Session Information
Date: Monday, November 6, 2017
Title: Osteoarthritis – Clinical Aspects Poster I: Clinical Trials and Interventions
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Knee osteoarthritis (KOA) is a major public health problem and a leading cause of long-term pain and disability. Few effective medical treatments for the disease currently exist. Acupotomy has been used as a new type of minimally-invasive surgical treatment for KOA pain. It combines techniques from acupuncture and micro-surgery that separates subcutaneous adhesions and muscle knots, resulting in immediate pain relief. A comprehensive literature review is an important step in understanding its benefits and for guiding treatment for KOA pain. We conducted a systematic review and meta-analysis to evaluate the efficacy of acupotomy for joint pain associated with KOA.
Methods: We performed a search on Cochrane Library, PubMed, EMBASE, 3 universal Chinese databases (CNKI, Wan Fang and VIP), and reference lists of published articles through June 2017. We include randomized controlled trials using acupotomy therapy for KOA patients who met the ACR diagnostic criteria. The effect of acupotomy on joint pain relief was measured with WOMAC pain subscale, VAS and other pain scores. Study quality was evaluated with Jadad criteria. The differences between treatment groups were reported as mean change (P-value).
Results: After screening 721 abstracts, 16 studies met eligibility criteria and were conducted between 2007 and 2015. A total of 1,416 KOA patients (65.2% female, mean age = 59 years, mean symptom duration = 87 months) were included. Table 1 summarizes the trials evaluating the effect of acupotomy therapy on joint pain relief. The typical treatment was once a week, for 1-5 weeks until pain relief. Additional massage therapy after acupotomy was included in four studies. Nine studies used acupuncture (1 traditional acupuncture and 9 electroacupuncture) as controls and others used therapeutic massage, oral nonsteroidal anti-inflammatory analgesics, or intra-articular hyaluronate injection. The overall quality of trials was modest (mean Jadad score=3). Almost all studies reported an effect of acupotomy on joint pain compared to a variety of controls. Figure 1 shows a meta-analysis comparing effects of acupotomy therapy with acupuncture controls on pain relief. A meta-analysis comparing acupotomy with other controls is not reported due to variation in outcomes assessed. Adverse events were not reported.
Conclusion: Acupotomy treatment may improve joint pain associated with KOA. Further rigorously designed and well-controlled RCTs with long-term follow-up are warranted.
Table 1. Sixteen RCTs of Acupotomy Therapy on Knee Osteoarthritis
|
Author Year |
N a (Age)b |
Acupotomy therapy |
Controls |
Duration (weeks) |
Pain Mean Differencec (P-value) |
|
Zeng 2007 |
24 (63y) |
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
VASd score: *2.05 (P<0.05) |
|
Peng 2008 |
32 (60y) |
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
VAS score: *0.43 (P<0.05) |
|
Guo 2009 |
60 (ND) |
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
Pain score of JOAe; Walking: ^3.00 (P<0.05) Stair activity: ^3.80 (P<0.05) VAS score: *0.97 (P<0.05) |
|
Zeng 2009 |
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
VAS score: *1.68 (P<0.01) Pain score of JOA: Walking: ^5.47 (P<0.01) Stair activity: ^2.35 (P<0.05) |
|
|
Guo 2010 |
180 (60y)
|
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
VAS score: *0.3 (P>0.05) Follow-up after a half year of treatment: *0.53 (P<0.05) |
|
Li 2011 |
76 (53y)
|
1.Release soft tissue adhesion (once/wk, 3times) 2.Massage therapy to improve joint movement (after acupotomy) |
Acupuncture therapy (30min,5times/1wk, 3wks) |
3 |
Pain score by HSSf: ^0.9 (P<0.05) |
|
Zhang 2011 |
58 (53y)
|
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
Pain scoreg by JOA: ^10.89 (P<0.05) |
|
Guo 2012 |
180 (60y)
|
Release tissue under points of pain (once/wk, 3times)
|
Acupuncture therapy (30min,3times/1wk, 3wks) |
3 |
Pain score of JOA: Walking: ^4.02 (P<0.01) Stair activity: ^3.5 (P<0.01) |
|
Xiong 2014 |
80 (62y)
|
Release tissue under points of pain (once/wk, 4times) |
Acupuncture therapy (once/day, 6 days) |
4 |
VAS score: *0.23 (P<0.05) |
|
Wang 2009 |
60 (49y)
|
Release soft tissue adhesion (once/wk; 1-3times until pain relieves) |
Sodium hyaluronate injection |
5 |
Pain score of WOMACh: *3.23 (P<0.01) |
|
Zhu 2011 |
80 (62y) |
1.Release soft tissue adhesion by the method named ¡±5 fingers¡± (once/6days,3times) 2. Massage therapy to improve joint movement (after acupotomy) |
Sodium hyaluronate injection (1¡Á2ml/6days, 3wks) |
3 |
Pain score by HSS: ^3.38 (P<0.05) |
|
Zheng 2015 |
80 (61y)
|
Release tissue under points of pain (once/wk, 5times) |
Sodium hyaluronate injection (1¡Á2ml/1 wk, 5 wks) |
5 |
VAS score: *0.77 (P<0.05) |
|
Zhou 2015 |
100 (58y)
|
Release tissue under points of pain (once/wk, 5times)
|
Sodium hyaluronate injection (1¡Á2ml/1 wk, 5 wks) |
5 |
VAS score: ^0.1 (P>0.05) Follow-up after a half year of treatment: *3.03 (P<0.05) |
|
Ding 2014 |
200 (58y)
|
1.Release soft tissue adhesion (once/wk, 4times) 2.Massage therapy to improve joint movement (after acupotomy) |
Diclofenac sodium (75mg/d, 2wks, oral pill) |
4 |
VAS score: *0.13 (P>0.05) Follow-up after a half year of treatment: *2.63 (P<0.05) |
|
Yao 2010
|
100 (61y)
|
1.Release tissue under points of pain (once/wk, 3times); 2.Massage therapy to improve joint movement (after acupotomy) |
Diclofenac sodium (25mg/time,3times/d, 15days, oral pill) |
3 |
Pain score by JOA Walking: ^4.98 (P<0.05) Stair activity: ^4.82 (P<0.01) |
|
Huang 2007 |
60 (65y)
|
Release soft tissue adhesion (once/wk; 1-4times until pain relieves) |
Therapeutic Massage (5times/wk, 4wks) |
4 |
Pain score of KSSi: ^11.58 (P<0.05) |
|
a N= number of patients included; b Mean age reported in years; c Mean difference was calculated between group comparisons; d VAS: Visual Analogue Scale (range 0-10, lower score = better outcome); e JOA: Japanese Orthopedic Association(walking subscale range 0-30, higher score = better outcome; stair activity subscale range 0-25, higher score = better outcome); f HSS: Hospital for Special Surgery Score (range 0-30, higher score = better outcome); g Score=sum of walking pain score and stair activity pain score ; h WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index (range 0-50, lower score = better outcome);i KSS: Knee Society Score (range 0-50, higher score = better outcome); * indicate decrease; ^ indicate increase. |
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To cite this abstract in AMA style:
Li J, Yuan P, Zhang R, Chen B, Dong B, Kang W, Zhang X, Hyon S, Bannuru RR, Harvey WF, Wang C. Acupotomy Therapy for Joint Pain Relief of Knee Osteoarthritis-Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/acupotomy-therapy-for-joint-pain-relief-of-knee-osteoarthritis-systematic-review-and-meta-analysis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/acupotomy-therapy-for-joint-pain-relief-of-knee-osteoarthritis-systematic-review-and-meta-analysis/