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

doi:10.1136/bmj.39280.509803.BE

BMJ, doi: 10.1136/bmj.39280.509803.BE, (Published 15 August 2007)

Research

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

Nadine E Foster, senior lecturer in therapies (pain management)¹, Elaine Thomas, senior lecturer in biostatistics¹, Panos Barlas, research fellow², Jonathan C Hill, arc lecturer in physiotherapy¹, Julie Young, research nurse¹, Elizabeth Mason, research physiotherapist¹, Elaine M Hay, professor of community rheumatology¹

¹ Primary Care Musculoskeletal Research Centre, Keele University, Stafford ST5 5BG, ² School of Health and Rehabilitation, Keele University

Correspondence to: N E Foster n.foster{at}keele.ac.uk

Objective To investigate the benefit of adding acupuncture toa course of advice and exercise delivered by physiotherapistsfor pain reduction in patients with osteoarthritis of the knee.

Design Multicentre, randomised controlled trial.

Setting 37 physiotherapy centres accepting primary care patientsreferred from general practitioners in the Midlands, UnitedKingdom.

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

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

Main outcome measures The primary outcome was change in scoreson the Western Ontario and McMaster Universities osteoarthritisindex pain subscale at six months. Secondary outcomes includedfunction, pain intensity, and unpleasantness of pain at twoweeks, 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 reductionsin 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. Meandifferences in change scores between advice and exercise aloneand each acupuncture group were 0.08 (95% confidence interval–1.0 to 0.9) for advice and exercise plus true acupunctureand 0.25 (–0.8 to 1.3) for advice and exercise plus non-penetratingacupuncture. Similar non-significant differences were seen atother follow-up points. Compared with advice and exercise alonethere were small, statistically significant improvements inpain intensity and unpleasantness at two and six weeks for trueacupuncture and at all follow-up points for non-penetratingacupuncture.

Conclusion The addition of acupuncture to a course of adviceand exercise for osteoarthritis of the knee delivered by physiotherapistsprovided no additional improvement in pain scores. Small benefitsin pain intensity and unpleasantness were observed in both acupuncturegroups, making it unlikely that this was due to acupunctureneedling effects.

Trial registration Current Controlled Trials ISRCTN88597683 [controlled-trials.com] .

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Rapid Responses:

Read all Rapid Responses

Acupunture vs prescribed medication: Dr Tanveer Afzal Afzal
bmj.com, 17 Aug 2007 [Full text]
Do the poor results of this study reflect inadequate or incorrect use of TCM acupuncture methodology?: Wainwright Churchill
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Exercise trumps acupuncture: but needles should not be dismissed: Adrian R White
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Re: Exercise trumps acupuncture: but needles should not be dismissed: John P Heptonstall
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Was the control procedure really a placebo?: Anthony Campbell
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Re: Was the control procedure really a placebo?: John P Heptonstall
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Physical exercise and Acupuncture in the treatment of knee osteoarthritis - Not both - but maybe either one of them?: Thomas CM Lundeberg, et al.
bmj.com, 18 Sep 2007 [Full text]
Re: Physical exercise and Acupuncture in the treatment of knee osteoarthritis - Not both - but maybe either one of them?: John P Heptonstall
bmj.com, 19 Sep 2007 [Full text]
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