Acupuncture as a symptomatic treatment for osteoarthritis
Evidence SummariesLevel of Evidence = C
Acupuncture may lead to small short-term improvements in pain and physical function in knee and hip osteoarthritis, but there is insufficient evidence on long-term benefits.
A Cochrane review 1 included 16 studies with a total of 3,498 subjects; 12 of the studies included only people with osteoarthritis (OA) of the knee, 3 only OA of the hip, and 1 a mix of people with OA of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain (SMD -0.28, 95% CI -0.45 to -0.11, statistical heterogeneity I2 = 64%; 9 studies, n=1835; 0.9 point greater improvement than sham on 20 point scale) and function (SMD -0.28, 95% CI -0.46 to -0.09, statistical heterogeneity I2 = 69%; 9 studies, n=1829; 2.7 point greater improvement on 68 point scale). These pooled short-term benefits did not meet the predefined thresholds for clinical relevance (i.e. 1.3 points for pain; 3.57 points for function). In comparison with sham acupuncture at the six-month follow-up, acupuncture showed borderline statistically significant, clinically irrelevant improvements in osteoarthritis pain (SMD -0.10, 95% CI -0.21 to 0.01; 4 studies, n=1,399; 0.4 point greater improvement than sham on 20 point scale) and function (SMD -0.11, 95% CI -0.22 to 0.00; 4 studies, n=1,398; 1.2 point greater improvement than sham on 68 point scale).
In a secondary analysis versus a waiting list control, acupuncture was associated with statistically significant, clinically relevant short-term improvements in osteoarthritis pain (SMD -0.96, 95% CI -1.19 to -0.72; 4 studies, n=884; 14.5 point greater improvement than sham on 100 point scale) and function (SMD -0.89, 95% CI -1.18 to -0.60, statistical heterogeneity I2=64%; 3 studies, n=864; 13.0 point greater improvement than sham on 100 point scale). In the head-on comparisons of acupuncture with the 'supervised osteoarthritis education' and the 'physician consultation' control groups, acupuncture was associated with clinically relevant short- and long-term improvements in pain and function. In the head on comparisons of acupuncture with 'home exercises/advice leaflet' and 'supervised exercise', acupuncture was associated with similar treatment effects as the controls. Acupuncture as an adjuvant to an exercise based physiotherapy program did not result in any greater improvements than the exercise program alone. Information on safety was reported in only 8 trials and even in these trials there was limited reporting and heterogeneous methods.
Comment: The quality of evidence is downgraded by study quality (it was not certain that the shams used in three of the sham-controlled trials were sufficiently credible in fully blinding participants to the treatment being evaluated), and by inconsistency (variability in results across studies).
1. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010;(1):CD001977. [PMID:20091527]
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