# A Pragmatic Trial to Determine the Benefit of Exercise Incentives and Corticosteroid Injections for Osteoarthritis of the Knee

> **NIH VA I21** · PHILADELPHIA VA MEDICAL CENTER · 2020 · —

## Abstract

PROJECT SUMMARY
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. Importantly, chronic reductions in physical activity in patients with
KOA may worsen pain, physical function, and exacerbate the metabolic consequences of obesity. The current
proposal aims to derive preliminary data to support a large pragmatic trial to address two important knowledge
gaps in the management of KOA in order to improve pain and function. Promoting physical activity has been
shown to be helpful in reducing pain and improving function in KOA. Our group has shown that social
incentives 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 efficacy and safety of
incentivizing physical activity using these approaches has not been studied in patients with KOA. Furthermore,
whether adjunct therapies such as corticosteroid injections may be a helpful to promote physical activity is
unknown and is an additional knowledge gap addressed by the current proposal. Despite widespread use,
definitive data quantifying the benefit, if any, of corticosteroid injections are lacking. A large randomized trial
tested the effects of corticosteroids injections every 3 months for a period of 2 years on patient reported pain.
This study demonstrated no improvement in pain compared to saline and a small decline in cartilage thickness
on MRI in the corticosteroid group. These data might suggest that corticosteroid injections result in more harm
than good, however, there are critical weaknesses to this study including that pain and function were only
assessed at 3-month intervals, while previous trials have suggested that peak benefit is expected at 4-8
weeks. We propose to fill these important Uknowledge gapsU with an innovative and efficient pragmatic study.
This double-blinded randomized clinical trial using a factorial and crossover design will leverage unique
resources available through the Penn Center for Innovation to capture important patient-reported outcomes in
real-time in 32 participants. We will randomize participants to receive social incentives with gamification to
promote increases in physical activity. Each patient will also receive both corticosteroids and saline in random
order. We will utilize innovative mobile applications for smart phones and wearable activity trackers through the
Way-to-HealthPTMP platform and assess, in real time, the impact of the interventions on patient-reported function
and pain as well as physical activity. The technology will allow for the recording of outcomes as they occur,
thereby avoiding information bias due to poor recall. The study will determine the benefit of social
incentivization to promote increases in physical activity in patients with KOA and to determine the efficacy of
corticosteroid injections for improving...

## Key facts

- **NIH application ID:** 9953831
- **Project number:** 5I21RX003157-02
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** JOSHUA F. BAKER
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9953831

## Citation

> US National Institutes of Health, RePORTER application 9953831, A Pragmatic Trial to Determine the Benefit of Exercise Incentives and Corticosteroid Injections for Osteoarthritis of the Knee (5I21RX003157-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9953831. Licensed CC0.

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