Posted on 29 August 2013
Researchers in the Department of Health Sciences and the Centre for Reviews and Dissemination at York carried out the systematic review with network meta-analysis, to allow comparison of range of physical treatments. This novel method created a matrix that provided comparison of all physical treatments even where there was no direct evidence of their respective merits.
The study was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and is reported in Osteoarthritis and Cartilage, the journal of the Osteoarthritis Research Society International.
The research team considered 156 randomised controlled trials in patients with osteoarthritis of the knee, which reported pain. Of these, 114 trials, covering 22 treatments and 9709 patients, provided data suitable for analysis though the researchers found that around 75 per cent of the trials had important methodological limitations.
Results showed that eight interventions: interferential therapy, acupuncture, TENS (transcutaneous electrical nerve stimulation), pulsed electrical stimulation, balneotherapy (bathing), aerobic exercise, sham acupuncture, and muscle-strengthening exercise produced a statistically significant reduction in pain when compared with standard care.
The researchers carried out a sensitivity analysis of satisfactory and good quality studies, most of which were of acupuncture (11 trials) or muscle-strengthening exercise (9 trials). Both interventions were statistically significantly better than standard care.
Dr, Hugh MacPherson, of the Department of Health Sciences at York, says: “Most international guidance for the treatment of osteoarthritis of the knee doesn’t include acupuncture, but it has probably got the best outcome across all the physical therapies.”
Dr Nerys Woolacott, of the Centre for Reviews and Dissemination, adds: “The limitations of the methods used and the quality of the original studies mean that strong claims cannot be made for differences detected between these physical therapies, but the results suggest acupuncture may be at least as good as the others.”