Efficacy of Acupuncture-Related Therapy in the Treatment of Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

Wei Liu; Yihua Fan; Yuanhao Wu; Xu Hou; Bin Xue; Peihao Li; Shumin Zhang; Qingyun Yue

doi:10.2147/JPR.S315956

Efficacy of Acupuncture-Related Therapy in the Treatment of Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

J Pain Res. 2021 Jul 19:14:2209-2228. doi: 10.2147/JPR.S315956. eCollection 2021.

Authors

Wei Liu^#^{1

2}, Yihua Fan^#^{1

2}, Yuanhao Wu^#^{1

2}, Xu Hou³, Bin Xue^{1

2}, Peihao Li^{1

2}, Shumin Zhang^{1

2}, Qingyun Yue^{1

2}

Affiliations

¹ First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, People's Republic of China.
² National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China.
³ Department of Endocrinology and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, People's Republic of China.

^# Contributed equally.

Abstract

Objective: Knee osteoarthritis (KOA) is prevalent in middle-aged and elderly people. This condition negatively affects the quality of life of patients. Although non-steroidal anti-inflammatory drugs (NSAIDs) are often used to relieve symptoms associated with KOA, it is associated with many side effects. Acupuncture and moxibustion therapies have been applied in the treatment of KOA. However, the efficacy of various acupuncture and moxibustion treatments has not been compared.

Methods: Randomized controlled trials (RCTs) on the application of acupuncture and moxibustion in the treatment of KOA were searched in English databases and Chinese databases. Data were retrieved from establishment of the database to September 2020. Data analysis was performed using Stata14.0 and GeMTC 0.14.3 softwares.

Results: A total of 40 RCTs involving 3215 patients with KOA were retrieved. Network meta-analysis revealed that the fire needle was superior to western medicine, electro-acupuncture, conventional acupuncture, warm needle and sham acupuncture; warm needle was better than conventional acupuncture and western medicine whereas electro-acupuncture was better than conventional acupuncture in improving pain scores in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Moreover, we found that fire needle and warm needle more effectively improved WOMAC stiffness scores than western medicine and sham moxibustion, whereas electro-acupuncture was superior to western medicine and sham moxibustion in improving WOMAC stiffness scores. Further analysis revealed that fire needle, warm needle and electro-acupuncture were more effective in improving WOMAC joint function scores than conventional acupuncture and western medicine. The fire needle was superior to conventional acupuncture and sham acupuncture, whereas electro-acupuncture was better than western medicine, conventional acupuncture and sham acupuncture in improving visual analogue scale scores.

Conclusion: This study shows that fire needle is superior to warm needle and electro-acupuncture, whereas warm needle and electro-acupuncture are better than conventional acupuncture, western medicine, sham moxibustion and sham acupuncture.

Keywords: acupuncture; knee osteoarthritis; moxibustion; network meta-analysis; randomized controlled trials.

Publication types

Review

Grants and funding

This study was financially supported by the National Natural Science Foundation of China (No.82074377), the National Key Research and Development Project (No.2018YFC1705201), Tianjin Key Specialty Program (20210602-1), the Special Scientific Research for Traditional Chinese Medicine (No.201507001-07), and High-Level Talent Selection and Training Project of Tianjin Health and Family Planning Industry (02005wuyuanhao).