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. 2013 Sep;21(9):1290-8.
doi: 10.1016/j.joca.2013.05.007.

Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis

M S Corbett  1 , S J C Rice, V Madurasinghe, R Slack, D A Fayter, M Harden, A J Sutton, H Macpherson, N F Woolacott
Affiliations

Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis

M S Corbett et al. Osteoarthritis Cartilage. 2013 Sep.

Abstract

Objective: To compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to knee osteoarthritis.

Design: Systematic review with network meta-analysis, to allow comparison of treatments within a coherent framework. Comprehensive searches were undertaken up to January 2013 to identify randomised controlled trials in patients with osteoarthritis of the knee, which reported pain.

Results: Of 156 eligible studies, 114 trials (covering 22 treatments and 9,709 patients) provided data suitable for analysis. Most trials studied short-term effects and many were classed as being of poor quality with high risk of bias, commonly associated with lack of blinding (which was sometimes impossible to achieve). End of treatment results showed that eight interventions: interferential therapy, acupuncture, TENS, pulsed electrical stimulation, balneotherapy, aerobic exercise, sham acupuncture, and muscle-strengthening exercise produced a statistically significant reduction in pain when compared with standard care. In a sensitivity analysis of satisfactory and good quality studies, most studies were of acupuncture (11 trials) or muscle-strengthening exercise (9 trials); both interventions were statistically significantly better than standard care, with acupuncture being statistically significantly better than muscle-strengthening exercise (standardised mean difference: 0.49, 95% credible interval 0.00-0.98).

Conclusions: As a summary of the current available research, the network meta-analysis results indicate that acupuncture can be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term. However, much of the evidence in this area of research is of poor quality, meaning there is uncertainty about the efficacy of many physical treatments.

Keywords: Knee; Network meta-analysis; Osteoarthritis; Pain; Physical treatments.

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Figures

Fig. 1
Fig. 1
a: SMDs of each treatment compared to standard care for the analysis including studies of any-quality. b: SMDs of each treatment compared to acupuncture for the analysis including studies of any-quality. c: SMDs of each treatment compared to standard care for the analysis including better-quality studies. d: SMDs of each treatment compared to acupuncture for the analysis including better-quality studies.
Fig. 2
Fig. 2
Network diagram for the end of treatment analysis of better-quality trials. The number of trials and patients included in the analysis are stated in Tables II(c–d). Each solid arrow indicates that there is a data point for that comparison entered into the analysis. The thickness reflects the number of trials. The dotted line reflects an extra comparison in a multi-arm trial. The numbers are a measure of inconsistency: 0 is no inconsistency; 1 is complete inconsistency.
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