Durable Effects of Acupuncture for Knee Osteoarthritis: A Systematic Review and Meta-analysis

Abstract

Purpose of review: Knee osteoarthritis (KOA) is a degenerative joint disease which can result in chronic pain and disability. The current interventions available for KOA often fail to provide long-lasting effects, highlighting the need for new treatment options that can offer durable benefits. Previous studies have suggested the efficacy of acupuncture for knee osteoarthritis (KOA) with its durability remaining uncertain. In this review, we aimed to investigate the durability of the efficacy after completion of treatment.

Recent findings: We performed thorough searches of PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials from inception to November 4, 2023. The outcomes were assessed at all available time points after completion of treatment. Primary outcomes were changes from baseline in pain and function measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales. Secondary outcomes included response rate, overall pain, the WOMAC stiffness subscale, total WOMAC index, and physical and mental health components of 12/36-item Short-Form Health Survey. A total of 10 randomized controlled trials (RCTs) involving 3221 participants were included. Pooled estimates suggested that acupuncture may offer potential improvements in function and overall pain for 4.5 months post-treatment versus sham acupuncture (SA). Acupuncture may provide durable clinically important pain relief and functional improvement up to 5 months post-treatment versus usual care, and up to 6 months post-treatment versus diclofenac. For acupuncture versus no treatment, one trial with large sample size indicated that improvements in pain and function persisted for 3 months post-treatment, while the other trial reported that significant pain reduction and functional improvement were only observed at the end of the treatment, not at 9 months post-treatment. However, acupuncture as adjunct to exercise-based physical therapy (EPT) showed no superiority to SA as an adjunct to EPT or EPT alone up to 11.25 months after completion of treatment. Acupuncture may provide pain alleviation and functional improvements in KOA patients for 3 to 6 months after completion of treatment with a good safety profile.

Keywords: Acupuncture; Durable effects; Function; Knee osteoarthritis; Pain.

Fig. 1

Flow diagram of the identification and selection of studies

Fig. 2

Risk of bias summary

Fig. 3

Acupuncture versus sham acupuncture: changes from baseline in WOMAC pain, WOMAC function, overall pain, WOMAC stiffness, and total WOMAC index

Fig. 4

Response rate

Fig. 5

Acupuncture versus usual care: changes from baseline in WOMAC pain, WOMAC function, overall pain, WOMAC stiffness, and total WOMAC index

Fig. 6

Dry needling versus diclofenac: changes from baseline in WOMAC pain, WOMAC function, overall pain, WOMAC stiffness, and total WOMAC index