Intervention Review

Acupuncture for peripheral joint osteoarthritis

  1. Eric Manheimer1,*,
  2. Ke Cheng2,
  3. Klaus Linde3,
  4. Lixing Lao4,
  5. Junghee Yoo5,
  6. Susan Wieland6,
  7. Daniëlle AWM van der Windt7,
  8. Brian M Berman1,
  9. Lex M Bouter8

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 16 APR 2008

DOI: 10.1002/14651858.CD001977.pub2


How to Cite

Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DAWM, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001977. DOI: 10.1002/14651858.CD001977.pub2.

Author Information

  1. 1

    University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, USA

  2. 2

    Shanghai University of TCM, Shanghai Research Center of Acupuncture and Meridians, Acupuncture-Moxibustion and Tuina, Shanghai, China

  3. 3

    Technische Universität München / Klinikum rechts der Isar, Institut für Allgemeinmedizin / Institute of General Practice, München, Germany

  4. 4

    University of Maryland School of Medicine, Complementary Medicine Program, Baltimore, Maryland, USA

  5. 5

    Kyunghee University, College of Oriental Medicine, Seoul, Korea, South

  6. 6

    Providence, Rhode Island, USA

  7. 7

    Keele University, Department of Primary Care & Health Sciences, Keele, Staffordshire, UK

  8. 8

    Executive Board of VU University Amsterdam, Amsterdam, Netherlands

*Eric Manheimer, Center for Integrative Medicine, University of Maryland School of Medicine, Kernan Hospital Mansion, 2200 Kernan Drive, Baltimore, Maryland, 21207-6697, USA. emanheimer@compmed.umm.edu.

Publication History

  1. Publication Status: New
  2. Published Online: 20 JAN 2010

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Background

Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective.

Objectives

To assess the effects of acupuncture for treating peripheral joint osteoarthritis.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, and EMBASE (both through December 2007), and scanned reference lists of articles.

Selection criteria

Randomized controlled trials (RCTs) comparing needle acupuncture with a sham, another active treatment, or a waiting list control group in people with osteoarthritis of the knee, hip, or hand.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We calculated standardized mean differences using the differences in improvements between groups.

Main results

Sixteen trials involving 3498 people were included. Twelve of the RCTs included only people with OA of the knee, 3 only OA of the hip, and 1 a mix of people with OA of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain (standardized mean difference -0.28, 95% confidence interval -0.45 to -0.11; 0.9 point greater improvement than sham on 20 point scale; absolute percent change 4.59%; relative percent change 10.32%; 9 trials; 1835 participants) and function (-0.28, -0.46 to -0.09; 2.7 point greater improvement on 68 point scale; absolute percent change 3.97%; relative percent change 8.63%); however, these pooled short-term benefits did not meet our predefined thresholds for clinical relevance (i.e. 1.3 points for pain; 3.57 points for function) and there was substantial statistical heterogeneity. Additionally, restriction to sham-controlled trials using shams judged most likely to adequately blind participants to treatment assignment (which were also the same shams judged most likely to have physiological activity), reduced heterogeneity and resulted in pooled short-term benefits of acupuncture that were smaller and non-significant. In comparison with sham acupuncture at the six-month follow-up, acupuncture showed borderline statistically significant, clinically irrelevant improvements in osteoarthritis pain (-0.10, -0.21 to 0.01; 0.4 point greater improvement than sham on 20 point scale; absolute percent change 1.81%; relative percent change 4.06%; 4 trials;1399 participants) and function (-0.11, -0.22 to 0.00; 1.2 point greater improvement than sham on 68 point scale; absolute percent change 1.79%; relative percent change 3.89%). In a secondary analysis versus a waiting list control, acupuncture was associated with statistically significant, clinically relevant short-term improvements in osteoarthritis pain (-0.96, -1.19 to -0.72; 14.5 point greater improvement than sham on 100 point scale; absolute percent change 14.5%; relative percent change 29.14%; 4 trials; 884 participants) and function (-0.89, -1.18 to -0.60; 13.0 point greater improvement than sham on 100 point scale; absolute percent change 13.0%; relative percent change 25.21%). In the head-on comparisons of acupuncture with the 'supervised osteoarthritis education' and the 'physician consultation' control groups, acupuncture was associated with clinically relevant short- and long-term improvements in pain and function. In the head on comparisons of acupuncture with 'home exercises/advice leaflet' and 'supervised exercise', acupuncture was associated with similar treatment effects as the controls. Acupuncture as an adjuvant to an exercise based physiotherapy program did not result in any greater improvements than the exercise program alone. Information on safety was reported in only 8 trials and even in these trials there was limited reporting and heterogeneous methods.

