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Abstract

Objective:

We aimed to explore the feasibility of evaluating the comparative effectiveness and safety of electroacupuncture (EA) relative to manual acupuncture (MA) for the treatment of knee osteoarthritis (KOA).

Methods:

A multicenter randomized controlled clinical trial was conducted in Beijing from September 2017 to January 2018. A total of 60 participants with KOA were randomly allocated to either EA (n = 30) or MA (n = 30) groups. Participants in the EA group were treated with EA at six to seven local traditional acupuncture points or ah shi points, and two to three distal points. Participants in the MA group had the same schedule as the EA group except that the electrical apparatus featured a working power indicator without actual current output, constituting a sham EA procedure, in order to blind participants. Both groups received 24 sessions over 8 weeks. The primary outcome was response rate, defined as a change of ⩾50% from baseline in the total scores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after 8 weeks. Secondary outcomes included pain, stiffness, function, quality of life, and acupuncture-related adverse events (AEs) at 4 and 8 weeks.

Results:

Of 60 participants randomized, 53 (88%) completed the study. Response rates were 43% for the EA group and 30% for the MA group by the intention-to-treat analysis. Although significant differences were observed in WOMAC pain, stiffness, and function scores within both groups, between-group differences at 8 weeks did not reach statistical significance (odds ratio = 1.75 (95% confidence interval = 0.593–5.162)). Rates of AEs were low and similarly distributed between groups.

Conclusion:

Both EA and MA interventions in KOA were feasible and appeared safe. Whether or not EA may have a stronger impact on pain and function requires further evaluation through larger, adequately powered, randomized controlled trials.

Trial registration number:

NCT03274713.

Keywords

electroacupuncture knee osteoarthritis manual acupuncture randomized controlled trial

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References

arcOGEN Consortium and arcOGEN Collaborators. Identification of new susceptibility loci for osteoarthritis (arcOGEN): a genome-wide association study. Lancet 2012; 380: 815–823.

Lawrence

Felson

Helmick

, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58: 26–35.

Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis. Melbourne, VIC, Australia: Royal Australian College of General Practitioners, 2009.

Hunt

Takacs

Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study. Osteoarthritis Cartilage 2014; 22(7): 904–911.

Tang

Wang

Zhan

, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China health and retirement longitudinal study. Arthritis Rheum 2016; 68(3): 648–653.

Hochberg

Martel-Pelletier

Monfort

, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicenter, randomized, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis 2016; 75(1): 37–44.

Wolfe

Lichtenstein

Singh

Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999; 340: 1888–1899.

Coxib and traditional NSAID Trialists’ (CNT) Collaboration, Bhala

Emberson

, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet 2013; 382: 769–779.

Arthritis Care. Osteoarthritis nation: The most comprehensive UK report of people with osteoarthritis. London: Arthritis Care, 2004.

10.

Astin

Pelletier

Marie

, et al. Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement. J Gerontol A Biol Sci Med Sci 2000; 55(1): M4–M9.

11.

Witt

Brinkhaus

Jena

, et al. Acupuncture in patients with osteoarthritis of the knee: a randomized trial. Lancet 2005; 366(9480): 136–143.

12.

Manyanga

Froese

Zarychanski

, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med 2014; 14: 312.

13.

Lin

, et al. Effectiveness and feasibility of acupuncture for knee osteoarthritis: a pilot randomized controlled trial. Clin Rehabil 2018; 32(12): 1666–1675.

14.

Chen

Wang

Mucelli

, et al. Electro-acupuncture is beneficial for knee osteoarthritis: the evidence from meta-analysis of randomized controlled trials. Am J Chin Med 2017; 45(5): 965–985.

15.

Neil

Benedict

David

Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain 2009; 147: 60–66.

16.

Sangdee

Teekachunhatean

Sananpanich

, et al. Electroacupuncture versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. BMC Complement Altern Med 2002; 2: 3.

17.

MacPherson

Altman

Hammerschlag

, et al. Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. PLoS Med 2010; 7: e1000261.

18.

Schulz

Altman

Moher

, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ 2010; 340: c332.

19.

Kellgren

Lawrence

JS.

Radiological assessment of osteoarthritis. Ann Rheum Dis 1957; 16: 494–502.

20.

ICH harmonized tripartite guideline: guideline for good clinical practice. Essential documents for the conduct of a clinical trial. J Postgrad Med 2001; 47: 264–267.

21.

Bellamy

Buchanan

Goldsmith

, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833–1840.

22.

Goldsmith

Boers

Bombardier

, et al. Criteria for clinically important changes in outcomes: development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT Committee. J Rheumatol 1993; 20(3): 561–565.

23.

Witt

Jena

Brinkhaus

, et al. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis Rheum 2006; 54: 3485–3493.

24.

Ware

Jr Kosinski

Keller

SD.

A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34(3): 220–233.

25.

Lam

CLK

Tse

EYY

Gandek

Is the standard SF-12 health survey valid and equivalent for a Chinese population?

Qual Life Res 2005; 14(2): 539–547.

26.

Liu

Xie

Wang

, et al. A randomized controlled trial of single point acupuncture in primary dysmenorrhea. Pain Med 2014; 15: 910–920.

27.

Chen

Fang

Jin

, et al. Acupuncture treatment for ischaemic stroke in young adults: protocol for a randomised, sham-controlled clinical trial. BMJ Open 2016; 6: e010073.

28.

Yang

Lin

, et al. Efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for knee osteoarthritis: study protocol for a randomised controlled trial. Trials 2019; 20: 79.

29.

Hinman

McCrory

Pirotta

, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA 2014; 312: 1313–1322.

30.

Vickers

Vertosick

Lewith

, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain 2018; 19(5): 455–474.

31.

Berman

Lao

Langenberg

, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004; 141(12): 901–910.

32.

Angst

Aeschlimann

Stucki

Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum 2001; 45(4): 384–391.

33.

LF.

Involvement of endogenous opioid peptides in acupuncture analgesia. Pain 1987; 31(1): 99–121.

34.

Gordon

JS.

Alternative medicine and the family physician. Am Fam Physician 1996; 54: 2205–2212, 2218–2220.

35.

Watkins

Maier

SF.

Glia: a novel drug discovery target for clinical pain. Nat Rev Drug Discov 2003; 2(12): 973–985.

36.

Zhang

Lao

Ren

, et al. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology 2014; 120(2): 482–503.

37.

Zhu

Gao

Chang

, et al. Placebo acupuncture devices: considerations for acupuncture research. Evid Based Complement Alternat Med 2013; 2013: 628907.

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Electroacupuncture versus manual acupuncture for knee osteoarthritis: a randomized controlled pilot trial

Abstract

Objective:

Methods:

Results:

Conclusion:

Trial registration number:

Keywords

Get full access to this article

References

Supplementary Material