Author:
Chen Jia,Guo Hong,Pan Juanhong,Li Hongpeng,Wang Yongshen,Liu Zhixiang,Xie Yulong,Jin Song
Abstract
Abstract
Objective
To conduct a systematic review and meta-analysis to investigate the clinical efficacy of acupuncture combined with active exercise training in improving pain and function of knee osteoarthritis (KOA) individuals.
Data sources
PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, Technology Periodical Database and China Biology Medicine were searched from their inceptions to April 5, 2023.
Review methods
We analyzed trials of acupuncture combined with active exercise training for KOA. The included studies were of high quality (Jadad ≥ 4) and RCTs. Study selection, data extraction, risk of bias and quality assessment were independently performed by two reviewers. We performed systematic analyses based on different outcome measures, including total efficiency rate, visual analogue scale (VAS), the Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), the Lysholm Knee Scale (LKS) and range of motion (ROM). We used Review Manager 5.3 and Stata/MP 14.0 to analyze the data. And it was verified by trial sequence analysis (TSA). If I2 > 50% and p < 0.05, we performed sensitivity analysis and subgroup analysis to find the source of heterogeneity. Publication bias was studied by funnel plot and Egger’s test was used to verify it.
Results
Full 11 high-quality studies (Jadad ≥ 4) including 774 KOA individuals were included in this review for meta-analysis. The results showed that acupuncture combined with active exercise training (combined group) was superior to the acupuncture group in improving the total effective rate [RR = 1.13, 95%CI (1.05, 1.22), I2 = 0%, P = 0.70], reducing the pain level (VAS) [MD = − 0.74, 95%CI (− 1.04, − 0.43), I2 = 68%, P < 0.05], improving knee joint function (WOMAC) [MD = − 6.97, 95%CI (− 10.74, − 3.19), I2 = 76%, P < 0.05] and improving joint range of motion (ROM) [MD = 6.25, 95%CI (2.37, 10.04), I2 = 0%, P = 0.71]. Similarly, the combined group showed significant improvements in the total effective rate [RR = 1.31, 95% CI (1.18, 1.47), I2 = 48%, P = 0.10], pain (VAS) [MD = 1.42, 95% CI (− 1.85, − 1.00), I2 = 65%, P = 0.02] and knee function (WOMAC) [MD = 7.05, 95% CI (− 11.43, − 2.66), I2 = 86%, P < 0.05] compared with the non-acupuncture group.
Conclusion
The combined effect of all studies showed significant benefits of acupuncture combined with active exercise training in improving the total effective rate, reducing pain, promoting recovery of knee function and expanding range of motion. However, some evaluation indicators are highly subjective and need to be further confirmed by more objective and evidence-based high-quality RCTs in future.
Systematic Review Registration: [PROSPERO], identifier [No. CRD42023425823].
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference66 articles.
1. Xu J, Xu H, Liang QQ, Shi Q, Wang YJ. Research progress of acupuncture treatment of knee osteoarthritis in recent 5 years. Chinese J Tradit Chin Med. 2020;35(07):3557–9.
2. Joint Surgery Group, Orthopaedic Branch of the Chinese Medical Association, Osteoarthritis Group, Orthopaedic Branch of the Chinese Medical Doctor Association, National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), et al. Chinese guidelines for the diagnosis and Treatment of osteoarthritis (2021 edition). Chin J Orthop. 2021;41(18):1291–314.
3. Dobson GP, Letson HL, Grant A, McEwen P, Hazratwala K, Wilkinson M, Morris JL. Defining the osteoarthritis patient: back to the future. Osteoarthr Cartil. 2018;26(8):1003–7. https://doi.org/10.1016/j.joca.2018.04.018.
4. O’Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol. 2018;32(2):312–26. https://doi.org/10.1016/j.berh.2018.10.007.
5. Menon J, Mishra P. Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system. Osteoarthr Cartil. 2018;26(4):480–4. https://doi.org/10.1016/j.joca.2017.12.007.