Authors' conclusions

Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, much of which may be due to expectation or placebo effects.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Acupuncture for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of acupuncture on osteoarthritis.

The review shows that in people with osteoarthritis,

-Acupuncture may lead to small improvements in pain and physical function after 8 weeks.

-Acupuncture may lead to small improvements in pain and physical function after 26 weeks.

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible side effects of acupuncture treatment include minor bruising and bleeding at the site of needle insertion.

What is osteoarthritis and what is acupuncture?

Osteoarthritis (OA) is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable. This can affect your physical function or ability to use your knee.

According to the philosophy of traditional acupuncture, energy circulates in 'meridians' located throughout the body.  Pain or ill health happens when something occurs to cause this meridian energy circulation to be blocked. The way to restore health is to stimulate the appropriate combination of acupuncture points in the body by inserting very thin needles.  Sometimes in painful conditions, electrical stimulation along with the needles is also used.  According to acupuncture theory, one way you can tell that acupuncture is relieving pain is that you may feel numbness or tingling, called de qi, where the needle is inserted.

Best estimate of what happens to people with osteoarthritis who have acupuncture:

Pain after 8 weeks:

-People who had acupuncture rated their pain to be improved by about 4 points on a scale of 0 to 20.
-People who received sham acupuncture rated their pain to be improved by about 3 points on a scale of 0 to 20.

-People who received acupuncture had a 1 point greater improvement on a scale of 0-20.  (5% absolute improvement).

Pain after 26 weeks:

-People who had acupuncture rated their pain to be improved by slightly more than 3 points on a scale of 0 to 20.
-People who received sham acupuncture rated their pain to be improved by slightly less than 3 points on a scale of 0 to 20.

-People who received acupuncture had under a 1 point greater improvement on a scale of 0-20.  (2% absolute improvement). 

Physical function after 8 weeks :

-People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68.
-People who received sham acupuncture rated their function to be improved by about 8 points on a scale of 0 to 68.

-People who received acupuncture had about a 3 point greater improvement on a scale of 0-68.  (4% absolute improvement) 

Physical function after 26 weeks :

-People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68.
-People who received sham acupuncture rated their function to be improved by about 10 points on a scale of 0 to 68.

-People who received acupuncture had about a 1 point greater improvement on a scale of 0-68.  (2% absolute improvement)

 

アブストラクト

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

末梢関節の変形性関節症に対する鍼治療

背景

末梢関節の変形性関節症は、疼痛および機能制限の主な原因である。安全で有効な治療法はあまりない。

目的

末梢関節の変形性関節症治療のための刺鍼術の効果を評価する。

検索戦略

Cochrane Central Register of Controlled Trials(コクラン・ライブラリ2008年第1号)、MEDLINE、およびEMBASE(ともに2007年12月まで)を検索し、論文の参考文献リストを入念に調べた。

選択基準

膝関節、股関節または手関節の変形性関節症のある人を対象に、刺鍼術を偽治療、別の治療、または待機者リストのコントロール群と比較しているランダム化比較試験(RCT)。

