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Structured Non-operative Treatment of Knee Osteoarthritis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT01535001
Recruitment Status : Completed
First Posted : February 17, 2012
Results First Posted : January 27, 2016
Last Update Posted : October 16, 2017
The Danish Rheumatism Association
Association of Danish Physiotherapists
Information provided by (Responsible Party):
Northern Orthopaedic Division, Denmark

Brief Summary:

The purpose of this study is to test whether an algorithm for systematic non-surgical treatment consisting of corrective insoles, neuromuscular training, weight loss, patient education and pharmacological treatment with paracetamol, non steroidal anti inflammatory drugs (NSAIDs) and Pantoprazole provides further improvement in pain, function and quality of life than standard non-surgical treatment (information on the disease and how to treat it) in patients with knee osteoarthritis.

The H1-hypothesis is that the treatment algorithm results in a greater increase in quality of life and functional capacity and greater reduction in pain than standard treatment at the primary endpoint, which is follow-up 12months after the start of the treatment.

See statistical analysis plan available under "Links" for further description of the study.

Condition or disease Intervention/treatment Phase
Osteoarthritis of the Knee Other: Neuromuscular training (NEMEX-TJR) Behavioral: Information Drug: Paracetamol Drug: Burana Drug: Pantoprazole Behavioral: Dietary counseling Behavioral: Patient education Other: Insoles Not Applicable

Detailed Description:

Knee osteoarthritis (OA) is the degenerative joint disease that most often requires treatment and at the same time the one associated with the greatest social costs. In addition, the disease has many personal costs and is greatly contributing to reduced functionality and autonomy of older adults.

It is recommended both nationally and internationally that the treatment of knee osteoarthritis should include multiple treatment modalities. Clinical guidelines recommend that exercise, weight loss and patient education is the first step in treatment and that insoles and pharmacological treatment can be included as a supplement.

However if the patient is not a candidate for total knee replacement, the patient most often receives only information on knee osteoarthritis, and on what they can do to treat the disorder and prevent it from being worse. This postponement of treatment can lead to a worsening of pain and function and a worse outcome after treatment. Therefore, the current treatment strategy for the patient group is problematic.

The current practice may be due to the lack of studies with high level of evidence that have examined the optimal non-operative treatment approach and compared it with the current standard treatment for this group of patients.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Structured Non-operative Treatment of Knee Osteoarthritis - a Randomized Controlled Trial of Pain, Physical Function and Quality of Life With 12months Follow-up
Study Start Date : February 2012
Actual Primary Completion Date : September 2014
Actual Study Completion Date : September 2014

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Osteoarthritis

Arm Intervention/treatment
Active Comparator: MEDIC
Medicine, Exercise, Diet, Insole and Cognitive/patient education (MEDIC) for three months.
Other: Neuromuscular training (NEMEX-TJR)
60min. of neuromuscular training two times a week for 3 months (12 weeks) using the neuromuscular training program called NEMEX-TJR.
Other Name: No other

Drug: Paracetamol
1 g x 4/day
Other Name: No other

Drug: Burana
400 mg x 3/day for three weeks
Other Name: No other

Drug: Pantoprazole
20mg x 1/day for three weeks
Other Name: No other

Behavioral: Dietary counseling
For participants with a BMI equal to or >25. The dietitian initiates a 3-month intervention that provides instruction and guidance in relation to diet and plans the number of visits according to the individual participant needs.
Other Name: No other

Behavioral: Patient education
The aim is to strengthen the participant's involvement in the treatment, so the participant will be in a position to handle, master and act reasonable in relation to their knee OA. This aspect of the intervention is based on principles from The Chronic Disease Self-Management Program, "Lær at leve med kronisk sygdom (Learn to live with chronic illness)" by The National Board of Health, Denmark and "Artrosskolan Spenshult" in Sweden.
Other Name: No other

Other: Insoles

The position of the knee is assessed using Single Leg Mini Squat. On the basis of this test it is decided which of two types of insoles (Formthotics System) the participant should have (neutral with a lateral wedge or neutral).

The participants will be advised to use the insoles in all shoes.

Other Name: No other

Active Comparator: Standard treatment
Information on knee osteoarthritis, and on what they can do to treat the disorder and prevent it from being worse.
Behavioral: Information

Information on knee osteoarthritis, and on what they can do to treat the disorder and prevent it from being worse.

Information will be given in a leaflet.

Other Name: No other

Primary Outcome Measures :
  1. Change From Baseline in KOOS4 (Knee Injury and Osteoarthritis Outcome Score) [ Time Frame: Primary: 12months. ]

    The average score for four of the five KOOS subscales, covering pain, symptoms, difficulties in functions of daily living, and quality of life (KOOS4), with scores ranging from 0 (worst) to 100 (best).

    Between group comparisons of treatment effect (change in KOOS4 from baseline to 1 year follow-up) will be dependent on data distribution. We expect the change to be normally distributed and analysis will be made using a mixed model ANOVA with subject being a random factor and visit (baseline, 3, 6 and 12 months), treatment arm (TKA + MEDIC, MEDIC) and site (Frederikshavn, Farsoe) being fixed factors. Baseline KOOS4 will be a covariate. Furthermore interactions between the fixed factors will be included in the model. P-values and 95% CI will be presented to assess superiority.

