemiology.com on May 2. Administrative. 6. including devil’s claw and ginger. Drafting of the manuscript: Perlman. this pilot study suggests that massage therapy is efficacious in the treatment of OA of the knee.22:141-161. Acquisition of data: Perlman. and Marie K. and Williams. with beneficial effects persisting for weeks following treat- ment cessation. Losses to follow-up were noteworthy. and Katz. such as cardiovascular. Clin Orthop. Elders MJ. Hochberg MC. MPH. and Katz. The potential importance of massage as an adjunct to or even an alternative to pharmacotherapy is selfevident.perlman@umdnj. Institute for Complementary and Alternative Medicine. Recent research has suggested that acupuncture may also be an effective option for patients with OA. Acknowledgment: We thank Michael Yablonski. All rights reserved. and hepatotic toxic effects. 5. . Study limitations include a single intervention and homogeneous study sample. which was 8 weeks after the subjects finished the weekly massage sessions. et al.41:778-799. Sabina. Current pharmacological treatments for OA are associated with high rates of adverse effects.edu). Buckwalter JA. Felson DT. Best Pract Res Clin Rheumatol. MS.5. Arden N. Linda Winz. Accessed April 10. Given the limitations and potential adverse effects of pharmacologic and nonpharmacologic treatments for OA. NCTMB. (REPRINTED) ARCH INTERN MED/ VOL 166. Sabina. Further study of massage to determine optimal treatment protocols. Nishioka K. Elena Mojica. absolute efficacy. The impact of osteoarthritis: implications for research. and David Hom. Critical revision of the manuscript for important intellectual content: Perlman.We used a wait-list control design because no validated method of performing “placebo massage” has been developed. Lawrence RC. J Rheumatol.5 The study duration was only 16 weeks. and the improvements in the intervention group largely persisted at the 16-week follow-up.30 may have been a factor in our results.cdc. gastrointestinal. cost-effectiveness. Centers for Disease Control and Prevention Web site. and Williams. 101. 7. No. Analysis and interpretation of data: Perlman and Njike. 2001.pdf. Drugs Aging. Health. we cannot reliably know if change in medications in any way affected our results.133:726-737. Financial Disclosure: None reported. Author Contributions: Study concept and design: Perlman. Statistical analysis: Njike. 4.35-38 There are also nonconventional and nutriceutical treatments for OA. Trials regarding the efficacy of glucosamine with or without chondroitin are inconclusive. An update on the pathogenesis and epidemiology of osteoarthritis. Obtained funding: Perlman and Williams.20:17-27. or even type of massage. School of Health Related Profession. Arnett FC. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. 3. DEC 11/25. 60(suppl):6-8. Orthop Nurs.5 Black and white individuals have similar rates of OA. However.1. The increasing impact of arthritis on public health. and pharmacologic interventions. 2011 ©2006 American Medical Association. an intention-to-treat analysis was used. Bergen Bldg. There may prove to be more—and less—effective approaches. Musculoskeletal Conditions in the United States. 1999. 2004. massage therapy seems to be a viable option as an adjunct to more conventional treatment modalities. Osteoarthritis: new insights. duration. Ann Intern Med. Because participants did not keep accurate medication diaries. 8. However. National Center for Health Statistics. Helmick CG. Neoantigens in osteoarthritic cartilage.35 have yet to be proven effective. knee and hand OA is more prevalent in women than men.22 There was limited precedent for selecting frequency. and therefore our findings may be conservative estimates of treatment effect. II: treatment approaches. 2006. 10. OA is a chronic condition. technical. Njike. University of Medicine and Dentistry. 2000. Perlman. massage therapist. 2006 2537 WWW. REFERENCES 1. MD. Funding/Support: This study was supported by the Centers for Disease Control and Prevention (grant SIP-1400) and Prevention Research Center core grant U48CCU115802. Other nutriceutical treatments. Sabina. Radiol Clin North Am. assessment. Stanley S. Newark. Baird CL. massage therapist. http://www. Felson DT. and generalization to other patient groups is clearly warranted. NJ 07107-1709 (a.COM Downloaded from www. both intragroup and intergroup differences were significant at 8 weeks. 2004. for their contributions. Rosemont. 65 Bergen St. Williams. Study supervision: Perlman and Katz. In conclusion.20:3-25. Rice DP. Lawrence RC. renal. Study participants were recruited in northern New Jersey.427(suppl):S6-S15. a recent randomized controlled clinical trial (the Glucosamine/chondroitin Arthritis Intervention Trial39) suggested that the combination is effective for patients with moderate to severe OA pain.gov/nchs/data/hus/hus0. Massage also seems to decrease pain and improve function in participants who were allowed to maintain their usual treatment. Furner S.