データ収集と分析

2名のレビューアが独自に試験の質を評価し、データを抽出した。追加情報については、研究著者に問い合わせた。群間の改善の差を用いて標準化平均差を計算した。

主な結果

3,498例を対象とした16件の試験を含めた。RCTのうち12件は膝関節の変形性関節症の人のみ、3件は股関節の変形性関節症の人のみ、1件は股関節および/または膝関節の変形性関節症の人の混合を対象としていた。偽治療コントロールと比較して刺鍼術は、変形性関節症の疼痛(標準化平均差-0.28、95%信頼区間-0.45~-0.11、20点尺度で偽治療よりも0.9点改善、絶対パーセント変化4.59%、相対パーセント変化10.32%、9件の試験で参加者1,835例)および機能(-0.28、-0.46~-0.09、68点尺度で2.7点改善、絶対パーセント変化3.97%、相対パーセント変化8.63%)において統計学的に有意な短期的改善を示した。しかし、これらを統合した短期的な利益は、臨床的関連性に対して事前に定義していた閾値を満たさず(すなわち、疼痛に対して1.3点、機能に対して3.57点)、実質上、統計学的な異質性がみられた。加えて、治療の割付けについて参加者を適切に盲検化した可能性が最も高いと判定された偽治療を用いる偽治療比較試験(生理学的活性を有する可能性が最も高いと判定された同一の偽治療)に限定した場合、異質性は減少し、その結果、統合した短期的な刺鍼術の利益は小さくなり、有意性も認めなかった。6ヵ月の追跡時点での偽刺鍼術と比較して刺鍼術は、変形性関節症の疼痛(-0.10、-0.21~0.01、20点尺度で偽治療よりも0.4点改善、絶対パーセント変化1.81%、相対パーセント変化4.06%、4件の試験で参加者1,399例)および機能(-0.11、-0.22~0.00、68点尺度で偽治療よりも1.2点改善、絶対パーセント変化1.79%、相対パーセント変化3.89%)について、統計学的にわずかに有意で臨床的に関連性のない改善が示された。待機者リスト・コントロールと比較した副次的解析で、刺鍼術は変形性関節症の疼痛(-0.96、-1.19~-0.72、100点尺度で偽治療よりも14.5点改善、絶対パーセント変化14.5%、相対パーセント変化29.14%、4件の試験で参加者884例)および機能(-0.89、-1.18~-0.60、100点尺度で偽治療よりも13.0点改善、絶対パーセント変化13.0%、相対パーセント変化25.21%)に対して、統計学的に有意で臨床的に関連性のある短期的な改善を示した。刺鍼術と、「監督下での変形性関節症の教育」および「医師受診」をコントロール群とした直接的比較では、刺鍼術は疼痛と機能に臨床的に関連性のある短期的および長期的な改善を示した。刺鍼術と、「在宅運動・アドバイス用パンフレット」および「監督下での運動」との直接的比較では、刺鍼術はコントロールと同様の治療効果があった。運動をベースとした理学療法プログラムを補った刺鍼術は、運動プログラム単独を上回る改善にはつながらなかった。安全性に関する情報は8件の試験のみで報告されていた。これらの試験でも報告は限られており、方法は異質であった。

著者の結論

偽治療との比較試験は、統計学的に有意な利益を示している。しかし、これらの利益は小さく、臨床的関連性について事前に定義していた閾値を満たさず、不完全な盲検化によるプラセボ効果に少なくとも一部起因していると思われる。末梢関節の変形性関節症に対する刺鍼術と待機者リストとの比較試験は、統計学的に有意で臨床的に関連性のある利益を示唆しており、その大半は期待効果またはプラセボ効果に起因している可能性がある。

訳注

監  訳: 内藤 徹,2010.4.15

実施組織: 厚生労働省委託事業によりMindsが実施した。

ご注意 : この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、Minds事務局までご連絡ください。Mindsでは最新版の日本語訳を掲載するよう努めておりますが、編集作業に伴うタイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。