Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial
Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial
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DOI：
10.1136/bmj.39280.509803.be
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发表时间：
2007-09-01
影响因子：
105.7
通讯作者：
Hay, Elaine M.
中科院分区：
文献类型：
--
作者：
Foster, Nadine E.;Thomas, Elaine;Hay, Elaine M.
目的探讨在物理治疗师提供的建议和运动中加入针灸对膝骨性关节炎患者的止痛作用。设计多中心随机对照试验。在英国米德兰兹郡设立37个理疗中心，接受从全科医生转诊的初级保健患者。352名50岁或以上的临床诊断为膝骨性关节炎的成年人。干预建议和锻炼(n=116)，建议和锻炼加真针(n=117)，建议和锻炼加非穿透针刺(n=119)。主要结果衡量的主要结果是6个月后西安大略省和麦克马斯特大学骨关节炎疼痛指数量表评分的变化。次要结果包括2周、6周、6个月和12个月时的功能、疼痛强度和疼痛不适感。平均(SD)基线疼痛评分为9.2(3.8)。在6个月时，建议和锻炼组的平均疼痛减轻为2.28(3.8)，建议和锻炼加真正针灸组为2.32(1)，建议和锻炼加非透刺组为2.53(4.2)。建议和锻炼加真针灸和建议和锻炼加非透刺组的平均变化分数差异为0.08(95%可信区间-1.0到0.9)，建议和锻炼加非透刺组的平均差异为0.25(-0.8到1.3)。在其他随访点也发现了类似的非显著差异。与建议和运动赎罪相比，真正针刺组和非透刺组在2周和6周以及非透刺组的所有随访点的疼痛强度和不适感均有轻微的统计学显著改善。结论物理治疗师在膝关节骨关节炎的建议和锻炼疗程中加入针灸并没有提供额外的疼痛评分改善。两个针刺组在疼痛强度和不适感方面都观察到了微小的好处，因此这不太可能是由于针刺效应造成的。
Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee.Design Multicentre, randomised controlled trial.Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midlands, United Kingdom.Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis.Interventions Advice and exercise (n=116), advice and exercise plus true acupuncture (n=117), and advice and exercise plus non-penetrating acupuncture (n=119).Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months. Secondary outcomes included function, pain intensity, and unpleasantness of pain at two weeks, six weeks, six months, and 12 months.Results Follow-up rate at six months was 94%. The mean (SD) baseline pain score was 9.2 (3.8). At six months mean reductions in pain were 2.28 (3.8) for advice and exercise, 2.32 (1 for advice and exercise plus true acupuncture, and 2.53 (4.2) for advice and exercise plus non-penetrating acupuncture. Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval -1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (-0.8 to 1.3) for advice and exercise plus non-penetrating acupuncture. Similar nonsignificant differences were seen at other follow-up points. Compared with advice and exercise atone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture.Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores. Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects.