Study Looks at PT with Different Acupuncture Techniques

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PHILADELPHIA — How does the safety and effectiveness of traditional acupuncture techniques compare to nonpenetrating acupuncture combined with exercise-based physical therapy (EPT)?

That was the question asked in a study that included researchers from the Philadelphia VAMC.

The answer: Puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT.

“Whether EPT, acupuncture, or other factors accounted for any improvement noted in both groups could not be determined in this study,” the authors wrote in an article published in the Journal of Clinical Rheumatology.

“Acupuncture is a traditional Chinese medicine treatment modality that has gained popularity in the United States, especially for painful conditions. Its use among U.S. adults increased from 2 million individuals in 2002 to 3.1 million per year in 2007,” according to background in the article, which added, “Recent high-quality clinical trials of acupuncture suggest that acupuncture may offer clinically relevant benefits when compared with standard medical care or wait-listed controls for acupuncture; however, studies that compare standard to nonstandard needling, either without puncturing the skin or in the wrong acupuncture points, have demonstrated smaller or negligible effects. A possible interpretation is that much of the acupuncture effects as compared with standard medical care are mediated through the entire process of acupuncture care (including patient-provider interaction and patient engagement) rather than the specific needling location or techniques. Expectation for relief was a predictor of reported benefit.”

Study authors noted that knee osteoarthritis is a chronic disease associated with significant morbidity and economic cost, but that “the efficacy of acupuncture in addition to traditional physical therapy has received little study.”

For the randomized, double-blind, controlled trial at three physical therapy centers in Philadelphia, the researchers studied 214 patients — 66% African-Americans — with at least six months of chronic knee pain and X-ray-confirmed Kellgren scores of 2 or 3. Acupuncture was administered in 12 sessions directly following EPT over six to 12 weeks.

Acupuncture was performed at the same nine points dictated by the traditional Chinese “Bi” syndrome approach to knee pain, using either standard needles or Streitberger non–skin-puncturing needles. Researchers were trying to determine the proportion of patients with at least a 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks.

According to the results, both treatment groups showed improvement from combined therapy with no statistically significant difference between true, 31.6% and nonpenetrating acupuncture, 30.3% or in reports of minor adverse events. No differences also were noted by race, sex or age, the authors reported.

“A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement,” they added.

1 Chen LX, Mao JJ, Fernandes S, Galantino ML, Guo W, Lariccia P, Teal VL, Bowman MA, Schumacher HR, Farrar JT. Integrating acupuncture with exercise-based physical therapy for knee osteoarthritis: a randomized controlled trial. J Clin Rheumatol. 2013 Sep;19(6):308-16. doi: 10.1097/RHU.0b013e3182a21848. PubMed PMID.

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