Oslo University Hospital and Diakonhjemmet Hospital, Oslo, Norway.
J Physiother. 2011;57(1):56. doi: 10.1016/S1836-9553(11)70009-1.
What are the comparative effects of Traditional Chinese Acupuncture (TCA) and sham acupuncture for patients with knee osteoarthritis (OA) when controlling for the effect of the acupuncturists' communication styles.
A nested 2-stage randomised clinical trial, where patients were randomised to 1 of 3 style groups, waiting list, high expectations, or neutral expectations, and nested within style, TCA, or sham acupuncture.
A hospital general internal medicine department in Texas, USA.
Men and women over 49 years with knee OA according to the American College of Rheumatology criteria. Additional inclusion criteria were pain in the knee in the preceding 2 weeks, > 3/10 on a visual analogue scale, no prior treatment with acupuncture, stable treatment with nonsteroidal anti-inflammatory drugs, analgesics, or glucosamine. Exclusion criterion was intraarticular injections in the knee in the previous 2 months. Randomisation of 560 participants allocated 238 to the high expectations group, 242 to the neutral expectations group, and 80 to the waiting list group.
Six acupuncturists licensed in traditional Chinese medicine carried out the intervention. For the communication style intervention, providers conveyed high expectations of improvement, by using positive utterances such as 'I think this will work for you', while neutral expectations were conveyed with uncertainty utterances such as 'It may or may not work for you'. For the acupuncture intervention the procedure and specific points were standardised by a panel consisting of the acupuncturists in each of the 2 arms: TCA points on the basis of clinical practice, and sham points outside the relevant meridians.
The primary outcomes were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, and Satisfaction with Knee Procedure (SKIP) measured at 4 weeks, 6 weeks (end of treatment), and 3 months.
527 (94%) participants completed the study. There were no significant differences between the TCA and sham groups in any of the outcome measures. Patients in the high expectations communication style group had statistically significant improvements in pain (J-MAP) and satisfaction (SKIP) compared with the neutral group. Mean differences (95% CI) at 3 months follow up were 0.4 (0.1 to 0.7) for J-MAP (1 to 7 scale), and 0.2 (0.03 to 0.3) for SKIP (1 to 5 scale).
In patients with knee OA, needling of meridian points was not more effective than the use of sham points, whereas acupuncturists' communication styles had a small but statistically significant effect on pain reduction and satisfaction.
在控制针灸师沟通方式的影响的情况下，与假针灸相比，传统中医针灸（TCA）对膝骨关节炎（OA）患者的比较效果如何？
嵌套的 2 期随机临床试验，其中患者被随机分配到 3 种风格组之一，即等待名单、高期望或中性期望，并且嵌套在风格、TCA 或假针灸内。
美国德克萨斯州的一家医院综合内科。
根据美国风湿病学会标准，年龄在 49 岁以上的男性和女性，患有膝 OA。其他纳入标准是膝关节在前 2 周内疼痛，视觉模拟量表 > 3/10，以前没有接受过针灸治疗，稳定使用非甾体抗炎药、镇痛药或葡萄糖胺治疗。排除标准是膝关节内关节内注射在前 2 个月内。560 名参与者的随机分组中，238 名分配到高期望组，242 名分配到中性期望组，80 名分配到等待名单组。
6 名持有中医执照的针灸师进行了干预。对于沟通方式的干预，提供者通过使用积极的话语，如“我认为这对你有效”，传达对改善的高度期望，而中性期望则通过不确定的话语传达，如“它可能对你有效，也可能无效”。对于针灸干预，由每个 2 个臂中的针灸师组成的小组对程序和特定点进行了标准化：TCA 点基于临床实践，而假点则在相关经络之外。
527 名（94%）参与者完成了研究。在任何结果测量中，TCA 和假组之间均无显着差异。与中性组相比，高期望沟通方式组的患者在疼痛（J-MAP）和满意度（SKIP）方面均有统计学上的显著改善。3 个月随访时的平均差异（95%CI）为 0.4（0.1 至 0.7），用于 J-MAP（1 至 7 分制），0.2（0.03 至 0.3），用于 SKIP（1 至 5 分制）。
在膝骨关节炎患者中，针刺经络点并不比使用假点更有效，而针灸师的沟通方式对减轻疼痛和提高满意度有较小但有统计学意义的影响。
