title: Factors influencing further acupuncture usage and a more positive outcome in patients with osteoarthritis of the knee and the hip: a 3-year follow-up of a randomized pragmatic trial.
abstract: OBJECTIVE
  Considering the chronicity of osteoarthritis-associated pain, we aimed to evaluate long-term outcome differences between patients who received immediate or delayed acupuncture in addition to usual care, and to identify predictors for further acupuncture usage and a better long-term outcome.
  
  
  METHODS
  The Acupuncture in Routine Care study was an open-label randomized pragmatic trial. As adjunct to usual care patients (>40 y, clinical and radiologic diagnosis of primary osteoarthritis of the knee or hip, pain duration >6 mo) received either immediate acupuncture in the first 3 months or delayed acupuncture in the subsequent 3 months. After 36 months 613 of 632 patients were available and asked to complete follow-up questionnaires. Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
  
  
  RESULTS
  A total of 500 (82%) of the contacted patients completed questionnaires. After 36 months the WOMAC Index did not differ significantly between groups (immediate acupuncture 36.53±26.19 vs. delayed acupuncture 38.24±25.54; P=0.420). Further acupuncture treatment during the follow-up period was reported by 202 patients and predicted by previous successful acupuncture treatment at baseline (odds ratio=2.5; 95% confidence interval, 1.6-3.9). Less osteoarthritis symptoms (WOMAC Index) after 36 months were predicted by being an acupuncture responder at 6 months (P<0.001), having higher school education (P=0.005), not wanting to use medications (P=0.016), and using additional therapies (P≤0.001 to P=0.025).
  
  
  CONCLUSIONS
  No long-term outcome differences were found between patients who received immediate versus those who received delayed acupuncture treatment. Education level and additional therapies were identified as predictors for a better long-term outcome.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Martins
authors.forename: Theresa
authors.initials: T
authors.lastname: Kaster
authors.forename: Lena
authors.initials: L
authors.lastname: Schützler
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Witt
mesh_terms: D015670:Acupuncture Therapy; D000368:Aged; D002908:Chronic Disease; D004522:Educational Status; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D059408:Pain Management; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016896:Treatment Outcome