title: Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial.
abstract: OBJECTIVE
  To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee.
  
  
  METHODS
  Multicentre, randomised controlled trial.
  
  
  METHODS
  37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midlands, United Kingdom.
  
  
  METHODS
  352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis.
  
  
  METHODS
  Advice and exercise (n=116), advice and exercise plus true acupuncture (n=117), and advice and exercise plus non-penetrating acupuncture (n=119).
  
  
  METHODS
  The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months. Secondary outcomes included function, pain intensity, and unpleasantness of pain at two weeks, six weeks, six months, and 12 months.
  
  
  RESULTS
  Follow-up rate at six months was 94%. The mean (SD) baseline pain score was 9.2 (3.8). At six months mean reductions in pain were 2.28 (3.8) for advice and exercise, 2.32 (3.6) for advice and exercise plus true acupuncture, and 2.53 (4.2) for advice and exercise plus non-penetrating acupuncture. Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval -1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (-0.8 to 1.3) for advice and exercise plus non-penetrating acupuncture. Similar non-significant differences were seen at other follow-up points. Compared with advice and exercise alone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture.
  
  
  CONCLUSIONS
  The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores. Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN88597683 [controlled-trials.com] .
authors: Primary Care Musculoskeletal Research Centre, Keele University, Stafford ST5 5BG. n.foster@keele.ac.uk
authors: Nadine E
authors: NE
authors: Foster
authors: Elaine
authors: E
authors: Thomas
authors: Panos
authors: P
authors: Barlas
authors: Jonathan C
authors: JC
authors: Hill
authors: Julie
authors: J
authors: Young
authors: Elizabeth
authors: E
authors: Mason
authors: Elaine M
authors: EM
authors: Hay
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000368:Aged; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D016896:Treatment Outcome
references: Rheumatology (Oxford). 1999 Apr;38(4):346-54
references: 10378713
references: Ann Rheum Dis. 1999 Jan;58(1):15-9
references: 10343535
references: BMJ. 2004 Nov 20;329(7476):1216
references: 15494348
references: Ann Intern Med. 2004 Dec 21;141(12):901-10
references: 15611487
references: Rheumatology (Oxford). 2005 Jan;44(1):67-73
references: 15353613
references: Eval Health Prof. 2005 Mar;28(1):9-26
references: 15677384
references: Soc Sci Med. 2005 Jul;61(1):133-55
references: 15847968
references: Neuroimage. 2005 May 1;25(4):1161-7
references: 15850733
references: Aust J Physiother. 2005;51(2):71-85
references: 15924510
references: Lancet. 2005 Jul 9-15;366(9480):136-43
references: 16005336
references: Arthritis Rheum. 2005 Jun 15;53(3):388-94
references: 15934131
references: Eur J Pain. 2006 May;10(4):287-333
references: 16095934
references: Acupunct Med. 2006 Mar;24(1):13-5
references: 16618044
references: Rheumatology (Oxford). 2006 Jun;45(6):757-60
references: 16418199
references: Ann Intern Med. 2006 Jul 4;145(1):12-20
references: 16818924
references: Clin Med. 2006 Jul-Aug;6(4):381-6
references: 16956145
references: Acupunct Med. 2006 Sep;24(3):118-22
references: 17013358
references: BMJ. 2006 Nov 11;333(7576):995
references: 17056608
references: Arthritis Rheum. 2006 Nov;54(11):3485-93
references: 17075849
references: Pain. 1999 Nov;83(2):235-41
references: 10534595
references: Arthritis Rheum. 1999 Jul;42(7):1361-9
references: 10403263
references: Rheumatology (Oxford). 2007 Mar;46(3):384-90
references: 17215263
references: BMJ. 2000 Sep 16;321(7262):683-6
references: 10987776
references: Ann Rheum Dis. 2001 Feb;60(2):91-7
references: 11156538
references: Br J Gen Pract. 2001 Jan;51(462):25-30
references: 11271869
references: Arthritis Rheum. 2001 Apr;44(4):819-25
references: 11315921
references: Complement Ther Med. 2001 Dec;9(4):237-45
references: 12184353
references: Pain. 2002 Nov;100(1-2):55-64
references: 12435459
references: J Rheumatol. 2003 Jul;30(7):1648-54
references: 12858473
references: Ann Rheum Dis. 2003 Dec;62(12):1145-55
references: 14644851
references: Osteoarthritis Cartilage. 2004 May;12(5):389-99
references: 15094138
references: BMC Musculoskelet Disord. 2004 Sep 2;5:31
references: 15345098
references: J R Soc Med. 1995 Apr;88(4):199-202
references: 7745565
references: Lancet. 1998 Aug 1;352(9125):364-5
references: 9717924
references: JAMA. 1998 Nov 4;280(17):1518-24
references: 9809733