Effects of Electroacupuncture for Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies.

First author (year)	Sample size (M/F)	Diagnostic criteria (radiologic evidence)	Mean age	Experimental group				Control group		Outcomes
				Intervention type	Total session	Duration/evaluation time points after baseline		Intervention type
Li [75]; (2015)	76 (36/40)	Chinese Rheumatology Association criteria	n.r.	EA	15	3 weeks/3 weeks	38	Medication (celecoxib 100 mg bid)	38	HSS knee score
Wu [76]; (2015)	100 (36/64)	ACR	61	EA	14	4 weeks/2 weeks, 4 weeks	50	Medication (topical diclofenac diethylamine emulgel 20 g qd)	50	Lequesne index; VAS; Rehabilitation value; (peak torque of muscle, fatigue index)
Ying [39]; (2015)	171 (76/95)	n.r.	58	EA	21	8 weeks/8 weeks	57	MA (same points)	57	Efficacy rate
Huang [40]; (2014)	168 (85/83)	ACR	59.6	EA; Medication (glucosamine hydrochloride 75 mg bid)	36	6 weeks/3 weeks, 6 weeks, 6 months	58	Medication (glucosamine hydrochloride 75 mg bid)/EA (same points)	53	Lequesne index; Efficacy rate
Li [41]; (2014)	100 (36/64)	ACR (K-L grade)	61	EA; Physiotherapy (thermotherapy)	20	23 days/23 days, 6 months	50	MA (tug-of-war needling, similar points) physiotherapy (thermotherapy)	50	WOMAC; VAS; Efficacy rate
Plaster [26]; (2014)	60 (11/49)	ACR	63.2	EA	1	1 day/immediately after treatment	30	MA (same points)	30	NRS; TUG test; Muscle strength; PPT
Ruan [77]; (2014)	72 (39/33)	ACR	55	EA	21	25 days/25 days	38	Medication (glucosamine hydrochloride 750 mg bid)	34	Lequesne index; IEMG and MF values; Efficacy rate
Ruan [42]; (2014)	88 (42/46)	ACR	53.6	EA; Medication (glucosamine hydrochloride 240 mg tid)	24	8 weeks/8 weeks	45	Medication (glucosamine hydrochloride 240 mg tid)	43	Efficacy rate
Fu [43]; (2013)	208 (103/105)	ACR	58.3	EA	24	4 weeks/4 weeks, 9 weeks	70	Medication (ibuprofen 0.3 g bid)/MA (same points)	70	WOMAC; SF-36; Efficacy rate
Zhao [44]; (2013)	93 (n.r.)	ACR	n.r.	EA	12	4 weeks/1 week, 2 weeks, 4 weeks	33	Medication (celecoxib 20 mg tid)	19	VAS; Knee function score (converted from IAC Lennox test and Lysholm scale)
Zhu [45]; (2013)	55 (22/33)	ACR (K-L grade)	68.7	EA	14	4 weeks/4 weeks, 12 weeks	28	Medication (diclofenac sodium 75 mg qd)	27	WOMAC; VAS; Serum MMP-3; Efficacy rate
Che [78]; (2012)	63 (25/38)	ACR	52	EA	10	20 days/20 days	32	Medication (diclofenac sodium 75 mg qd)	31	Efficacy rate
Li [46]; (2012)	100 (37/63)	Chinese Orthopedic Association Criteria	53.8	EA	20	4 weeks/4 weeks	50	MA (similar points)	50	Efficacy rate
Mavrommatis [27]; (2012)	120 (29/91)	ACR (K-L grade)	61.8	EA; Medication (etoricoxib 60 mg qd)	16	8 weeks/4 weeks, 8 weeks, 12 weeks	40	Sham EA^† medication (etoricoxib 60 mg qd)/medication (etoricoxib 60 mg qd)	40	WOMAC; VAS; SF-36v2; PPT
Teng [47]; (2012)	86 (32/54)	ACR	61	EA	24	8 weeks/8 weeks	30	MA (same points)	26	Efficacy rate
Ji [79]; (2011)	70 (31/39)	ACR	56	EA	24	8 weeks/8 weeks	35	Medication (meloxicam 7.5 mg qd)	35	Lequesne index; VAS; ISOA; IDS
Meng [28]; (2011)	69 (16/53)	n.r.	n.r.	EA; Medication (acetaminophen 500 mg qid/free); Physiotherapy (n.r.)	9	3 weeks/8 weeks, 20 weeks	28	Medication (acetaminophen 500 mg qid/free); Physiotherapy (n.r.)	18	Knee score and functional score; (Knee Society Clinical Rating System as modified by Insall); VAS; Medication dose
