Curative Effect of Electroacupuncture and Manual Acupuncture for Knee Osteoarthritis: A Meta-Analysis
Abstract
Background: We aimed to examine how electroacupuncture and manual acupuncture affect treatment results, pain levels, and joint function in individuals with knee osteoarthritis.
Methods: Research was carried out in various databases including PubMed, Medline, Embase, CENTRAL, and CNKI. Following the "Cochrane manual", the risk of bias of included RCTs was assessed. A funnel plot was utilized to evaluate any potential bias in the publications. The impact size was indicated by the average discrepancy along with its 95% confidence interval.
Results: The EA group showed a higher effectiveness rate (P = 0.001) and a lower WOMAC pain score (P < 0.00001) compared to the control group. The EA group had a lower WOMAC pain score compared to the SA/exercise group and the group that received manual acupuncture. The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group under intense electroacupuncture stimulation (P < 0.0001). The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group when weak current acupuncture was applied (P = 0.0001). However, no significant difference in WOMAC function score between EA and control group.
Conclusion: Comparison to manual acupuncture, placebo acupuncture, and exercise training, electroacupuncture enhanced the effectiveness of treating KOA and decreased the WOMAC pain score in patients with KOA. The level of pain relief achieved may be linked to the strength of the current stimulation. However, electroacupuncture had no significant effect on WOMAC function score.
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2. Nazari G. Knee osteoarthritis (2017). J Phys-iother, 63 (3):188.
3. Lin KW (2018). Treatment of Knee Osteo-arthritis. Am Fam Physician, 98 (9):603-606.
4. Siddiq M, Clegg D, Jansen TL, et al (2022). Emerging and New Treatment Options for Knee Osteoarthritis. Curr Rheumatol Rev, 18 (1):20-32.
5. Cao P, Li Y, Tang Y, et al (2020). Pharma-cotherapy for knee osteoarthritis: cur-rent and emerging therapies. Expert Opin Pharmacother, 21 (7):797-809.
6. Bunzli S, Taylor N, O'Brien P, et al (2021). How Do People Communicate About Knee Osteoarthritis? A Discourse Anal-ysis. Pain Med, 22 (5):1127-1148.
7. Imani F, Patel VB (2019). Therapeutic Chal-lenges for Knee Osteoarthritis. Anesth Pain Med, 9 (3):e95377.
8. Yeoh P, Lai KW, Goh SL, et al (2021). Emergence of Deep Learning in Knee Osteoarthritis Diagnosis. Comput Intell Neurosci, 2021:4931437.
9. Khan S, Logan P C, Asokan A, et al (2020). The Assessment and Management of the Arthritic Knee: An Update. Cureus, 12 (11):e11582.
10. Charlesworth J, Fitzpatrick J, Perera N, et al (2019). Osteoarthritis- a systematic re-view of long-term safety implications for osteoarthritis of the knee. BMC Mus-culoskelet Disord, 20(1):151.
11. Allaeys C, Arnout N, Van Onsem S, et al (2020). Conservative treatment of knee osteoarthritis. Acta Orthop Belg, 86 (3):412-421.
12. Hunter D J, Harris R E (2021). Acupuncture and Knee Osteoarthritis: Does Dose Matter? Arthritis Rheumatol, 73 (3):371-373.
13. Lee YJ, Han CH, Jeon JH, et al (2020). Ef-fectiveness and safety of polydioxanone thread-embedding acupuncture (TEA) and electroacupuncture (EA) treatment for knee osteoarthritis (KOA) patients with postoperative pain: An assessor-blinded, randomized, controlled pilot trial. Medicine (Baltimore), 99 (30):e21184.
14. Wang T Q, Li Y T, Wang L Q, et al (2020). Electroacupuncture versus manual acu-puncture for knee osteoarthritis: a ran-domized controlled pilot trial. Acupunct Med, 38 (5):291-300.
15. Hinman R S, McCrory P, Pirotta M, et al (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312 (13):1313-1322.
16. Lam W C, Au KY, Qin Z, et al (2021). Su-perficial Needling Acupuncture vs Sham Acupuncture for Knee Osteoarthritis: A Randomized Controlled Trial. Am J Med, 134 (10):1286-1294.e2.
17. Zhang L, Yuan H, Zhang L, et al (2019). Ef-fect of acupuncture therapies combined with usual medical care on knee osteoar-thritis. J Tradit Chin Med, 39 (1):103-110.
18. Sterne J, Savovic J, Page MJ, et al (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 366:l4898.
19. Lin L (2020). Comparison of four hetero-geneity measures for meta-analysis. J Eval Clin Pract, 26 (1):376-384.
20. Chen LX, Mao J J, Fernandes S, et al (2013). Integrating acupuncture with exercise-based physical therapy for knee osteoar-thritis: a randomized controlled trial. J Clin Rheumatol, 19 (6):308-316.
