Acupuncture helps improve knee and hip osteoarthritis
November 2006 Filed in: Pain
Acupuncture plus routine care were effective in
controlling the pain of knee and hip osteoarthritis
(OA), and results were maintained for 6 months,
according to the results of a randomised controlled
trial reported in the October 30 Early View issue of
Arthritis & Rheumatism.
"In routine care, a broad variety of acupuncture styles is used, and acupuncture is often administered in conjunction with other treatments," writes Claudia M. Witt, MD, of the Charité University Medical Center in Berlin, Germany, and colleagues. "To date there has been little information about the effectiveness of acupuncture treatment provided as an adjunct to routine medical care.... Based in part on the results of the present study, the German Federal Committee of Physicians and Health Insurers proposed in April 2006 that acupuncture will be reimbursed by statutory health insurance funds."
This study enrolled 3,633 patients with chronic pain due to OA of the knee or hip, of whom 357 were randomized to receive up to 15 sessions of acupuncture in a 3-month period; 355 were randomised to a control group receiving no acupuncture; and 2921 did not consent to randomisation and underwent acupuncture treatment. Mean age was 61.8 ± 10.8 years; and 61% of patients were female. All patients received usual medical care in addition to the study treatment. Outcome measures were clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short-Form 36) at baseline and after 3 and 6 months of treatment.
At three months, the mean WOMAC had improved by 17.6 ± 1.0 in the acupuncture group and by 0.9 ± 1.0 in the control group (3-month scores, 30.5 ± 1.0 vs 47.3 ± 1.0; difference in improvement, 16.7 ± 1.4; P < .001). Quality-of-life improvements were also more dramatic in the acupuncture group than in the control group (P < .001). These improved outcomes with acupuncture were maintained for 6 months, and they were comparable to those of nonrandomized patients who received acupuncture.
"These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip," the authors write. "Physician characteristics, such as the level of formal acupuncture training or certification, did not influence treatment outcomes."
Study limitations include lack of blinding, treatment regimens varying greatly among patients, broad inclusion criteria with possibly some diagnostic misclassification, and the indicators used might not adequately reflect the quality of treatment delivered by the clinician.
"Acupuncture should be considered as a treatment option for patients with knee or hip OA-associated chronic pain," the authors conclude.
Various statutory health insurance funds in Germany supported this study (Techniker Krankenkasse, Betriebskrankenkasse [BKK] Aktiv, Bosch BKK, DaimlerChrysler BKK, Bertelsmann BKK, BKK BMW, Siemens-Betriebskrankenkasse, BKK Deutsche Bank, BKK Hoechst, HypoVereinsbank BKK, Ford BKK, Betriebskrankenkasse der Allianz Gesellschaften, Vereins-und Westbank BKK, and Handelskrankenkasse, and Innungskrankenkasse Hamburg).
In an accompanying editorial, Tao Liu, MD, and Chen Liu, MD, of the 2nd Teaching Hospital, Jilin University in Changchun, People's Republic of China, note that acupuncture has a different conceptual and theoretical basis from that of biomedicine.
"In real-world primary care, few patients with OA seek acupuncture as the sole treatment, and due to the inconclusive information regarding its efficacy, acupuncture is very likely an undervalued treatment option as an element of a multidisciplinary integrative approach to treating this disorder," Drs. Liu and Liu write. "Given that the biologic mechanism of acupuncture is still unclear, the study by Witt et al furthers our understanding of acupuncture and adds to the accumulated evidence supporting its efficacy. Such evidence warrants extensive use of acupuncture in various chronic pain conditions."
Arthritis Rheum. Published online October 30, 2006.
"In routine care, a broad variety of acupuncture styles is used, and acupuncture is often administered in conjunction with other treatments," writes Claudia M. Witt, MD, of the Charité University Medical Center in Berlin, Germany, and colleagues. "To date there has been little information about the effectiveness of acupuncture treatment provided as an adjunct to routine medical care.... Based in part on the results of the present study, the German Federal Committee of Physicians and Health Insurers proposed in April 2006 that acupuncture will be reimbursed by statutory health insurance funds."
This study enrolled 3,633 patients with chronic pain due to OA of the knee or hip, of whom 357 were randomized to receive up to 15 sessions of acupuncture in a 3-month period; 355 were randomised to a control group receiving no acupuncture; and 2921 did not consent to randomisation and underwent acupuncture treatment. Mean age was 61.8 ± 10.8 years; and 61% of patients were female. All patients received usual medical care in addition to the study treatment. Outcome measures were clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short-Form 36) at baseline and after 3 and 6 months of treatment.
At three months, the mean WOMAC had improved by 17.6 ± 1.0 in the acupuncture group and by 0.9 ± 1.0 in the control group (3-month scores, 30.5 ± 1.0 vs 47.3 ± 1.0; difference in improvement, 16.7 ± 1.4; P < .001). Quality-of-life improvements were also more dramatic in the acupuncture group than in the control group (P < .001). These improved outcomes with acupuncture were maintained for 6 months, and they were comparable to those of nonrandomized patients who received acupuncture.
"These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip," the authors write. "Physician characteristics, such as the level of formal acupuncture training or certification, did not influence treatment outcomes."
Study limitations include lack of blinding, treatment regimens varying greatly among patients, broad inclusion criteria with possibly some diagnostic misclassification, and the indicators used might not adequately reflect the quality of treatment delivered by the clinician.
"Acupuncture should be considered as a treatment option for patients with knee or hip OA-associated chronic pain," the authors conclude.
Various statutory health insurance funds in Germany supported this study (Techniker Krankenkasse, Betriebskrankenkasse [BKK] Aktiv, Bosch BKK, DaimlerChrysler BKK, Bertelsmann BKK, BKK BMW, Siemens-Betriebskrankenkasse, BKK Deutsche Bank, BKK Hoechst, HypoVereinsbank BKK, Ford BKK, Betriebskrankenkasse der Allianz Gesellschaften, Vereins-und Westbank BKK, and Handelskrankenkasse, and Innungskrankenkasse Hamburg).
In an accompanying editorial, Tao Liu, MD, and Chen Liu, MD, of the 2nd Teaching Hospital, Jilin University in Changchun, People's Republic of China, note that acupuncture has a different conceptual and theoretical basis from that of biomedicine.
"In real-world primary care, few patients with OA seek acupuncture as the sole treatment, and due to the inconclusive information regarding its efficacy, acupuncture is very likely an undervalued treatment option as an element of a multidisciplinary integrative approach to treating this disorder," Drs. Liu and Liu write. "Given that the biologic mechanism of acupuncture is still unclear, the study by Witt et al furthers our understanding of acupuncture and adds to the accumulated evidence supporting its efficacy. Such evidence warrants extensive use of acupuncture in various chronic pain conditions."
Arthritis Rheum. Published online October 30, 2006.