Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial.
BACKGROUND
There is some evidence that acupuncture for pain and osteoarthritis (OA) of the knee is more than a placebo, and short term clinical benefits have been observed when acupuncture is compared to usual care. However there is insufficient evidence on whether clinical benefits of acupuncture are sustained over the longer term. In this study our key objectives are to inform the design parameters for a fully powered pragmatic randomised controlled trial. These objectives include establishing potential recruitment rates, appropriate validated outcome measures, attendance levels for acupuncture treatment, loss to follow up and the sample size for a full scale trial.


METHODS
Potential participants aged over 50 with pain and osteoarthritis of the knee were identified from a GP database. Eligible patients were randomised to either 'acupuncture plus usual care' and 'usual care' alone, with allocation appropriately concealed. Acupuncture consisted of up to 10 sessions usually weekly. Outcome measures included Western Ontario and McMaster Universities (WOMAC) index with the sample size for a full scale trial determined from the variance.


RESULTS
From the GP database of 15,927 patients, 335 potential trial participants were identified and invited to participate. After screening responses, 78 (23%) were identified as eligible and 30 patients who responded most promptly were randomised to 'acupuncture plus usual care' (15 patients) and 'usual care' alone (15 patients). Attendance for acupuncture appointments was high at 90% of the maximum. Although the trial was not powered to detect significant changes in outcome, the WOMAC pain index showed a statistically significant reduction at 3 months in the acupuncture group compared to usual care. This was not sustained at 12 months. The sample size for a fully powered two-arm trial was estimated to be 350.


CONCLUSIONS
This pilot study provided the evidence that a fully powered study to explore the longer term impact of acupuncture would be worthwhile, and relevant design features for such a trial were determined.


BACKGROUND
ISRCTN25134802.
Department of Health Sciences, University of York, York, UK. harrietlansdown@gmail.com
Harriet
H
Lansdown
Katie
K
Howard
Stephen
S
Brealey
Hugh
H
MacPherson
D015667:Acupuncture Analgesia; D000368:Aged; D019992:Databases as Topic; D004185:Disability Evaluation; D004739:England; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010349:Patient Compliance; D018579:Patient Selection; D011320:Primary Health Care; D012044:Regression Analysis; D015203:Reproducibility of Results; D012107:Research Design; D018401:Sample Size; D013997:Time Factors; D016896:Treatment Outcome