Integrating acupuncture with exercise-based physical therapy for knee osteoarthritis

Knee osteoarthritis is a chronic disease linked with significant morbidity and economic cost. The efficacy of acupuncture in addition to traditional physical therapy has not received very much study. The authors conducted this study to compare the efficacy and safety of adding a standardized true acupuncture protocol versus nonpenetrating acupuncture to exercise-based physical therapy (EPT). They conducted a randomized, double-blind, controlled trial at 3 physical therapy centers in Philadelphia, PA. We studied 214 patients (66% African Americans) with at least 6 months of chronic knee pain and x-ray-confirmed Kellgren scores of 2 or 3. Patients received 12 sessions of acupuncture directly following EPT over 6 to 12 weeks. Acupuncture was performed at the same 9 points dictated by the traditional Chinese “Bi” syndrome approach to knee pain, using either standard needles or Streitberger non-skin-puncturing needles. The primary outcome was the proportion of patients with at least a 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks. Both treatment groups showed improvement from combined therapy with no difference between true (31.6%) and nonpenetrating acupuncture (30.3%) in Western Ontario and McMaster Universities Osteoarthritis Index response rate (P = 0.5) or report of minor adverse events. A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement. No differences were evident by race, sex, or age.


The authors concluded that puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT. They not that it cannot be determined whether EPT, acupuncture, or other factors accounted for any improvement noted in both groups from this study. Adding also that expectation of relief was a predictor of reported improvement.