The effectiveness and safety of acupuncture for knee osteoarthritis: An overview of systematic reviews

Juan Li, Yu-Xi Li, Liao-Jun Luo, Jing Ye, Dong-Ling Zhong, Qi-Wei Xiao, Hui Zheng, Chun-Mei Geng, Rong-Jiang Jin, Fan-Rong Liang, Juan Li, Yu-Xi Li, Liao-Jun Luo, Jing Ye, Dong-Ling Zhong, Qi-Wei Xiao, Hui Zheng, Chun-Mei Geng, Rong-Jiang Jin, Fan-Rong Liang

Abstract

Background: Knee osteoarthritis (KOA), known as severe degenerative arthritis, commonly occurs in middle-aged and elderly people all over the world. Acupuncture as traditional oriental intervention is getting widely used and several systematic reviews (SRs) have reported the effectiveness of acupuncture on pain relief and functional recovery in patients with KOA.

Objective: Conducting an overview of SRs to provide more reliable evidence-based medical references for clinical practitioners and researchers of the effectiveness and safety of acupuncture for KOA.

Data sources: EMBASE, Medline, Web of science, the Cochrane library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, China Biology Medicine, Wan Fang Digital Journals, and PROSPERO databases from inception to December 2018, magazines, websites, and unpublished sources.

Selection criteria: Potential SRs were independently selected by 2 reviewers following a predetermined protocol.

Data extraction: Data information of included SRs were independently extracted by 2 reviewers following a predetermined standardized data extraction form.

Review appraisal: The risk of bias and reporting quality of included SRs were evaluated by the Risk of Bias in Systematic reviews (ROBIS) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The quality of evidence of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: A total of 12 SRs were included. All the SRs were published in recent 12 years, ranging from 2006 to 2017. According to ROBIS, 4 SRs were in low risk in domain 1 and 7 in domain 3 of phase 2, and 2 SRs were low risk in phase 3. Among 27 items of PRISMA, 19 items were reported over 70% of compliance. Using GRADE assessment, of 34 outcomes, high quality of evidence was found in 5 outcomes, 17 outcomes were rated moderate quality, and 11 outcomes were low quality. According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating KOA. In terms of Lequesne index and Lysholm knee score scale score, the effectiveness of electroacupuncture was better than that of western medicine.

Limitations: There might be missing information. There may be duplicated clinical trials included by each SR that might have impact on the synthetic findings.

Conclusions: According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating KOA. However, there are some risk of bias and reporting deficiencies still needed to be improved.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of the systematic reviews selection process. CNKI = China National Knowledge Infrastructure, VIP = the Chinese Science and Technology Periodical Database, CBM = China Biology Medicine disc, KOA = knee osteoarthritis, RCT = randomized controlled trial; SR = systematic review.

References

    1. Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000;133:635–46.
    1. Dawson J, Linsell L, Zondervan K, et al. Impact of persistent hip or knee pain on overall health status in elderly people: a longitudinal population study. Arthritis Rheum 2005;53:368–74.
    1. Xiang YJ, Dai SM. Prevalence of rheumatic diseases and disability in China. Rheumatol Int 2009;29:481–90.
    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;68:648–53.
    1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73:1323–30.
    1. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137–62.
    1. Nelson AE, Allen KD, Golightly YM, et al. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the US bone and joint initiative. Semin Arthritis Rheum 2014;43:701–12.
    1. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA 2000;284:1247–55.
    1. Jüni P, Reichenbach S, Egger M. COX 2 inhibitors, traditional NSAIDs, and the heart: adverse event data from clinical trials must inform decision making. BMJ 2005;330:1342.
    1. Jordan KM, Arden NK, Doherty M, et al. Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62:1145–55.
    1. Vas J, Méndez C, Perea-Milla E, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 2004;329:1216.
    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;141:901–10.
    1. Cao L, Zhang XL, Gao YS, et al. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J 2012;33:526–32.
    1. Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Fam Community Health 2008;31:247–54.
    1. Yang M, Jiang L, Wang Q, et al. Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review. PloS One 2017;12:e0189884.
    1. Hochberg MC, Altman RD, April KT, et al. American College of RheumatologyAmerican College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012;64:465–74.
    1. Fitzgerald GK, Hinman RS, Zeni J, Jr, et al. OARSI Clinical Trials recommendations: design and conduct of clinical trials of rehabilitation interventions for osteoarthritis. Osteoarthritis Cartilage 2015;23:803–14.
    1. Whiting P, Jelena Savović, Higgins JPT, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016;69:225–34.
    1. Bougioukas KI, Liakos A, Tsapas A, et al. Preferred reporting items for overviews of systematic reviews including harms checklist: a pilot tool to be used for balanced reporting of benefits and harms. J Clin Epidemiol 2018;93:9–24.
    1. Kwon YD, Pittler MH, Ernst E. Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology 2006;45:1331–7.
    1. Chai H, Du YH. Meta-analysis for acupuncture and moxibustion treatment of knee osteoarthritis. Liaoning J Tradit Chin Med 2009;36:1197–200.
    1. Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010;45:CD001977.
    1. White A, Foster N, Cummings M, et al. The effectiveness of acupuncture for osteoarthritis of the knee: a systematic review. Acupunct Med 2006;241 Suppl:40–8.
    1. Lu M, Tan XY, Huang L. Meta-analysis of acupuncture and moxibustion in treatment of knee osteoarthritis. Guiding J Trad Chin Med Pharm 2012;18:81–3.
    1. Corbett MS, Rice SJ, Madurasinghe V, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage 2013;21:1290–8.
    1. Lu W. Needle warming moxibustion versus oral western medicine for knee osteoarthritis: a systematic review and meta-analysis. J Trauma Emerg (Electronic Version) 2015;2:30–4.
    1. Shim JW, Jung JY, Kim SS. Effects of electroacupuncture for knee osteoarthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2016;2016:3485875.
    1. Hu HJ. Meta-analysis of Acupuncture and moxibustion in treatment of knee Osteoarthritis. Today Nurse 2016;9:115–7.
    1. Lin J, Fu CL, Li L, et al. Effect of electroacupuncture on knee osteoarthritis: a systematic review. Rehabil Med 2016;26:52–8.
    1. Chen N, Wang J, Mucelli A, et al. Electro-acupuncture is beneficial for knee osteoarthritis: the evidence from meta-analysis of randomized controlled trials. Am J Chin Med 2017;45:965–85.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
    1. PLoS Medicine Editors. Best practice in systematic reviews: the importance of protocols and registration. PLoS Med 2011;8:e1001009.
    1. Stewart L, Moher D, Shekelle P. Why prospective registration of systematic reviews makes sense. Syst Rev 2012;1:7.
    1. Chien PF, Khan KS, Siassakos D. Registration of systematic reviews: PROSPERO. BJOG 2012;119:903–5.
    1. Doig GS, Simpson F. Efficient literature searching: a core skill for the practice of evidence-based medicine. Intensive Care Med 2003;29:2119–27.
    1. Dickersin K. Publication bias: Recognizing the problem, understanding its origins and scope, and preventing harm. Publication bias in meta-analysis. Prevent Assess Adjust 2005;11–33.
    1. Dwan K, Gamble C, Williamson PR, et al. Systematic review of the empirical evidence of study publication bias and outcome reporting bias: an updated review. PloS One 2013;8:e66844.
    1. Scherer RW, Langenberg P, Von Elm E. Full publication of results initially presented in abstracts. Cochrane Database Syst Rev 2007;MR000005.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться