Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee

Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee

A Randomized, Controlled Trial

From University of Maryland School of Medicine, Baltimore, Maryland.

Abstract

Background: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal.

Objective: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee.

Design: Randomized, controlled trial.

Setting: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility.

Patients: 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± 8.4 years).

Intervention: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks.

Measurements: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

Results: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, −2.9 [95% CI, −5.0 to −0.8]; P = 0.01) but not in WOMAC pain score (mean difference, −0.5 [CI, −1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, −0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, −2.5 [CI, −4.7 to −0.4]; P = 0.01), WOMAC pain score (mean difference, −0.87 [CI, −1.58 to −0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02).

Limitations: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis.

Conclusions: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

Article and Author Information

Acknowledgments: The authors thank Mary Bahr, study coordinator; Jody Boone, arthritis educator; Marcos Hsu, ND, LAc, acupuncturist; Michelle Sittig and Deborah Taber, research assistants; Danuta Bujak, RN, CRNP, PhD, nurse practitioner; and Amy Martin Burns, administrative assistant, for their contributions.
Grant Support: By the National Center for Complementary and Alternative Medicine (National Institutes of Health Cooperative Agreement U01 AT-00171), with advice and encouragement by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Brian Berman, MD, Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207.
Current Author Addresses: Drs. Berman, Lao, Lee, and Gilpin: Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207.
Dr. Langenberg: EPM Gender Based, 102 A, HH, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201.
Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 834, Baltimore, MD 21201.
Author Contributions: Conception and design: B. Berman, L. Lao, P. Langenberg, M.C. Hochberg.
Analysis and interpretation of the data: B. Berman, P. Langenberg, W.L. Lee, A.M.K. Gilpin, M.C. Hochberg.
Drafting of the article: B. Berman, L. Lao, P. Langenberg.
Critical revision of the article for important intellectual content: B. Berman, L. Lao, P. Langenberg, A.M.K. Gilpin, M.C. Hochberg.
Final approval of the article: B. Berman, L. Lao, P. Langenberg, W.L. Lee, A.M.K. Gilpin, M.C. Hochberg.
Statistical expertise: P. Langenberg.
Obtaining of funding: B. Berman, L. Lao.
Administrative, technical, or logistic support: L. Lao.
Collection and assembly of data: W.L. Lee.

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