Acupuncture for osteoarthritis of the knee - A systematic review

Objective. To evaluate trials of acupuncture for osteoarthritis (OA) of the knee, to assess the methodologic quality of the trials and determine wheth er low-quality trials are associated with positive outcomes, to document ad verse effects, to identify patient or treatment characteristics associated with positive response, and to identify areas of future research. Methods. Eight databases and 62 conference abstract series were searched. R andomized or quasi-randomized trials of all languages were included and eva luated for methodologic quality using the Jadad scale. Outcomes were pain, function, global improvement, and imaging. Data could not be pooled; theref ore, a best-evidence synthesis was performed to determine the strength of e vidence by control group. The adequacy of the acupuncture procedure was ass essed by 2 acupuncturists trained in treating OA and blinded to study resul ts. Results. Seven trials representing 393 patients with knee OA were identifie d. For pain and function, there was limited evidence that acupuncture is mo re effective than being on a waiting list for treatment or having treatment as usual. For pain, there was strong evidence that real acupuncture is mor e effective than sham acupuncture; however, for function, there was inconcl usive evidence that real acupuncture is more effective than sham acupunctur e. There was insufficient evidence to determine whether the efficacy of acu puncture is similar to that of other treatments. Conclusion. The existing evidence suggests that acupuncture may play a role in the treatment of knee OA. Future research should define an optimal acup uncture treatment, measure quality of life, and assess acupuncture combined with other modalities.