title: Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial.
abstract: BACKGROUND
  In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.
  
  
  METHODS
  We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.
  
  
  RESULTS
  WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1-12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.
  
  
  CONCLUSIONS
  Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00970008.
authors.affiliation: Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America. adam.perlman@duke.edu
authors.forename: Adam I
authors.initials: AI
authors.lastname: Perlman
authors.forename: Ather
authors.initials: A
authors.lastname: Ali
authors.forename: Valentine Yanchou
authors.initials: VY
authors.lastname: Njike
authors.forename: David
authors.initials: D
authors.lastname: Hom
authors.forename: Anna
authors.initials: A
authors.lastname: Davidi
authors.forename: Susan
authors.initials: S
authors.lastname: Gould-Fogerite
authors.forename: Carl
authors.initials: C
authors.lastname: Milak
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking