{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:26:31Z","timestamp":1781648791840,"version":"3.54.5"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["RX003644"],"award-info":[{"award-number":["RX003644"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this study was to determine the benefit of a behaviorally designed incentive program and glucocorticoid injections in reducing symptoms and promoting physical activity in patients with knee osteoarthritis (KOA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a pragmatic, multisite, factorially designed, blinded, randomized clinical trial. Participants with a clinical diagnosis of KOA and an indication for joint injection (age 40\u201385 years; Kellgren\u2010Lawrence x\u2010ray grade \u22651) were randomized to receive a behavioral incentive to promote physical activity. They were further randomized to receive glucocorticoid injections or lidocaine\u2010only injections in a crossover design. Primary outcomes were the average daily steps measured biweekly over 28 weeks and change in the Knee Osteoarthritis Outcome Score (KOOS; average of five subdomains) measured biweekly between 2 and 12 weeks after each injection. Mixed\u2010effects models evaluated time\u2010averaged effects. Secondary analyses evaluated within\u2010person changes after crossover injections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 221 randomized participants (mean age 62 years; 84% male), 204 (92.3%) completed follow\u2010up. Participants receiving the incentive program walked 771 more steps per day (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.01). KOOS scores were not improved in the incentive arm. Glucocorticoid injections did not result in greater improvement in KOOS scores or subdomains at any time point or when evaluating the time\u2010averaged effect (\u03b2 1.72 [95% confidence interval (CI) \u22121.08 to 4.52];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.23). A crossover analysis among 196 participants demonstrated no benefit (\u03b2 0.36 [95% CI \u22121.17 to 1.90];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.29). Participants were 55% accurate in guessing the order of their injections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Behaviorally designed incentive programs can promote physical activity among patients with symptomatic KOA with no effect on KOA symptoms. Glucocorticoid injections, compared to lidocaine\u2010only injections, did not show a benefit.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art70176-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.70176","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:40:16Z","timestamp":1776256816000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Behavioral Incentives for Exercise and Intra\u2010Articular Glucocorticoids for Knee Osteoarthritis: Results From a Factorially Designed Pragmatic Randomized Clinical Trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0799-7563","authenticated-orcid":false,"given":"Joshua F.","family":"Baker","sequence":"first","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"},{"name":"Department of Medicine University of Pennsylvania  Philadelphia"},{"name":"Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8707-7649","authenticated-orcid":false,"given":"Katherine D.","family":"Wysham","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System and University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Quinones","sequence":"additional","affiliation":[{"name":"Washington DC VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9649-3588","authenticated-orcid":false,"given":"Bryant R.","family":"England","sequence":"additional","affiliation":[{"name":"Medicine Service, VA Nebraska\u2010Western Iowa Health Care System and Department of Internal Medicine University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitian","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Olave","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wetzel","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Gillcrist","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Criswell","family":"Lavery","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Keller","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Kramer","sequence":"additional","affiliation":[{"name":"Medicine Service, VA Nebraska\u2010Western Iowa Health Care System and Department of Internal Medicine University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibianna","family":"Ateh","sequence":"additional","affiliation":[{"name":"Washington DC VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1964-5318","authenticated-orcid":false,"given":"Hannah","family":"Brubeck","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System and University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-4621","authenticated-orcid":false,"given":"Daniel K.","family":"White","sequence":"additional","affiliation":[{"name":"University of Delaware  Newark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Ogdie","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pennsylvania  Philadelphia"},{"name":"Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9515-1711","authenticated-orcid":false,"given":"Tuhina","family":"Neogi","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla R.","family":"Scanzello","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania"},{"name":"Department of Medicine University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22716"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23323"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22897"},{"issue":"1","key":"e_1_2_6_5_1","first-page":"57","article-title":"Exercise and fatigue in rheumatoid arthritis","volume":"16","author":"Balsamo S","year":"2014","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0533-5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20587"},{"issue":"5","key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.2217\/ijr.12.53","article-title":"Recommendations and the state of the evidence for physical activity interventions for adults with rheumatoid arthritis: 2007 to present","volume":"7","author":"Iversen MD","year":"2012","journal-title":"Int J Clin Rheumatol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22561"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1123\/jpah.2012-0194"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000478"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.41142"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2022.100264"},{"key":"e_1_2_6_14_1","volume-title":"Thinking Fast and Slow","author":"Kahneman D.","year":"2011"},{"key":"e_1_2_6_15_1","volume-title":"Nudge: Improving Decisions About Health, Wealth, and Happiness","author":"Thaler RH","year":"2008"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-0771(200004\/06)13:2<233::AID-BDM325>3.0.CO;2-U"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17565"},{"issue":"10","key":"e_1_2_6_18_1","article-title":"Intra\u2010articular corticosteroid for knee osteoarthritis","volume":"2015","author":"J\u00fcni P","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1231"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.5283"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0461"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-2188-0"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.101940"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.00154"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1510059"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010846"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06529-w"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2147"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.00027"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43019-024-00210-z"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2021.03.005"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.210543"},{"issue":"1","key":"e_1_2_6_33_1","first-page":"131","article-title":"Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities","volume":"29","author":"Angst F","year":"2002","journal-title":"J Rheumatol"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.08.029"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-7-18"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22362"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22398"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.10255"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3458"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001944"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-07009-1"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.12.017"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.21893"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000000358"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2024.100456"}],"container-title":["Arthritis &amp; Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.70176","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/art.70176","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.70176","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:33:43Z","timestamp":1777534423000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.70176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":44,"alternative-id":["10.1002\/art.70176"],"URL":"https:\/\/doi.org\/10.1002\/art.70176","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"assertion":[{"value":"2025-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"art.70176"}}