Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial

Abstract

Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial Nadine E Foster, senior lecturer in therapies (pain management), 1 Interventions Advice and exercise (n=116), advice and exercise plus true acupuncture (n=117), and advice and exercise plus non-penetrating acupuncture (n=119). Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months. Secondary outcomes included function, pain intensity, and unpleasantness of pain at two weeks, six weeks, six months, and 12 months. Results Follow-up rate at six months was 94%. The mean (SD) baseline pain score was 9.2 (3.8). At six months mean reductions in pain were 2.28 (3.8) for advice and exercise, 2.32 (3.6) for advice and exercise plus true acupuncture, and 2.53 (4.2) for advice and exercise plus non-penetrating acupuncture. Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval −1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (−0.8 to 1.3) for advice and exercise plus non-penetrating acupuncture. Similar nonsignificant differences were seen at other follow-up points. Compared with advice and exercise alone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for nonpenetrating acupuncture. Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores. Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects.Trial registration Current Controlled Trials ISRCTN88597683.

Role of exercise for knee pain: What do older adults in the community think?

“…Exercise, including local strengthening exercise and general aerobic exercise, has consistently been shown to be beneficial for older adults with knee pain. Exercise can improve function and reduce pain (2,3), improve physical performance (including walking distance and stair climbing [4]), improve muscle strength, increase joint range of motion and walking speed (5,6), and increase self-efficacy (7). In addition, it has wider health benefits, such as reducing the risk of cardiovascular disease (8,9).…”

Research into practice: improving musculoskeletal care in general practice

“…Short-term improvements in health outcomes, reduced use of antiinflammatory drugs, and high patient satisfaction were achieved by giving patients with knee osteoarthritis greater access to community physiotherapy (individualised exercise programme; advice on activity and pacing) and pharmacists (face-to-face medication review and advice). In separate trials we have confirmed the benefits of advice and exercise for knee osteoarthritis, that acupuncture yields no additional benefit, 13 and that for hand osteoarthritis joint protection education offered by occupational therapists is beneficial. …”

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…Our previous trial results suggested that a lower limb exercise programme that was supervised and progressed over six treatment sessions resulted in greater improvements in pain than one that was provided over an average of four sessions. 34,203 Therefore, the protocol for ITE was developed to ensure the prescription of an individualised, supervised and progressed lower limb exercise programme.…”

“…The Acupuncture, Physiotherapy and Exercise (APEX) trial, 202 which incorporated a more intensive exercise intervention that was supervised and progressed over six treatment sessions, resulted in greater improvements in pain than the exercise programme in the TOPIK trial. 34,203 Similarly, other recent trials 30,98 and reviews 204 showed small to moderate, short-term reductions in knee pain and disability that are not sustained in the long term. 192 Exercise is clearly worth doing but we need to find out if, and how, the beneficial effects can be maintained over time.…”

“…Conversations with patients during telephone follow-ups in the APEX trial helped to explain why the effects of exercise might be suboptimal. 202,203 Participants reported misconceptions about exercise in the presence of knee joint damage and pain, difficulty fitting the exercises into a daily routine, overly complex exercise programmes, insufficient tailoring of the exercise programmes for their individual needs and, in some cases, they simply forgot to do the exercises. These reviews highlight a lack of information about how to optimise exercise for this patient group.…”