Clinical decisions in the use of acupuncture as an adjunctive therapy for osteoarthritis of the knee

Abstract

Objective • To determine whether demographic, medical history, or arthritis assessment data may influence outcome and rate of decay for patients with osteoarthritis treated with acupuncture. Design • Seventy-three persons with symptomatic osteoarthritis of the knee were recruited for this randomized controlled trial. Both treatment and crossover control groups received acupuncture treatments twice weekly for 8 weeks. Patients self-scored on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lequesne Algofunctional Index at baseline and 4, 8, and 12 weeks. Sample size for this outcomes analysis was 60 patients at 4 weeks, 58 at 8 weeks, and 52 at 12 weeks. Results • Patients' scores on both indexes improved at 4, 8, and 12 weeks. Scores were stable regardless of the baseline severity of the osteoarthritis. Despite some decay in outcomes at week 12, measures were significantly improved over baseline. With WOMAC scores partitioned into equal quartiles, a strong effect on outcome was apparent at 12 weeks (4 weeks after treatment) related to initial WOMAC scores. The group with the least disability and pain rebounded to original levels to a greater degree than did those who initially were more disabled. The more disabled groups retained the benefits of acupuncture treatment through the 12-week period. Conclusion • Acupuncture for patients with osteoarthritis of the knee may best be used early in the treatment plan, with a methodical decrease in frequency in treatment once the acute treatment period is completed to avoid a rebound effect. Demographic and medical history data were not mediating variables.