21. Chen Y, Jia Y J, LU J H, et al (2020). (Com-parision of therapertic effect of differ-ent acupuncture methods for knee oste-oarthritis). Zhen Ci Yan Jiu, 45 (7):569-573.
22. Duanmu XL, Xu L, Li X, et al (2023). Clini-cal Observation of Knee Osteoarthritis Treated with Electroacupuncture Com-bined with Isokinetic Muscle Strength Training. Shandong Journal Of Traditional Chinese Medicine, 42 (8):831-835
23. Gao J, Ouyang B S, Zhang Y, et al (2012). (Comparison of the clinical therapeutic effects between electroacupuncture and warming needle moxibustion for knee osteoarthritis of kidney deficiency and marrow insufficiency pat-tern/syndrome). Zhongguo Zhen Jiu, 32 (5):395-398.
24. Hu W, XIE B, Tan J (2023). Combination therapy of electroacupuncture with acu-point-to-acupoint penetration needling and Mulligan mobilization with move-ment for mild-to-moderate knee osteo-arthritis: A randomized controlled study. Journal of Hunan University of Chinese, 43 (08):1486-1491.
25. Ji LL, Ouyang BS (2011). Clinical Observa-tion on Electroacupuncture for Knee Osteoarthritis. Shanghai J Acu-mox, 30 (09):620-621.
26. Jubb RW, Tukmachi ES, Jones PW, et al (2008). A blinded randomised trial of acupuncture (manual and electroacu-puncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupunct Med, 26 (2):69-78.
27. Li SL, AO M, Xiao Y, et al (2018). Clinical observation of electro-acupuncture combined with fumigation and steaming therapy of Chinese medicine on knee osteoarthritis. Hebei J TCM, 40 (01):109-112.
28. Tu J F, Wang LQ, Shi GX, et al (2021). (Ef-fect of acupuncture on knee injury and osteoarthritis outcome score in patients with knee osteoarthritis). Zhongguo Zhen Jiu, 41 (1):27-30.
29. Wang TQ, Li YT, Wang LQ, et al (2020). Electroacupuncture versus manual acu-puncture for knee osteoarthritis: a ran-domized controlled pilot trial. Acupunct Med, 38 (5):291-300.
30. Yin XZ (2017). Effect of Electroacupunc-ture on Knee Osteoarthritis. Chinese Genral Practice, 20 (S3):388-389.
31. Ju YZ; Wang Y; Chen LeC, et al (2017). Clinical Study of Electro-acupuncture for Knee Osteoarthritis. Shanghai Journal of Acupuncture and Moxibustion, 12: 1111-1115.
32. Zhang B, Jiang LL (2017). Clinical observa-tion of electroacupuncture combined with Chinese medicine in the treatment of early knee osteoarthritis. Clinical La-boratory Journal (Electronic Edition), 6 (01):143-145.
33. Zhang Q, Fang J, Chen L, et al (2020). Dif-ferent kinds of acupuncture treatments for knee osteoarthritis: a multicentre, randomized controlled trial. Trials, 21 (1):264.
34. Wu GW, Chen J, Huang YM, et al (2019). Electroacupuncture Delays Cartilage Degeneration by Modulating Nuclear Factor-kappaB signaling Pathway. Chin J Integr Med, 25 (9):677-683.
35. Yuan X C, Wang Q, Su W, et al (2018). Elec-troacupuncture potentiates peripheral CB2 receptor-inhibited chronic pain in a mouse model of knee osteoarthritis. J Pain Res, 11:2797-2808.
36. Liang X S, Li L, Li J, et al (2022). Advances in the clinical research on electroacu-puncture in treatment of knee osteoar-thritis. Chinese Journal of Diagnostics (Elec-tronic Edition), 11(2):61-64.
37. Fu SX, Hou MJ, Li ZH, et al (2020). Effects of Electro-Acupuncture on Vertical Ground Reaction Force and Impulse Symmetry of Patients with Knee Osteo-arthritis during Stair Climbing．J Med Biomech, 35 (4):335-340.
38. Xu HF, Zhao G P, Yang JJ, et al (2021). Three-Dimensional Finite Element Analysis of Electroacupuncture for Pa-tients with Knee Osteoarthritis during Ascent and Descent Stair. Chinese Journal of Biomedical Engineering, 40(3):321-329.
39. Lv Z T, Shen L L, Zhu B, et al (2019). Ef-fects of intensity of electroacupuncture on chronic pain in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther, 21 (1):120.
40. Huang DE, Qin Y, Lin M N, et al (2020). [Clinical efficacy of different waves of electroacupuncture on knee osteoarthri-tis and its effect on TGF-β1 in joint flu-id]. Zhongguo Zhen Jiu, 40(4):370-4.
41. Zhang YY, Li XH, Wu MX (2019). Effect of electroacupuncture at Wnt/β-catenin signaling pathway on inhibiting carthage degeneration in rats with knee osteoar-thritis. Zhongguo Zhen Jiu, 39 (10):1081-1086.
42. Li P, Zhang Y, Li F, et al (2023). The Effi-cacy of Electroacupuncture in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis (J). Adv Biol (Weinh), 7 (10):e2200304.
2. Nazari G. Knee osteoarthritis (2017). J Phys-iother, 63 (3):188.
3. Lin KW (2018). Treatment of Knee Osteo-arthritis. Am Fam Physician, 98 (9):603-606.
4. Siddiq M, Clegg D, Jansen TL, et al (2022). Emerging and New Treatment Options for Knee Osteoarthritis. Curr Rheumatol Rev, 18 (1):20-32.
5. Cao P, Li Y, Tang Y, et al (2020). Pharma-cotherapy for knee osteoarthritis: cur-rent and emerging therapies. Expert Opin Pharmacother, 21 (7):797-809.
6. Bunzli S, Taylor N, O'Brien P, et al (2021). How Do People Communicate About Knee Osteoarthritis? A Discourse Anal-ysis. Pain Med, 22 (5):1127-1148.
7. Imani F, Patel VB (2019). Therapeutic Chal-lenges for Knee Osteoarthritis. Anesth Pain Med, 9 (3):e95377.
8. Yeoh P, Lai KW, Goh SL, et al (2021). Emergence of Deep Learning in Knee Osteoarthritis Diagnosis. Comput Intell Neurosci, 2021:4931437.
9. Khan S, Logan P C, Asokan A, et al (2020). The Assessment and Management of the Arthritic Knee: An Update. Cureus, 12 (11):e11582.
10. Charlesworth J, Fitzpatrick J, Perera N, et al (2019). Osteoarthritis- a systematic re-view of long-term safety implications for osteoarthritis of the knee. BMC Mus-culoskelet Disord, 20(1):151.
11. Allaeys C, Arnout N, Van Onsem S, et al (2020). Conservative treatment of knee osteoarthritis. Acta Orthop Belg, 86 (3):412-421.
12. Hunter D J, Harris R E (2021). Acupuncture and Knee Osteoarthritis: Does Dose Matter? Arthritis Rheumatol, 73 (3):371-373.
13. Lee YJ, Han CH, Jeon JH, et al (2020). Ef-fectiveness and safety of polydioxanone thread-embedding acupuncture (TEA) and electroacupuncture (EA) treatment for knee osteoarthritis (KOA) patients with postoperative pain: An assessor-blinded, randomized, controlled pilot trial. Medicine (Baltimore), 99 (30):e21184.
14. Wang T Q, Li Y T, Wang L Q, et al (2020). Electroacupuncture versus manual acu-puncture for knee osteoarthritis: a ran-domized controlled pilot trial. Acupunct Med, 38 (5):291-300.
15. Hinman R S, McCrory P, Pirotta M, et al (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312 (13):1313-1322.
16. Lam W C, Au KY, Qin Z, et al (2021). Su-perficial Needling Acupuncture vs Sham Acupuncture for Knee Osteoarthritis: A Randomized Controlled Trial. Am J Med, 134 (10):1286-1294.e2.
17. Zhang L, Yuan H, Zhang L, et al (2019). Ef-fect of acupuncture therapies combined with usual medical care on knee osteoar-thritis. J Tradit Chin Med, 39 (1):103-110.
18. Sterne J, Savovic J, Page MJ, et al (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 366:l4898.
19. Lin L (2020). Comparison of four hetero-geneity measures for meta-analysis. J Eval Clin Pract, 26 (1):376-384.
20. Chen LX, Mao J J, Fernandes S, et al (2013). Integrating acupuncture with exercise-based physical therapy for knee osteoar-thritis: a randomized controlled trial. J Clin Rheumatol, 19 (6):308-316.
21. Chen Y, Jia Y J, LU J H, et al (2020). (Com-parision of therapertic effect of differ-ent acupuncture methods for knee oste-oarthritis). Zhen Ci Yan Jiu, 45 (7):569-573.
22. Duanmu XL, Xu L, Li X, et al (2023). Clini-cal Observation of Knee Osteoarthritis Treated with Electroacupuncture Com-bined with Isokinetic Muscle Strength Training. Shandong Journal Of Traditional Chinese Medicine, 42 (8):831-835
23. Gao J, Ouyang B S, Zhang Y, et al (2012). (Comparison of the clinical therapeutic effects between electroacupuncture and warming needle moxibustion for knee osteoarthritis of kidney deficiency and marrow insufficiency pat-tern/syndrome). Zhongguo Zhen Jiu, 32 (5):395-398.
24. Hu W, XIE B, Tan J (2023). Combination therapy of electroacupuncture with acu-point-to-acupoint penetration needling and Mulligan mobilization with move-ment for mild-to-moderate knee osteo-arthritis: A randomized controlled study. Journal of Hunan University of Chinese, 43 (08):1486-1491.
25. Ji LL, Ouyang BS (2011). Clinical Observa-tion on Electroacupuncture for Knee Osteoarthritis. Shanghai J Acu-mox, 30 (09):620-621.
26. Jubb RW, Tukmachi ES, Jones PW, et al (2008). A blinded randomised trial of acupuncture (manual and electroacu-puncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupunct Med, 26 (2):69-78.
27. Li SL, AO M, Xiao Y, et al (2018). Clinical observation of electro-acupuncture combined with fumigation and steaming therapy of Chinese medicine on knee osteoarthritis. Hebei J TCM, 40 (01):109-112.
28. Tu J F, Wang LQ, Shi GX, et al (2021). (Ef-fect of acupuncture on knee injury and osteoarthritis outcome score in patients with knee osteoarthritis). Zhongguo Zhen Jiu, 41 (1):27-30.
29. Wang TQ, Li YT, Wang LQ, et al (2020). Electroacupuncture versus manual acu-puncture for knee osteoarthritis: a ran-domized controlled pilot trial. Acupunct Med, 38 (5):291-300.
30. Yin XZ (2017). Effect of Electroacupunc-ture on Knee Osteoarthritis. Chinese Genral Practice, 20 (S3):388-389.
31. Ju YZ; Wang Y; Chen LeC, et al (2017). Clinical Study of Electro-acupuncture for Knee Osteoarthritis. Shanghai Journal of Acupuncture and Moxibustion, 12: 1111-1115.
32. Zhang B, Jiang LL (2017). Clinical observa-tion of electroacupuncture combined with Chinese medicine in the treatment of early knee osteoarthritis. Clinical La-boratory Journal (Electronic Edition), 6 (01):143-145.
33. Zhang Q, Fang J, Chen L, et al (2020). Dif-ferent kinds of acupuncture treatments for knee osteoarthritis: a multicentre, randomized controlled trial. Trials, 21 (1):264.
34. Wu GW, Chen J, Huang YM, et al (2019). Electroacupuncture Delays Cartilage Degeneration by Modulating Nuclear Factor-kappaB signaling Pathway. Chin J Integr Med, 25 (9):677-683.
35. Yuan X C, Wang Q, Su W, et al (2018). Elec-troacupuncture potentiates peripheral CB2 receptor-inhibited chronic pain in a mouse model of knee osteoarthritis. J Pain Res, 11:2797-2808.
36. Liang X S, Li L, Li J, et al (2022). Advances in the clinical research on electroacu-puncture in treatment of knee osteoar-thritis. Chinese Journal of Diagnostics (Elec-tronic Edition), 11(2):61-64.
37. Fu SX, Hou MJ, Li ZH, et al (2020). Effects of Electro-Acupuncture on Vertical Ground Reaction Force and Impulse Symmetry of Patients with Knee Osteo-arthritis during Stair Climbing．J Med Biomech, 35 (4):335-340.
38. Xu HF, Zhao G P, Yang JJ, et al (2021). Three-Dimensional Finite Element Analysis of Electroacupuncture for Pa-tients with Knee Osteoarthritis during Ascent and Descent Stair. Chinese Journal of Biomedical Engineering, 40(3):321-329.
39. Lv Z T, Shen L L, Zhu B, et al (2019). Ef-fects of intensity of electroacupuncture on chronic pain in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther, 21 (1):120.
40. Huang DE, Qin Y, Lin M N, et al (2020). [Clinical efficacy of different waves of electroacupuncture on knee osteoarthri-tis and its effect on TGF-β1 in joint flu-id]. Zhongguo Zhen Jiu, 40(4):370-4.
41. Zhang YY, Li XH, Wu MX (2019). Effect of electroacupuncture at Wnt/β-catenin signaling pathway on inhibiting carthage degeneration in rats with knee osteoar-thritis. Zhongguo Zhen Jiu, 39 (10):1081-1086.
42. Li P, Zhang Y, Li F, et al (2023). The Effi-cacy of Electroacupuncture in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis (J). Adv Biol (Weinh), 7 (10):e2200304.
| Files | ||
| Issue | Vol 53 No 9 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i9.16450 | |
| Keywords | ||
| Knee osteoarthritis Electroacupuncture Pain Function | ||
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How to Cite
1.
Luo H, Jing C, Liu H. Curative Effect of Electroacupuncture and Manual Acupuncture for Knee Osteoarthritis: A Meta-Analysis. Iran J Public Health. 2024;53(9):1951-1963.
