ACUPUNCTURE FOR OSTEOARTHRITIS OF THE KNEE

Acupuncture for osteoarthritis of the knee

Background

This programme consists of a series of inter-related projects integral to the theme of the evaluation of acupuncture for chronic illness in primary care. CRD is undertaking a technology assessment to determine how clinically effective and cost effective acupuncture is in the treatment of osteoarthritis of the knee in the context of NHS prescribing.

Evaluation of a single therapy for a single condition provides only a limited basis for NHS decision making. More relevant will be a full evaluation comparing the clinical and cost-effectiveness of acupuncture with all relevant comparator treatments using both direct and indirect comparisons. In clinical practice, osteoarthritis of the knee is treated in the first instance with analgesic drugs such as paracetamol and or topical non-steroidal anti-inflammatory drugs (NSAIDs) and where these are ineffective, a NSAID or COX-2 inhibitor is recommended. Physical therapies such as acupuncture are generally considered as adjunct therapies given to complement pharmacological based pain relief. Exercise or manual therapies, which the NICE Guidelines recommend as part of core therapy, are also given in addition to, rather than instead of, analgesic drugs.

Therefore the decision problem is ‘how does the clinical and cost-effectiveness of acupuncture for osteoarthritis of the knee compare with alternative physical therapies in patients already managed with pharmacological treatment?

Findings

The searches retrieved 3,820 references. Of these, following screening of titles and abstracts, 553 full papers were considered potentially relevant to the review and a total of 138 trials were eligible; 134 original trials formed the basis of the review since four papers could not be translated. Thirty two studies (24%) were classified as being of either good or satisfactory study quality whilst the remainder were poor.

There were 22 main interventions and comparators in the included studies. Muscle-strengthening exercise, acupuncture, TENS, and balneotherapy were the most commonly studied interventions.

The network meta-analysis of physical interventions for knee pain due to osteoarthritis, indicates that acupuncture is one of a number of physical treatments that produces a clinically-relevant effect in alleviating pain in the short-term. Moreover, acupuncture compared favourably with the other treatments. We also found reliable evidence that muscle-strengthening exercise also has pain-alleviating effects significantly better than standard care. Acupuncture also significantly improved levels of overall disability. Although further research is needed to substantiate these conclusions, acupuncture should nevertheless be considered as an evidence-based treatment option for relieving pain due to osteoarthritis of the knee.

Conducted by: CRD, the Centre for Health Economics and the Department of Health Sciences, University of York

Further details

Project page on Department of Health Sciences website

Publications

Centre for Reviews and Dissemination. Acupuncture and other physical treatments for the relief of chronic pain due to osteoarthritis of the knee: a systematic review and network meta-analysis. CRD Report 40. York: University of York. 2012

Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, Sutton AJ, Macpherson H, Woolacott NF. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage 2013;21(9):1290-8

Woolacott N, Corbett M, Rice S. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology 2012; [Epub ahead of print]

Posters

Rice SJC, Woolacott NF, Corbett MS, R Slack R. Issues affecting the validity of a network meta-analysis of acupuncture and other physical therapies for the relief of chronic pain due to osteoarthritis of the knee. 19th Cochrane Colloquium. Madrid, Spain, 19-22 October 2011

Woolacott NF, Corbett MS, Rice SJC. The use and reporting of WOMAC for the assessment of treatment benefit for the pain of osteoarthritis of the knee. 19th Cochrane Colloquium. Madrid, Spain, 19-22 October 2011

Funding

Commissioned by the National Institute for Health Research