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Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39280.509803.BE (Published 30 August 2007) Cite this as: BMJ 2007;335:436
  1. Nadine E Foster, senior lecturer in therapies (pain management)1,
  2. Elaine Thomas, senior lecturer in biostatistics1,
  3. Panos Barlas, research fellow2,
  4. Jonathan C Hill, arc lecturer in physiotherapy1,
  5. Julie Young, research nurse1,
  6. Elizabeth Mason, research physiotherapist1,
  7. Elaine M Hay, professor of community rheumatology1
  1. 1Primary Care Musculoskeletal Research Centre, Keele University, Stafford ST5 5BG
  2. 2School of Health and Rehabilitation, Keele University
  1. Correspondence to: N E Foster n.foster{at}keele.ac.uk
  • Accepted 8 July 2007

Abstract

Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee.

Design Multicentre, randomised controlled trial.

Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midlands, United Kingdom.

Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis.

Interventions Advice and exercise (n=116), advice and exercise plus true acupuncture (n=117), and advice and exercise plus non-penetrating acupuncture (n=119).

Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months. Secondary outcomes included function, pain intensity, and unpleasantness of pain at two weeks, six weeks, six months, and 12 months.

Results Follow-up rate at six months was 94%. The mean (SD) baseline pain score was 9.2 (3.8). At six months mean reductions in pain were 2.28 (3.8) for advice and exercise, 2.32 (3.6) for advice and exercise plus true acupuncture, and 2.53 (4.2) for advice and exercise plus non-penetrating acupuncture. Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval −1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (−0.8 to 1.3) for advice and exercise plus non-penetrating acupuncture. Similar non-significant differences were seen at other follow-up points. Compared with advice and exercise alone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture.

Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores. Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects.

Trial registration Current Controlled Trials ISRCTN88597683.

Footnotes

  • We thank Chan Vohora, Hannah Yates, Rhian Hughes, Jo Bailey, Gail White, Sue Weir, Claire Calverley, Wendy Clow, Peter Croft, and Krysia Dziedzic (Primary Care Musculoskeletal Research Centre); the physiotherapists based at the following NHS trusts: Amber Valley Primary Care Trust, South, Eastern, Heart of, and North Birmingham primary care trusts, East and South Staffordshire primary care trusts, Mid Staffordshire General Hospitals NHS Trust, East Cheshire Primary Care Trust, Mid Cheshire Hospitals NHS Trust, East Cheshire NHS Trust, Derby Hospitals NHS Foundation Trust, Worcestershire Acute Hospitals NHS Trust, Shrewsbury and Telford Hospital NHS Trust, Shropshire Community Primary Care Trust, Burton Hospitals NHS Trust, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, South Warwickshire Primary Care Trust, South Warwickshire Hospitals NHS Trust, North Stoke, and Staffordshire Moorlands primary care trusts; and Adrian White, Michael Cummings, and Hugh MacPherson for categorising patients on the de qi sensation.

  • Contributors: All authors participated in the interpretation of the results and drafting of the article. NEF contributed to the design, funding application, advice and exercise intervention, training of the therapists, and management of the trial. ET contributed to the outcomes measured, data management, and analysis. PB contributed to the design, funding application, acupuncture interventions, and training of the therapists. JCH and EM contributed to the management of the trial, data collection, and training of the therapists. JY contributed to the recruitment procedures, data collection, and management. EMH contributed to the design, funding application, and management of the trial. NEF and EMH are guarantors.

  • Funding: This study was supported by a project grant from the Arthritis Research Campaign, UK (grant H0640) and Support for Science funding secured by the North Staffordshire Primary Care Research Consortium for NHS service support costs. NEF is funded by a primary care career scientist award from the Department of Health and NHS research and development, UK. JCH is funded by a lecturership in physiotherapy from the Arthritis Research Campaign, UK.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the West Midlands multicentre research ethics committee and by 13 local ethics committees.

  • Accepted 8 July 2007
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