Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses

Abstract

Background. Knee osteoarthritis (KOA) can cause chronic pain and seriously affect the quality of patient lives. The continued emergence of high-quality RCTS requires us to update the quality of evidence. This study aims to evaluate the efficacy of acupuncture for KOA patients and calculate the required information size (RIS) to determine whether further clinical studies are required. Methods. We searched PubMed, Embase, WOS, CBM, CNKI, VIP, WHO ICTRP, ChiCTR, and Grey literature to collect randomized controlled trials (RCTs) of acupuncture for KOA from inception to December 2021. A meta-analysis was performed according to the Cochrane systematic review method by using Review Manager 5.4 and TSA 0.9.5.10 beta, and GRADE was used to evaluate the quality of the evidence. Trial sequential analysis was used to control random errors and calculate the required information size. Results. Eleven RCTs with 2484 patients were included in our meta-analysis, meeting the inclusion criteria for the meta-analysis. The meta-analysis indicated that acupuncture had beneficial effect on knee osteoarthritis in reducing pain [ n = 2387 ; SMD = − 0.12 , 95% CI (-0.20, -0.04); I 2 = 0 % ] and improved patients function activities [ n = 2408 ; MD = − 1.25 , 95% CI (-1.97, -0.53); I 2 = 0 % ], but true acupuncture showed no significant effect in relieve patient’s stiffness [ n = 1337 ; MD = − 0.07 , 95% CI (-0.30, 0.15); I 2 = 0 % ]. We pooled the studies which found no significant difference in improving the quality life of mental [ n = 1462 ; SMD = 0.02 , 95% CI (-0.23, 0.27); I 2 = 78 % ] and patients physical health (SF-36 or SF-12) [ n = 1745 ; SMD = 1.01 , 95% CI (-0.08, 2.11); I 2 = 0 % ] compared with sham acupuncture. The pain and function TSA graphs indicated that cumulative Z-curves intersected with the traditional level of statistical favoring acupuncture, and more RCTs will required in the future studies. Conclusion. Acupuncture has beneficial effect on pain relief and improves function activities, and this treatment can be recommended as a beneficial alternative therapy in patients with KOA, particularly for chronic patients and those currently undergoing long-term pain and help them increasing quality of life. But it should be further verified through more RCTs in function. Available studies suggested that acupuncture was superior to sham acupuncture in reduce pain and function as verified by TSA.

Ayurveda in Knee Osteoarthritis—Secondary Analyses of a Randomized Controlled Trial

“…Compared to other CIM interventions, our study interventions have shown similar (and in part, greater) effects on the WOMAC Index than other CIM interventions; e.g., acupuncture, leeches, and Tai Chi [ 38 , 39 , 40 , 41 , 42 ]. Direct comparisons with the results of this study are possible only to a limited extent, because other studies differed in part fundamentally from the present study in terms of study designs, intervention, and implementation.…”

Knowledge Mapping of International Research on Acupuncture for Chronic Pain: A Bibliometric Analysis

“…Trials to prove the effectiveness of acupuncture in the treatment of pain is and will be the focuses of this research field. [88][89][90][91][92] The current burst keywords include impact, symptom, depression and stress, indicating that researchers are currently paying more attention to the psychological problems caused by CP. This shows that in recent years, researchers have gradually shifted from simply focusing on chronic pain to secondary symptoms of psychological problems caused by chronic pain, such as depression and stress.…”

Domestic Clinical Research Trends of Motion-Style Acupuncture Treatment: A Scoping Review

“…료 효과를 나타내며 1) , 근골격계 질환에서는 통증을 완 화하고, 관절 가동범위를 개선하여 환자의 삶의 질을 높 여주는 효과가 있다 [2][3][4] . 최근에는 조작 방법을 발전시켜 전통 침술에 전기 치료, 열 자극, 약물 치료 등을 접목시 킨 전침 5) , 화침 6) , 매선 요법 7) , 약침 8) 등이 개발되어 임 상에서 응용되고 있다.…”