Perneger TV. and the two in combination for painful knee osteoarthritis. 2002. 2001. 1997. Clin Rehabil. 2006. 2006. Curr Opin Rheumatol. 26. Seligman S. et al. Sigal LH. Galper DI. Reda DJ. NSAID-associated adverse effects and acid control aids to prevent them: a review of current treatment options.29:1039-1049. 2006. Larson MG. Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Use of alternative therapies by older adults with osteoarthritis. Hernandez-Reif M. traction and manipulation. placebo-controlled study. Dixon ME. Sonet B. Bellamy N. Bloch D. Field T. 2004. 40. 2002.287:64-71. Asch E. All rights reserved. Langenberg P. Gitton X. N Engl J Med. Massage. Wieting JM. 2001. Quintino O. Vioxx. 29. et al. Matchaba P. Preyde M. 27:1196-1214. Lao L. Glucosamine. 2006. 14:109-110. Goldsmith CH. Efficacy of rofecoxib. Mersfelder TL. 38. 32.14:58-62. Dalessio DJ. Brown K. J Altern Complement Med. 2004. Nayak S. et al. Cullen KE. randomized. Curr Opin Rheumatol. Krammer G. 2004. Sunshine W. Naesdal J.emedicine . 2006. Glossary of terms. and acetaminophen in osteoarthritis of the knee: a randomized trial [published correction appears in JAMA. Semin Arthritis Rheum. Vanderbist F. http://www. Field TM. controlled trial. Lozada CJ.162:1815-1820. Complementary and alternative medicine for pain management in rheumatic disease. Campbell J. et al. Hogue JH. 21.331:1675-1679. 15. Brinkhaus B.141:901-910. DEC 11/25. Harris CL. 1988.7:65-70. CMAJ.18:539-556. Schoenberger NE. 30. Whelton PK. (REPRINTED) ARCH INTERN MED/ VOL 166. Holden JD. American Massage Therapy Association. Ann Intern Med. 23.22:607-617. 2001. Editorial: studies on pain and the hawthorne effect. double-blind. 27. 22. 2005. Klag MJ. Sereno A. Celecoxib Trial (VACT) Group.17:181-191. 24. 18.366:136-143. 16. 2006 2538 WWW. 13. Matheis RJ. 37. Jena S.28:542-547. http://www. 2003. celecoxib. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. aspirin. 1996. Accessed April 10. American Massage Therapy Association Web site. Effects of adjunctive Swedish massage and vibration therapy on short-term postoperative outcomes: a randomized. 1974. and side effects. Hawthorne effects and research into professional practice.24:54-62. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Geba GP. Ramsey SD. Ernst E. 17. 20. N Engl J Med. Topolski TD.36:679-686.45:222-227. 34. J Rheumatol Suppl. 39. 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. Clin Ther. Taylor AG. 35. Berman BM. 1994. 1999. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. Arthritis Rheum. The use of complementary and alternative therapies for chronic pain following spinal cord injury: a pilot survey. Arthritis Rheum. et al. Cugalj AP.43:49-51.18:256-260.26:1774-1782.287:989]. 14. Liang MH. 2005.354: 795-808. Weaver AL. J Spinal Cord Med. Schwartz JA.amtamassage. Coffiner M. Acetaminophen. Taylor P. Setty AR. 2005. Cardiovascular safety of lumiracoxib: a meta-analysis of all randomized controlled trials 1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis.29:119132. Musculoskeletal conditions and complementary/alternative medicine. Risk of kidney failure associated with the use of acetaminophen.COM Downloaded from www. Ann Pharmacother. Connective tissue massage in the treatment of fibromyalgia. Malonne H. Shifleft SC. efficacy.34:773-784. Outcome measurement in osteoarthritis clinical trials. J Rheumatol. Altman R. 1986. Accessed April 10. Clegg DO. Buchanan WW. 31. 25.15:1833-1840. Use of unconventional therapies by individuals with multiple sclerosis. Matheis RJ. 2:18-22. Brattberg G. 33. Nayak S.ARCHINTERNMED. Lancet. chondroitin sulfate. 19. Schnitzer TJ. Clin Ther. Polis AB. 2000. 36. et al. 2002.com/pmr/topic200. Bellamy N. . An update on osteoarthritis therapeutics.12. 2003. Juvenile rheumatoid arthritis: benefits from massage therapy. controlled trial.com on May 2.3:235-244. Best Pract Res Clin Rheumatol. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.htm. Herbal medications commonly used in the practice of rheumatology: mechanisms of action.archinternmed.org/about/terms . et al. and nonsteroidal antiinflammatory drugs. 2002. Agostinelli S. Efficacy and tolerability of sustained-release tramadol in the treatment of symptomatic osteoarthritis of the hip or knee: a multicenter. Eur J Pain. Stitt LW. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Drug Saf.9:77-89. JAMA. J Clin Rheumatol. 2011 ©2006 American Medical Association. J Pediatr Psychol. Witt C. Lee WL. Hochberg MC. Gilpin AMK. 1995. 28. Ernst E. Pathophysiology and first-line treatment of osteoarthritis. J Eval Clin Pract. 1985. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized.html. Arthritis Rheum. Shiflett SC. et al. Hogenmiller MS. Spencer AC. Headache.