Berman, 1999²³⁸

1 month

Duration of pain: mean 7.2 years

Fair

A. Acupuncture + usual care (n=36): 20 minute treatments, 2/week for 8 weeks using Traditional Chinese Medicine theory; 9 acupoints points (5 local, 4 distal) with elicitation of de qi; electrical stimulation was used at local points (2.5 to 4 Hz, pulses of 1.0 ms); no new physiotherapy or exercise programs

B. Usual care alone (n=37): current level of oral therapy throughout the trial

A vs. B

Age: 66 vs. 66

Female: 47% vs. 72%

Caucasian: 92% vs. 74%

BMI: 32 vs. 32

Duration of symptoms: 7.5 vs. 6.9 years

Baseline WOMAC total (scale unclear): 48.4 vs. 51.4

Baseline WOMAC function (scale unclear): 34.3 vs. 34.4

Baseline Lequesne Index (0-24): 11.7 vs. 12.3

Baseline WOMAC pain (scale unclear): 9.6 vs. 9.9

A vs. B

1 month

WOMAC total: 31.6 vs. 50.4, difference −18.9 (95% CI −26.5 to −11.2)

WOMAC function: 23.2 vs. 36.8, difference −13.6 (95% CI −19.4 to −7.8)

Lequesne Index: 9.3 vs. 12.4, difference −3.1 (95% CI −4.8 to −1.3)

WOMAC pain: 5.6 vs. 9.5, difference −4.0 (95% CI −5.5 to −2.4)

Berman, 2004²³⁹

6 months

Duration of pain: NR

Fair

A. Acupuncture (n=186): electrical stimulation at knee acupoints (5 local and 4 distal) at low frequency (8 Hz and square biphasic pulses (0.5 ms pulse width) for 20 minutes.

B. Sham acupuncture (n=183): modified combined insertion (at sham points in abdominal area) and noninsertion (at 3 local and 4 distal points on the knee) procedure; mock electric stimulation was attached to sham needles at the knee for 20 minutes.

Both groups received 8 weeks of 2 sessions per week, followed by 2 weeks of 1 session per week, 4 weeks of 1 session every other week, and 12 weeks of 1 session per month. Total of 26 weeks, 25 possible sessions.

A vs. B

Age: 65 vs. 66 years

Female: 63.2% vs. 61.8%

non-Hispanic white: 70% vs. 70.7%

Bilateral OA: 25.0% vs. 28.9%

Length of diagnosis of OA

<5 years: 53.8% vs. 53%

6−10 years: 19.9% vs. 18.0%

>10 years: 25.8% vs. 29.0%

Using opioids: 5.5% vs. 5.0%

Baseline WOMAC Function (0-68): 31.3 vs. 31.3

Baseline WOMAC Pain (0-20): 8.9 vs. 8.9

A vs. B

6 months

Δ from baseline, WOMAC Function: −12.4 vs. −9.9, p<0.01

Δ from baseline, WOMAC Pain: −3.8 vs. −2.9, p<0.01

A vs. B

6 months

Δ from baseline, SF-36 Physical Health Score: 10.7 vs. 8.2, p=0.21

Δ from baseline, Patient Global Assessment: 0.5 vs. 0.2, p=0.02

Hinman, 2014²⁴⁰

9 months

Duration of pain: mean 7.2 years

Good (sham)

Fair (no treatment)

A. Needle acupuncture (n=70): combination of Western and traditional Chinese acupuncture; maximum of 6 points (4 on study limb and 2 distal points) at initial session, in other sessions points were added at therapist’s discretion. Needles were left in while patient rested.

B. Laser acupuncture (n=71): combination of Western and traditional Chinese acupuncture; delivered to selected points using standard Class 3B laser devices (measured output 10mW and energy output 0.2 J/point)

C. No treatment (n=71): did not receive acupuncture; continued in an observational study, unaware they were in an acupuncture trial

D. Sham laser acupuncture (n=70): same as true laser but no laser was emitted, only red nonlaser light at the probe tip lit up.

