A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient‐provider communication

Abstract

Objectives There is conflicting evidence on the efficacy of Traditional Chinese Acupuncture (TCA), and the role of placebo effects elicited by acupuncturists’ behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA to sham acupuncture, and examine the effects of acupuncturists’ communication style. Methods Acupuncturists were trained to interact in one of two communication styles: ‘high’ or ‘neutral’ expectations. Patients were randomized to one of 3 groups: waiting list, ‘high’ or ‘neutral’, and nested within style, TCA or sham acupuncture over 6 weeks. Sham acupuncture was performed in non-meridian points, with shallow needles and minimal stimulation. Primary outcome measures were: Joint-specific Multidimensional Assessment of Pain (J-MAP), Western Ontario McMaster Osteoarthritis Index (WOMAC), and satisfaction. Results 455 patients who received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP and WOMAC pain compared to the waiting group (-1.1, -1.0, and -0.1, p<0.001; -13.7, -14, -1.7, p<0.001). Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the ‘high’ expectations group. Fifty-two percent and 43% in the TCA and sham groups thought they had received TCA (kappa=0.05), suggesting successful blinding. Conclusion TCA was not superior to sham acupuncture. However, acupuncturists’ style had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.

Do multimorbidity and deprivation influence patients’ emotional expressions and doctors’ responses in primary care consultations? – An exploratory study using multilevel analysis

“…Finally, all findings were drawn in a correlational, rather than a causal, direction. Studies adopting experimental methods are needed to establish causal relationships, for example, employing randomized control design [35] to study effects of multimorbidity on cue expression, or manipulating the type of emotional cue provision [36] to study clinician responses.…”

Controlling Practitioner–patient Relationships in Acupuncture Trials: A Systematic Review and Meta-Regression

“…105 The second trial, of knee osteoarthritis, randomised participants to an acupuncturist who provided either a high expectation of success or neutral expectation, or to a waiting list, with those allocated to initial treatment further randomised to sham or verum acupuncture. 107 Again, these trialists found that participants randomised to receive treatment from an acupuncturist with higher expectations did better on two out of the three primary outcome measures.…”

Placebo effect in osteoarthritis: Why not use it to our advantage?

“…In a randomized controlled trial of acupuncture for OA, traditional Chinese acupuncture was found not to be superior to sham acupuncture. However, "acupuncturists' styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior" [29] . Telephone contact is shown to be a useful intervention that can enhance the functional status of OA patients by reducing pain and improving psychological health [30] .…”