Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Controversies in the Use of Acupuncture for Osteoarthritis (OA). A Systematic Review of the Quality and Treatment Features of Randomized Clinical Trials (RCT).
Marengo2, Maria F., Waimann2, Christian A., Lopez-Olivo2, Maria A., Looney1, Carol, Suarez-Almazor3, Maria E.
Acupuncture is one of the most frequently used non-pharmacological therapies for musculoskeletal disorders. There is conflicting evidence on its efficacy for the management of knee OA, which could potentially be attributable to the quality and variability of methodologies used across RCTs. We conducted a systematic review of the evidence reported for acupuncture in the treatment of knee OA.
We electronically searched Embase, Medline, Web of Science and Cochrane Library up to June 9 2010, and manually searched the bibliography included in the identified systematic reviews and meta-analyses. We selected all RCTs which included patients with knee OA, compared needle acupuncture with a sham procedure, and reported pain outcomes. We excluded articles were the control group did not receive a sham intervention. We evaluated the quality of the trials using the Cochrane methods to assess risk of bias (0-worst to 11-best), and we also identified the characteristics of the trials, and specifically the modalities used for the acupuncture and sham treatments. Two authors independently agreed on eligibility and assessed the quality and methods.
Summary of the Results:
We identified 6 systematic reviews. Of 14 RCTs, 9 included a sham intervention. Eight of the trials included the WOMAC as an outcome. A total of 1034 patients received acupuncture and 1127 sham intervention. Five of the 9 RCT reported statistically significant results with respect to pain. Six RCTs had a quality score of at least 7 points. The 3 with lower quality did not report statistically significant findings. Marked differences were observed with respect to trial characteristics, acupuncture treatment and sham procedures, with respect to use and number of points, duration and frequency of treatments and sham pricedures (penetrating versus non-penetrating needles). Negative trials were more likely to have used fewer acupuncture points, shorter duration and number of treatments, electric stimulation in the sham group. Very few studies controlled for the potential placebo effects of the interaction between acupuncturists and research staff with participants.
RCTs of acupuncture in the treatment of knee OA show variability in the results that does not appear to be related to quality of the trial, but is associated with the characteristics of the acupuncture treatment and the procedures used for the sham intervention.
To cite this abstract, please use the following information:
Marengo, Maria F., Waimann, Christian A., Lopez-Olivo, Maria A., Looney, Carol, Suarez-Almazor, Maria E.; Controversies in the Use of Acupuncture for Osteoarthritis (OA). A Systematic Review of the Quality and Treatment Features of Randomized Clinical Trials (RCT). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :941