Efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for knee osteoarthritis: statistical analysis plan for a randomized controlled trial

Jian-Feng Tu, Jing-Wen Yang, Li-Qiong Wang, Yang Wang, Jin-Ling Li, Na Zhang, Lu-Lu Lin, Zhang-Sheng Yu, Cun-Zhi Liu, Jian-Feng Tu, Jing-Wen Yang, Li-Qiong Wang, Yang Wang, Jin-Ling Li, Na Zhang, Lu-Lu Lin, Zhang-Sheng Yu, Cun-Zhi Liu

Abstract

Background: Acupuncture is widely used for knee osteoarthritis (KOA), despite contradictory evidence. This study is designed to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA.

Methods/design: This is a multi-center three-arm randomized controlled trial. It will enroll 480 participants with KOA in China. Participants will be randomly assigned 1:1:1 to receive 24 sessions of electro-acupuncture, manual acupuncture, or sham acupuncture over 8 weeks. The primary outcome is the response rate, which is the proportion of patients who achieve the minimal clinically important improvement in pain and function at 8 weeks. The primary outcome will be analyzed using the Z-test with the intention-to-treat set. Secondary outcomes include pain, function, global patient assessment, and quality of life. Full details of the statistical analysis plan for the primary and secondary outcomes will be described in this article. The statistical analysis plan was written and submitted without knowledge of the study data.

Discussion: The data will be analyzed according to this pre-specified statistical analysis plan to avoid data-driven analysis and to enhance the transparency of the trial. The aim of the trial is to provide high-quality evidence on the efficacy of acupuncture for KOA.

Trial registration: Clinicaltrials.gov, NCT03366363 . Registered on 20 November 2017.

Keywords: Acupuncture; Knee osteoarthritis; Statistical analysis plan.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Responder criteria. WOMAC Western Ontario and McMaster Universities Osteoarthritis Index
Fig. 2
Fig. 2
Flow diagram. EA electro-acupuncture, MA manual acupuncture, SA sham acupuncture

References

    1. Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, et al. Osteoarthritis. Lancet. 2015;386:376–387. doi: 10.1016/S0140-6736(14)60802-3.
    1. Tang X, Wang S, Zhan S, et al. The Prevalence of Symptomatic Knee Osteoarthritis in China: Results From the China Health and Retirement Longitudinal Study. Arthritis Rheumatol. 2016;68:648–653. doi: 10.1002/art.39465.
    1. Guillemin F, Rat AC, Mazieres B, et al. Prevalence of symptomatic hip and knee osteoarthritis: a two-phase population-based survey. Osteoarthr Cartil. 2011;19:1314–1322. doi: 10.1016/j.joca.2011.08.004.
    1. Hiligsmann M, Cooper C, Arden N, Boers M, Branco JC, Luisa Brandi M, et al. Health economics in the field of osteoarthritis: an expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Semin Arthritis Rheum. 2013;43:303–313. doi: 10.1016/j.semarthrit.2013.07.003.
    1. Mahler E, Minten MJ, Leseman-Hoogenboom MM, Poortmans P, Leer J, Boks SS, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis. 2019;78:83–90.
    1. da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Jüni P, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2017;390:e21–21e33. doi: 10.1016/S0140-6736(17)31744-0.
    1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–388. doi: 10.1016/j.joca.2014.01.003.
    1. Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin N Am. 2007;33:71–86. doi: 10.1016/j.rdc.2006.12.008.
    1. Su D, Li L. Trends in the use of complementary and alternative medicine in the United States: 2002-2007. J Health Care Poor Underserved. 2011;22:296–310.
    1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172:1444–1453. doi: 10.1001/archinternmed.2012.3654.
    1. Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014;312:1313–1322. doi: 10.1001/jama.2014.12660.
    1. White A, Cummings M, Barlas P, et al. Defining an adequate dose of acupuncture using a neurophysiological approach--a narrative review of the literature. Acupunct Med. 2008;26:111–120. doi: 10.1136/aim.26.2.111.
    1. Zhang Q, Yue J, Lu Y. Acupuncture treatment for chronic knee pain: study by Hinman et al underestimates acupuncture efficacy. Acupunct Med. 2015;33:170. doi: 10.1136/acupmed-2015-010776.
    1. Armour M, Smith CA. Treating primary dysmenorrhoea with acupuncture: a narrative review of the relationship between acupuncture 'dose' and menstrual pain outcomes. Acupunct Med. 2016;34:416–424. doi: 10.1136/acupmed-2016-011110.
    1. He W, Zhu B, Yu X, Liu B, Xu N, Jing X. Compairison between western and Chinese acupuncture and its enlightenment. Zhongguo Zhen Jiu. 2015;35:105–108.
    1. Lin Lu-Lu, Li Yong-Ting, Tu Jian-Feng, Yang Jing-Wen, Sun Ning, Zhang Shuai, Wang Tian-Qi, Shi Guang-Xia, Du Yi, Zhao Jing-Jie, Xiong Da-Chang, Hou Hai-Kun, Liu Cun-Zhi. Effectiveness and feasibility of acupuncture for knee osteoarthritis: a pilot randomized controlled trial. Clinical Rehabilitation. 2018;32(12):1666–1675. doi: 10.1177/0269215518790632.
    1. Noordergraaf A, Silage D. Electroacupuncture. IEEE Trans Biomed Eng. 1973;20:364–366. doi: 10.1109/TBME.1973.324289.
    1. Tu JF, Yang JW, Lin LL, Wang TQ, Du YZ, Liu ZS, et al. Efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for knee osteoarthritis: study protocol for a randomised controlled trial. Trials. 2019;20:79. doi: 10.1186/s13063-018-3138-x.
    1. Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum. 1995;38:1541–1546. doi: 10.1002/art.1780381104.
    1. Forestier R, Desfour H, Tessier JM, et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis. 2010;69:660–665. doi: 10.1136/ard.2009.113209.
    1. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S240–S252. doi: 10.1002/acr.20543.
    1. Tubach F, Ravaud P, Baron G, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005;64:29–33. doi: 10.1136/ard.2004.022905.
    1. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141:901–910. doi: 10.7326/0003-4819-141-12-200412210-00006.
    1. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31:73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–732. doi: 10.7326/0003-4819-152-11-201006010-00232.
    1. Li P, Stuart EA, Allison DB. Multiple Imputation: A Flexible Tool for Handling Missing Data. JAMA. 2015;314:1966–1967. doi: 10.1001/jama.2015.15281.
    1. Finfer S, Bellomo R. Why publish statistical analysis plans. Crit Care Resusc. 2009;11:5–6.
    1. Gamble C, Krishan A, Stocken D, Lewis S, Juszczak E, Doré C, et al. Guidelines for the Content of Statistical Analysis Plans in Clinical Trials. JAMA. 2017;318:2337–2343. doi: 10.1001/jama.2017.18556.

Source: PubMed

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