Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial

Abstract

Background: 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.

Objective: Examine effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care.

Design: 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.

Participants: Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments.

Intervention: Sixty minutes of protocolized full-body massage or light-touch.

Main measures: 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.

Key results: 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.

Conclusions: 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.

Trial registration: clinicaltrials.gov NCT01537484.

Keywords: arthritis; knee pain; massage; musculoskeletal pain; osteoarthritis.

Figure 1

Participant flow diagram.^aExclusion criteria were as follows: previous diagnosis of osteoarthritis; age younger than 35 years; diagnosis of rheumatoid arthritis, fibromyalgia, and recurrent or active pseudogout; presence of cancer or other decompensating conditions; kidney or liver failure; asthma requiring the use of steroids or oral corticosteroids within past 4 weeks; use of intra-articular corticosteroids within the past 12 weeks; use of hyaluronate within the past 6 months; knee arthroscopy within the past year; knee replacement on study knee; significant knee injury within past 6 months; presence of a rash or open wound over the knee; current regular use of massage therapy.

Figure 2

Schematic of study design.

Figure 3

Unadjusted mean WOMAC Global scores. Higher scores on the WOMAC indicate worse outcome; N number of participants with primary outcome, WOMAC Global score.