Electric and manual acupuncture both outperformed a sham equivalent

by Scott Harris
Contributing Writer, MedPage Today
2/9/2021

Among patients with knee osteoarthritis, both manual and electro-acupuncture outperformed sham acupuncture in reducing pain and improving function, new randomized controlled trial data showed.

Of 480 patient participants recruited for the trial, efficacy was evaluated in 442. The primary outcome was response rate, or the proportion of patients who achieved clinically significant improvements in pain and function after 8 weeks.

Responses rates among the three groups were 60.3% (91/151) for patients receiving electro-acupuncture, 58.6% (85/145) for manual acupuncture, and 47.3% (69/146) for those receiving sham acupuncture. Response rates among patients in the electro and manual acupuncture groups were substantially higher than that of the sham group at weeks 16 and 26 of the trial.

Cun-Zhi Liu, MD, PhD, a physician-researcher at the University of Chinese Medicine in Beijing, served as first author of the study, which appeared in Arthritis & Rheumatology. Liu recently discussed the study and its findings with MedPage Today. The exchange has been edited for length and clarity.

What was the key question or knowledge gap this study was designed to address?

Liu: Although the number of research studies on acupuncture in knee osteoarthritis has grown markedly, its efficacy remains a subject of controversy. The present trial was designed to assess the efficacy of acupuncture versus sham acupuncture for knee osteoarthritis.

What were your key findings?

Liu: The results suggested that electro-acupuncture should be recommended as a potential therapy for knee osteoarthritis.

Among patients with knee osteoarthritis, electro-acupuncture resulted in less pain and better function at week 8 than sham acupuncture. These effects persisted though week 26.

Did anything surprise you about the results?

Liu: The actual response rate of electro-acupuncture (60.3%) was much less than the expected 70%.

A recent trial indicated that strong-electricity electro-acupuncture was better than weak-electricity electro-acupuncture in alleviating knee pain. In our trial, the electric stimulation was set to be as imperceptible as possible in the electro-acupuncture group for blinding purposes. This may partly account for the low response rate of electro-acupuncture.

How do you think the study might affect the way clinicians view acupuncture — especially those who might be skeptical of this approach — or they way they care for people with knee osteoarthritis?

Liu: This large randomized controlled trial followed strict methodological requirements. And the evidence this trial adds is high-quality. Based on that, we infer that some doctors will refer their patients to an acupuncturist to receive electro-acupuncture treatment.

How can clinicians help patients tell the difference between real and sham acupuncture?

Liu: An addition of 10% of response rate over the control group is suggested to be clinically meaningful. The difference between electro-acupuncture and sham acupuncture is 13%.

One of the strengths of this trial is the use of the primary outcome at an individual level. The responder analysis compared the proportion of patients with each intervention who experienced a change greater than minimal clinically important improvement. This type of data presentation can provide patients with more straightforward information to decide whether a treatment should be used.

Where do you think more study is needed on this topic?

Liu: Trials are needed to evaluate the effectiveness of electro-acupuncture in the real world. Furthermore, the noninvasive acupoint stimulator, which can be manipulated by the patients themselves at home after the training by acupuncturists, should be further researched and developed.

You can read the study here.

LAST UPDATED 02.09.2021