Review Article

Acutherapy for Knee Osteoarthritis Relief in the Elderly: A Systematic Review and Meta-Analysis

Table 2

Characteristics of the included RCTs.

SourceSample sizePeriodGroup setting (n)Age
Mean (SD)
InterventionMain acupointsOutcomes

Li et al.
(2017) [10]
1508 weeks(i) acupressure (50)71.7 (5.7)PressureEX-HN3 Anmian, HT7, SP6, LIV3Primary outcome
(WOMAC-pain)
Secondary outcome
(NRS; WOMAC-physical function)
(ii) sham acupressure (50)73.2 (7.4)PressureNon-acupoint
(iii) control (50)73.3 (6.2)Previous usual care
Write et al. (2016) [11]6012 weeks(i) group acupuncture (20)64.7 (7.7)Needle insertion
Needle insertion +electrical stimulation
Up to 8 common pointsPrimary outcome
(WOMAC)
Secondary outcome
(EQ-5D, OKS, NSAIDs taking)
(ii) individual acupuncture (20)65.1 (9.9)
(iii) control (20)64.9 (10.8)Education
Berman et al.
(2004) [12]
57026 weeks(i) acupuncture (190)65.2(8.4)Needle insertion + electrical stimulationGB34, SP9, ST36, ST35, EX-LE5, UB60, GB39, SP6, KID3Primary outcome
(WOMAC)
Secondary outcome
(SF-36; patient global assessment;
6-minute walk time)
(ii) sham acupuncture (191)66.2 (8.7)Nonpenetrating needleSame acupoints
(iii) control (189)65.1 (8.8)Arthritis education
Witt et al.
(2005) [13]
3008 weeks(i) acupuncture (150)64·5 (6·4)Needle insertionST34, ST35, ST36; SP9, SP10; BL40; KID 10; GB33, GB34; LIV8Primary outcome
(WOMAC)
Secondary outcome
(VAS; PDI; SF-36; SES; HAD)
(ii) sham acupuncture (76)63.4 (6.6)Needle insertionnon-acupoints
(iii) control (74)63.6 (6.7)Previous usual care
Witt et al.
(2006) [14]
7123 months(i) acupuncture (357)60.6 (10.2)Needle insertionSelected by physicianPrimary outcome (WOMAC)
Secondary outcome (SF-36)
(ii) control (355)61.9 (10.6)Previous usual care
Foster et al.
(2007) [15]
35212 months(i) acupuncture +advice & exercise (117)63.1 (8.7)Needle insertion + advice and exerciseSP9, SP10, ST34, ST35, ST36, EX-LE5, GB34, trigger points.Primary outcome (WOMAC-pain)
Secondary outcome
(WOMAC; participant global assessment)
(ii) sham acupuncture +advice & exercise (119)62.8 (9.4)Non-penetrating needle + advice & exerciseSame acupoints
(iii) control (116)63.8 (8.3)Previous usual care
Williamson et al.
(2007) [16]
1816 weeks(i) acupuncture (60)72.4 (7.71)Needles insertionSP10, EX-LE5, ST35, ST36, SP9, GB34, LIV3Primary outcome (OKS)
Secondary outcome
(WOMAC; VAS; HAD);
(ii) physiotherapy (60)70.0 (8.79)Exercises
(iii) control (61)69.6 (10)Advice
Berman et al.
(1999) [17]
7312 weeks(i) acupuncture (37)65.7 (7.95)Needle insertion + electrical stimulationGB34, SP9, ST36, ST35, EX-LE5, UB60, GB39, SP6, KID3WOMAC
Lequesne indices
(ii) control (36)65.5 (9.13)Previous usual care
Chen et al.
(2013) [18]
21312 weeks(i) acupuncture (104)60.5 (11.1)Needle insertionGB34, SP9, ST 36, ST 35, EX-LE5Primary outcome (WOMAC)
Secondary outcome (BPI; SF-36; Patient Global Impression of ChangeL; 6-min walk distance
(ii) sham acupuncture (109)60.4 (11.7)Non-penetrating needleSame acupoints
