Meta-analysis: Acupuncture for Osteoarthritis of the Knee

Manheimer, Eric; Linde, Klaus; Lao, Lixing; Bouter, Lex M.; Berman, Brian M.

doi:10.7326/0003-4819-146-12-200706190-00008

Cited by 208 publications

(176 citation statements)

References 58 publications

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“…40 Aminimal clinically important improvement (MCII) has been established for the change in 100mm VA S score in osteoarthritis of the knee: 41 Either a 19.9mm absolute change or a 40.8% relative improvement in pain are said to be clinically relevant. In our study the VA S change for pain in the study knee after acupuncture was 29mm, a 46% relative improvement, while in the sham group it was only 8mm, or a 15% relative improvement.…”

Section: Discussionmentioning

confidence: 99%

A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee

Jubb¹,

Tukmachi²,

Jones

et al. 2008

Acupunct Med

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Objectives To compare the effect of acupuncture (manual and electroacupuncture) with that of a nonpenetrating sham ('placebo' needle) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation. Methods Acupuncture naïve patients with symptomatic and radiological evidence of osteoarthritis of the knee were randomly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed 'placebo' needle system. Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome. Both manual and electrical stimulation were used. Response was assessed using the WOMAC index for osteoarthritis of the knee, self reported pain scale, the EuroQol score and plasma β-endorphin. The effectiveness of blinding was assessed. Results There were 34 patients in each group. The primary end point was the change in WOMAC pain score after the course of treatment. Comparison between the two treatment groups found a significantly greater improvement with acupuncture (mean difference 60, 95% CI 5 to 116, P= 0.035) than with sham. Within the acupuncture group there was a significant improvement in pain (baseline 294, mean change 95, 95% CI 60 to 130, P<0.001) which was not seen by those who had sham acupuncture (baseline 261, mean change 35, 95% CI -10 to 80, P=0.12). Similar effects within group, but not between groups, were seen with the secondary end points of WOMAC stiffness, WOMAC function, and self reported pain. One month after treatment the between group pain difference had been lost (mean difference 46; 95% CI -9 to 100, P=0.10) although the acupuncture group was still benefiting compared to baseline (mean difference 59; 95% CI 16 to 102, P=0.009). The EuroQol score, a generic measure of health related quality of life, was not altered by the treatments. A minority of patients correctly guessed their treatment group (41% in the acupuncture group and 44% in the control group). Plasma β-endorphin levels were not affected by either treatment. Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee, and is significantly superior to non-penetrating sham acupuncture. The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture.

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Section: Discussionmentioning

confidence: 99%

A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee

Jubb¹,

Tukmachi²,

Jones

et al. 2008

Acupunct Med

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“…Also, another recent metaanalysis of acupuncture for OA of the knee shows that there is a clinically irrelevant short-term and long-term improvement in pain and function compared with a sham control. 4 This underlines the issue raised in the guideline concerning heterogeneity of acupuncture trial outcomes.…”

Section: The Long-term Effectiveness Of Acupuncturementioning

confidence: 99%

Nice Guideline on Osteoarthritis: Is it Fair to Acupuncture? Yes

Latimer¹

2009

Acupunct Med

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The NICE Osteoarthritis Guideline Development Group (GDG) has been challenged for not using the available acupuncture evidence in the most appropriate manner in three crucial areas. This response explains the methods used by the GDG with particular reference to the economic analysis, and illustrates that the methods used were those most appropriate for developing a NICE clinical guideline. The cost-effectiveness conclusions made by the GDG are supported by the currently available evidence.

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“…A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used for quality assessment of the reviews [1][2]. Results 14 systematic reviews (6 conducted meta-analyses) satisfied our eligibility criteria with overall acceptable quality [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Results published in the reviews rely partly on identical and to some extent on different studies.…”

Section: Objectivementioning

confidence: 99%