Chuan-Yang Liu, Yan-Shan Duan, Hang Zhou, Yu Wang, Jian-Feng Tu, Xue-Ying Bao, Jing-Wen Yang, Myeong Soo Lee, Li-Qiong Wang
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Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture.</p><p><strong>Conclusions: </strong>The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors.</p><p><strong>Prospero registration number: </strong>CRD42021232177.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis.\",\"authors\":\"Chuan-Yang Liu, Yan-Shan Duan, Hang Zhou, Yu Wang, Jian-Feng Tu, Xue-Ying Bao, Jing-Wen Yang, Myeong Soo Lee, Li-Qiong Wang\",\"doi\":\"10.1136/bmjebm-2023-112626\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time.</p><p><strong>Design: </strong>Systematic review and pairwise and exploratory network meta-analysis.</p><p><strong>Setting: </strong>PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023.</p><p><strong>Participants: </strong>Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA.</p><p><strong>Interventions: </strong>Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA).</p><p><strong>Main outcomes measures: </strong>The primary outcome was pain intensity at the end of treatment.</p><p><strong>Results: </strong>80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture.</p><p><strong>Conclusions: </strong>The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. 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引用次数: 0
摘要
研究目的本研究旨在评估(1)针灸对膝关节骨性关节炎(KOA)患者的效果和安全性,并探讨(2)针灸效果是否因针灸类型、针灸剂量和随访时间而有所不同:设计:系统回顾、配对和探索性网络荟萃分析:PubMed、Embase、Cochrane对照试验中央注册中心、Web of Science、中国国家知识基础设施、中国生物医学文献数据库、中国科技期刊VIP数据库和万方数据库(从开始到2023年11月13日):在KOA患者中比较针灸与假针灸、非甾体类抗炎药(NSAIDs)、常规护理或候诊组、关节内注射(IA)和空白组的随机对照试验:符合条件的干预措施包括人工针灸(MA)和电针(EA):主要结果测量:主要结果是治疗结束时的疼痛强度:结果:共纳入 80 项试验(9933 名参与者)。确定性极低的证据表明,与假针灸相比,针灸可降低疼痛强度(标准化平均差,SMD -0.74,95% CI -1.08 至 -0.39,相当于视觉模拟量表的差异为 -18.50 mm,-27.00 至 -9.75),与非甾体抗炎药相比,针灸可降低疼痛强度(SMD -0.86至 -1.26至-0.46,相当于-21.50毫米,-31.50至-11.50)、常规护理或等待名单组(SMD-1.01,-1.47至-0.54,相当于-25.25毫米,-36.75至-13.50)和空白组(SMD-1.65,-1.99至-1.32,相当于-41.25毫米,-49.75至-33.00),但不包括IA注射。其他结果也有类似结果。在大多数亚组分析中,针灸类型、针灸剂量和随访时间都没有显示出显著的相对效应。只有与非甾体抗炎药相比,针灸剂量越大,疼痛缓解效果越好(交互作用 p 结论:研究结果表明,针灸在减轻 KOA 患者疼痛和改善身体功能方面可能具有重要的临床效果,但证据的确定性很低。电针和较高的针灸剂量可能是两个潜在的促成因素:CRD42021232177。
Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis.
Objectives: This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time.
Design: Systematic review and pairwise and exploratory network meta-analysis.
Setting: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023.
Participants: Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA.
Interventions: Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA).
Main outcomes measures: The primary outcome was pain intensity at the end of treatment.
Results: 80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture.
Conclusions: The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors.
期刊介绍:
BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence.
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