Mavrommatis et al. (2012) [19]1208 weeks(i) acupuncture (40)62.3 (9.9)Needle insertion + etoricoxibST36, SP9, SP10, GB34, EX-LE 2, Ex-LE5Primary outcome (WOMAC)
Secondary outcome
(SF-36; VAS; Algometer)
(ii) sham acupuncture (40)60.1(11.1)Non-penetrating needle + etoricoxibSame acupoints
(iii) control (40)63 (10.6)Etoricoxib only
Jubb et al.
(2008) [20]
685 weeks(i) acupuncture (34)64.1 (1.6)Needle insertionLI4, SP10, Ex-LE5, SP9, GB34, ST 36, LIV 3, BL 40, BL 57.Primary outcome (WOMAC-pain)
Secondary outcome (WOMAC; VAS)
(ii) sham acupuncture (34)66.1 (1.9)Non-penetrating needleSame acupoints
Scharf et al.
(2007) [21]
103926 weeks(i) acupuncture (330)62.8 (9.9)Needle insertionST34, ST36, EX-LE5, SP9, SP10, GB34Primary outcome
(WOMAC)
Secondary outcome
(SF-12; global patient assessment)
(ii) sham acupuncture (367)63.0 (10.1)Non-penetrating needleNon-acupoints
(iii) control (342)62.6 (10.1)Previous usual care
Manheimer et al. (2006) [22]57026 weeks(i) acupuncture (190)65.2 (8.4)Needle insertionGB34, SP9, ST36, ST35 BL60, GB39, SP6, KI3Primary outcome
(WOMAC-pain & function)
Secondary outcome
(patient global assessment; 6-minute walk distance; SF-36)
(ii) sham acupuncture (190)66.2 (8.7)Non-penetrating needleSame acupoints
(iii) control (190)65.1 (8.8)Education
Kim et al. (2014) [23]21213 weeks(i) moxibustion (102)56 ()Burn moxibustion coneST36, ST35, ST34, SP9, Ex-LE5, SP10Primary outcome (WOMAC; SF-36; BDI; physical performance)
(ii) control (110)57 ()Previous usual careSecondary outcome (C-reactive protein; Erythrocyte sedimentation rate
Ren et al. (2011) [24]596 weeks(i) moxibustion (31)64.03 (7.2)Burn moxibustion coneEX-LE 5, ST35, trigger points
Same acupoints
WOMAC; temperature
(ii) sham moxibustion (28)62.57 (8.12)Burn non-moxibustion cone
Zhao et al. (2009) [25]404 weeks(i) laser acupuncture (20)60.10 (6.83 )Laser stimulation on acupointST 35Primary outcome (WOMAC)
Secondary outcome (patient global assessment; medication usage; masking effectiveness; adverse effect)
(ii) sham laser acupuncture (20)59.40 (6.15)Laser intervention on non-acupoint2 cm from ST35
Yurtkuran et al. (2007) [26]552 weeks(i) laser acupuncture (27)51.83 ± 6.83Laser stimulationSP9Primary outcome
(VAS; 50 foot w; KC; MTS; WOMAC)
Secondary outcome (Quality of life)
(ii) sham laser acupuncture (26)53.48 (7.13)Red light stimulationSame acupoints

[a] WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; [b] NRS: the numeric rating scale; [c] EQ-5D: EuroQol five-dimension quality of life instrument; [d] OKS: Oxford Knee Score; [e] NSAIDs: nonsteroidal anti-inflammatory drugs; [f] SF-36: The Short Form (36) Health Survey; [g] VAS: visual analogue scale; [h] PDI: pain disability index; [i] SES: questionnaire for assessing the emotional aspects of pain; [j] ADS: Hospital Anxiety and Depression Scale; [k] BPI: Brief Pain Inventory; [l] SF-12: 12-Item Short Form Health Survey; [m] BDI: Beck Depression Inventory; [n] 50 foot w: 50-foot walking time; [o] KC: knee circumference; [p]MTS: Medial Tenderness Score.