MOA 2: the DEMO Trial

MOA 2: the DEMO trial – Dosing, Exercise and Manual therapy in Osteoarthritis

Principal Investigators: Associate Professor J Haxby Abbott (Department of Surgical Sciences), Professor G Kelley Fitzgerald (University of Pittsburgh), Professor Julie M Fritz (University of Utah), Associate Professor John Childs (US Army-Baylor University)

Co-Investigators: Dr Gerard Brennan (Intermountain Health Care, Utah), Associate Professor Kenneth Smith
(University of Pittsburgh)

Study Details

Exercise therapy is known to be effective, and is recommended as the first line of treatment for patients with knee osteoarthritis (OA), a major cause of pain, disability and healthcare costs. However if not continued, the benefits diminish within months. It is believed that ‘booster’ intervention sessions help make effects endure, improving long-term outcomes, but their effectiveness has not been adequately tested. There are also early indications that manual therapy may improve the effectiveness of exercise therapy.

In a pair of matched randomised clinical trials (RCTs), we will investigate regularly scheduled booster sessions as a strategy for maintaining the beneficial effects of exercise therapy, and the effect of providing manual therapy in addition to exercise therapy as a strategy for increasing the magnitude of effect of exercise therapy. The first study was a RCT of 75 people with knee OA, in Dunedin, New Zealand. This was followed by a multi-centre RCT of 300 people with knee OA in Pittsburgh, Utah, and Texas, USA. Both trials will assess whether adding these two key elements to standardized exercise therapy is effective – and cost-effective – to one- and two-years follow-up.


This research is funded by the United States Agency for Healthcare Research and Quality (AHRQ), the University of Otago, and was conducted during tenure of Dr Abbott’s Sir Charles Hercus Health Research Fellowship of the Health Research Council of New Zealand.



Abbott JH, Chapple CM, Fitzgerald GK, Fritz JM, Childs J, Harcombe H, Stout K. The incremental effects of manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis: A randomized clinical trial. J Orthop Sports Phys Ther. 2015; (in press)



Department of Surgical SciencesOrthopaedic Surgery University of Otago Dunedin School of Medicine