Secondary Outcome Measures :
  1. Change From Baseline in EQ-5D [ Time Frame: Primary: 12months. ]

    Between groups comparisons of the change from baseline to the 1 year follow-up in all secondary endpoint will be handled similar to the primary endpoint. See statistical analysis plan for further description (available under "Links").

    Range of EQ-5D Descriptive Index is -0.59 to 1.00 (worst to best), while the EQ VAS goes from 0 to 100 (worst to best).

  2. Change From Baseline in 20-meter Walk [ Time Frame: Primary: 12months. ]
  3. Change in the Five KOOS Subscale Scores From Baseline [ Time Frame: Primary: 12 months. ]
    Range of all subscales are 0 to 100 (worst to best).

  4. Weight Change in kg From Baseline [ Time Frame: Primary: 12months. ]
    Weight change in kg measured without shoes at the same time of day and on the same scale

  5. Proportion of Users of Pain Medication [ Time Frame: Baseline and 12months. ]
    With possible answers being yes and no

  6. Number of Serious Adverse Events Reported at Index Knee [ Time Frame: Primary: 12months. ]
    Adverse events (AE) and seriously adverse events (SAE) will be registered in three ways and divided into index knee or sites other than index knee. The project physiotherapist will record any adverse events that the participant experiences or tells them about. For the participants allocated to, or crossing over to, TKA, a project worker will look through hospital records to register if any pre-defined perioperative and postoperative adverse events occurred. At all follow-ups, the assessor will use open-probe questioning to assess adverse events in all participants.

  7. Change From Baseline in Time From the Timed Up and Go [ Time Frame: Primary: 12 months. ]

Other Outcome Measures:
  1. Exploratory Outcomes [ Time Frame: Baseline, 3months, 6months, 12months and 24months ]
    1. Pain intensities on a 100 mm VAS with terminal descriptors of 'no pain' and 'worst pain possible' in various situations.
    2. Number of sites with pain in the previous 24 hours shaded on a region-divided body chart
    3. Pain location and type assessed using the Knee Pain Map.
    4. Maximum isometric muscle strength measured bilaterally in knee flexion and knee extension in a make test using a handheld dynamometer (Powertrack II TM Commander).
    5. Pressure pain thresholds measured bilaterally using a handheld algometer (Algometer Type II) at five sites at the knee and the m. tibialis anterior muscle and the m. extensor carpi radialis longus.
    6. Postural balance assessed using an instrumented force platform (Good Balance), measuring the centre of pressure excursion.
    7. Self-efficacy in improving pain, function and QOL in various situations using a 100 mm VAS with terminal descriptors of 'very unsure' and 'very sure'.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Knee-OA detected by x-ray (Kellgren & Lawrence grade 1 or greater)
  • KOOS4 of ≤ 75
  • Considered not to be a candidate for Total Knee Replacement (TKR) by the orthopedic surgeon.
  • The participant is > 18 years of age.
  • The participant can provide relevant and adequate, informed consent.

Exclusion Criteria:

  • Prior TKA ipsilateral
  • Rheumatoid arthritis
  • Mean VAS > 60mm the last week on a 0-100mm scale
  • Possible pregnancy or planning pregnancy;
  • Inability to comply with the protocol;
  • Inadequacy in written and spoken Danish.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01535001

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Department of Occupational and Physiotherapy, Aalborg Hospital-Aarhus University Hospital
Aalborg, Denmark, 9000
Farsoe Hospital
Farsø, Denmark, 9640
Vendsyssel Hospital, Frederikshavn
Frederikshavn, Denmark, 9900
Sponsors and Collaborators
Northern Orthopaedic Division, Denmark
The Danish Rheumatism Association
Association of Danish Physiotherapists
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Principal Investigator: Søren T. Skou, PhD-student Orthopaedic Research Unit, Aalborg University Hospital, Denmark
Study Chair: Ewa M. Roos, PhD Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
Study Chair: Lars Arendt-Nielsen, Dr.Sci.Med. Center for Sensory-Motor Interaction (SMI), Department of Health Sciences and Technology, Aalborg University
Study Chair: Mogens B. Laursen, PhD Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair: Sten Rasmussen, M.D. Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair: Michael S. Rathleff, PhD-student Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair: Ole H. Simonsen, Dr.Sci.Med. Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Additional Information:
National Board of Health, Denmark. Referenceprogram for knæartrose. Copenhagen: National Board of Health, Denmark; 2007. [22.02.2010] found at: http://www.sst.dk/publ/Publ2007/PLAN/SfR/Refprg_knaeartrose.pdf

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Northern Orthopaedic Division, Denmark
ClinicalTrials.gov Identifier: NCT01535001    
Other Study ID Numbers: N-20110085
First Posted: February 17, 2012    Key Record Dates
Results First Posted: January 27, 2016
Last Update Posted: October 16, 2017
Last Verified: September 2017
Keywords provided by Northern Orthopaedic Division, Denmark:
Osteoarthritis, Knee
Treatment Outcome
Time Factors
Combined Modality Therapy
Middle Aged
Aged, 80 and over
Analysis of Variance
Additional relevant MeSH terms:
Layout table for MeSH terms
Osteoarthritis, Knee
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Ulcer Agents
Gastrointestinal Agents
Proton Pump Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action