Lu [29]; (2010)	20 (n.r.)	n.r. (K-L grade)	63.8	EA	1	1 day/immediately after treatment	10	Sham EA^§	10	VAS; Gait analysis
Wu [80].; (2010)	80 (34/46)	ACR	48.6	EA	20	23 days/23 days	40	Medication (fenbid 30 mg bid)	40	Efficacy rate
Ahsin [30]; (2009)	84 (n.r.)	ACR	n.r.	EA	10	10 days/10 days	26	Sham EA^§	58	VAS; WOMAC; Plasma β-endorphin cortisol
Hou [48]; (2008)	50 (24/26)	ACR	62.5	EA	24	30 days/30 days	25	MA (same points)	25	Efficacy rate
Jubb [31]; (2008)	68 (13/55)	n.r.	65.1	EA	10	5 weeks/5 weeks, 9 weeks	34	Sham EA^†	34	WOMAC; VAS; Euro-Qol score; Plasma β-endorphin
Wu [49]; (2008)	40 (15/25)	ACR	61.8	EA	12	4 weeks/4 weeks	20	Medication (diclofenac sodium 25 mg tid)	20	Lysholm scale
Qiu [53]; (2006)	60 (9/51)	ACR	55.7	EA	8	4 weeks/2 weeks, 4 weeks	30	Medication (Voltaren 75 mg qd)	30	WOMAC
Berman [32]; (2004)	570 (205/365)	n.r. (K-L grade)	65.5	EA	23	26 weeks/4 weeks, 8 weeks, 14 weeks, 26 weeks	190	Sham EA^†/education	191	WOMAC; Patient global assessment; Walk distance for 6 minutes; SF-36
Tukmachi [33]; (2004)	29 (5/24)	n.r. (K-L grade)	62	EA; Medication (current medication, n.r.)	10	5 weeks/5 weeks, 9 weeks	10	Medication (current medication, n.r.)/EA (same points)	10	WOMAC; VAS
Vas [34]; (2004)	97 (16/81)	ACR	67.1	EA; Medication (diclofenac 50 mg tid/free)	12	12 weeks/12 weeks	48	sham EA^† medication (diclofenac 50 mg tid/free)	49	WOMAC; VAS; PQLC; Medication dose
Ng [35]; (2003)	24 (1/23)	n.r.	85	EA	8	2 weeks/2 weeks, 4 weeks	8	General education	8	NRS; TUG test; Passive ROM
Sangdee [36]; (2002)	193 (43/150)	ACR	62.9	EA; Medication (diclofenac 25 mg tid/free)	12	4 weeks/4 weeks	49	Sham ES^‡ medication (diclofenac 25 mg tid/free)/EA with placebo medication/sham ES^‡ with placebo medication	49	WOMAC; VAS; Lequesne index; Time to walk 50 feet; Medication dose
Berman [37]; (1999)	73 (28/45)	ACR (K-L grade)	65	EA	16	8 weeks/4 weeks, 8 weeks, 12 weeks	37	Medication (n.r.)	36	WOMACLequesne index
Yurtkuran [38]; (1999)	100 (9/91)	n.r.	58.1	EA	10	2 weeks/2 weeks	25	Sham ES^‡	25	PPI; Stiffness; Time to walk 50 feet; Muscle strength (quadriceps); Active knee flexion

M/F: number of males/number of females, : number, ACR: American College of Rheumatology criteria, K-L grade: Kellgren-Lawrence grade, n.r.: not reported, EA: electroacupuncture, MA: manual acupuncture, ES: electrical stimulation, qd: once a day, bid: twice a day, tid: three times a day, qid: four times a day, WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index, VAS: visual analogue scale, NRS: numeric rating scale, PQLC: profile of quality of life in the chronically ill, PPI: present pain intensity, PPT: pressure pain threshold, TUG test: Timed Up-and-Go test, SF-36v2: Short-Form 36 version 2, SF-36: Short-Form 36-item Health Survey, HSS: Hospital for Special Surgery, IEMG and MF values: integrated electromyogram and median frequencies values measured by surface electromyography, ISOA: index of severity of osteoarthritis, and IDS: index of disease severity.
Multiple-arm study.
Sham electroacupuncture using nonpenetrating acupuncture with sham electrical stimulation at the same points.
Sham electrical stimulation without acupuncture using patch electrodes at the same points.
Sham electroacupuncture using penetrating acupuncture with sham electrical stimulation at nonacupoints.