Behavioral Incentives for Exercise and Intra‐Articular Glucocorticoids for Knee Osteoarthritis: Results From a Factorially Designed Pragmatic Randomized Clinical Trial
Primary result · Average daily stepsResult — go to the resultDifference 771 steps per dayAuthors' conclusion
Behaviorally designed incentive programs can promote physical activity among patients with symptomatic KOA with no effect on KOA symptoms. Glucocorticoid injections, compared to lidocaine-only injections, did not show a benefit.
Study context
- Population
- Participants with clinical diagnosis of knee OA and indication for joint injection (age 40–85 years; Kellgren-Lawrence grade ≥1)204 completed follow-up
- Participants
- 221 participants
- Comparison
- Behavioural incentive for physical activity vs none; GC injections vs lidocaine-only injections (crossover)
- Primary endpoint
- Co-primary: average daily steps measured biweekly over 28 weeks; change in KOOS (average of five subdomains) measured biweekly 2-12 weeks after each injection
- Follow-up
- 28 weeks (steps); 2-12 weeks after each injection (KOOS)
Methodological detailspragmatic, multisite, factorial, blinded, crossover (injections), Participants were 55% accurate in guessing the order of their injections
- Pragmatic
- Multisite
- Factorial
- Blinded
- Crossover (injections)
- Participants were 55% accurate in guessing the order of their injections
Primary result
Average daily steps · 28 weeks
Difference
771 steps per day
P = 0.01
As reported in the abstract
Further findings
Knee Osteoarthritis Outcome Score (KOOS), incentive program
- KOOS scores were not improved in the incentive arm
KOOS, within-person crossover analysis of injections
- Crossover analysis among 196 participants: no benefit, β
- 0.36 (95% CI −1.17 to 1.90); P = 0.29
- Secondary analysis
Accuracy of guessing injection order (blinding)
- Participants accurate in guessing injection order
- 55%
Original publication
Behavioral Incentives for Exercise and Intra‐Articular Glucocorticoids for Knee Osteoarthritis: Results From a Factorially Designed Pragmatic Randomized Clinical Trial. Arthritis Rheumatol. Published 15 April 2026. doi:10.
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