For all acupuncture and sham groups, sessions were 20 minutes in duration, 1-2 times per week for 12 weeks (8 to 12 sessions total)

A vs. B vs. C vs. D

Age: 64 vs. 63 vs. 63 vs. 64 years

Female: 46% vs. 39% vs. 56% vs. 56%

Duration of symptoms ≥ 10 years: 41% vs. 38% vs. 27% vs. 50%

Bilateral symptoms: 64% vs. 66% vs. 51% vs. 63%

Opioid use: 1% vs. 3% vs. 1% vs. 1%

Previous acupuncture for knee pain: 7% vs. 13% vs. 7% vs. 3%

Baseline WOMAC function (0-68): 31.3 vs. 27.0 vs. 26.1 vs. 27.5

Baseline NRS activity restriction (0-10): 5.0 vs. 4.3 vs. 4.1 vs. 4.5

Baseline WOMAC pain (0-20): 9.0 vs. 8.3 vs. 7.8 vs. 8.6

Baseline NRS average pain overall (0-10): 5.3 vs. 4.9 vs. 5.1 vs. 5.0

Baseline NRS pain on walking (0-10): 5.5 vs. 4.8 vs. 4.8 vs. 5.2

Baseline NRS pain on standing (0-10): 4.6 vs. 3.8 vs. 4.1 vs. 4.3

A vs. C

9 months

WOMAC function: 22.4 vs. 23.6; adjusted difference −3.7 (95% CI −8.2 to 0.8)

Activity restriction, NRS: 3.4 vs. 4.1; adjusted difference −1.1 (95% CI −2.1, −0.2)

WOMAC pain: 6.7 vs. 7.4; adjusted difference −1.4 (95% CI −2.7 to 0.0)

Overall Pain, NRS: 4.0 vs. 4.6; adjusted difference −0.7 (95% CI −1.6 to 0.2)

Pain on walking, NRS: 4.1 vs. 4.4; adjusted difference −0.6 (95% CI −1.5 to 0.4)

Pain on standing, NRS: 3.7 vs. 4.0; adjusted difference −0.5 (95% CI −1.4 to 0.5)

B vs. C

9 months

WOMAC function: 22.6 vs. 23.6; adjusted difference −0.6 (95% CI −1.5 to 0.3)

Activity restriction, NRS: 3.7 vs. 4.1; adjusted difference −0.4 (95% CI −1.4, 0.5)

WOMAC pain: 7.1 vs. 7.4; adjusted difference −0.4 (95% CI −1.8 to 1.0)

Overall Pain, NRS: 4.0 vs. 4.6; adjusted difference −0.6 (95% CI −1.5 to 0.3)

Pain on walking, NRS: 4.1 vs. 4.4; adjusted difference −0.3 (95% CI −1.2 to 0.7)

Pain on standing, NRS: 3.8 vs. 4.0; adjusted difference −0.2 (95% CI −1.1 to 0.8)

B vs. D

9 months

WOMAC function: 22.6 vs. 21.6; adjusted difference 1.1 (95% CI −4.8 to 7.0)

Activity restriction, NRS: 3.7 vs. 3.9; adjusted difference −0.1 (95% CI −1.1 to 1.0)

WOMAC pain: 7.1 vs. 6.9; adjusted difference 0.0 (95% CI −1.9 to 1.9)

Overall pain, NRS: 4.0 vs. 3.9; adjusted difference 0.0 (95% CI −0.9 to 1.0)

Pain on walking, NRS: 4.1 vs. 4.2; adjusted difference 0.0 (95% CI −1.0 to 1.1)

Pain on standing, NRS: 3.8 vs. 3.5; adjusted difference 0.5 (95% CI −0.7 to 1.6)

A vs. C

9 months

AQoL-6D (−0.04 to 1.00): 0.74 vs. 0.77; adjusted difference: −0.01 (95% CI −0.07 to 0.05)

SF−12 PCS (0-100): 41.7 vs. 38.9; adjusted difference 2.3 (95% CI −1.7 to 6.3)

SF-12 MCS (0-100): 51.1 vs. 54.4; adjusted difference −0.9 (95% CI −5.2 to 3.4)

Opioid use: 0% (0/70) vs. 1% (1/71)

B vs. C

9 months

AQoL-6D: 0.73 vs. 0.77; adjusted difference: 0.01 (95% CI −0.05 to 0.06)

SF-12 PCS: 38.8 vs. 38.9; adjusted difference −0.4 (95% CI −4.4 to 3.6)

SF-12 MCS: 52.1 vs. 54.4; adjusted difference −0.9 (95% CI −5.5 to 3.7)

Opioid use: 2% (1/71) vs. 1% (1/71)

B vs. D

9 months

AQoL-6D: 0.73 vs. 0.74; adjusted difference 0.01 (95% CI −0.05 to 0.08)

SF-12 PCS: 38.8 vs. 38.2; adjusted difference 0.4 (95% CI −3.8 to 4.5)

SF-12 MCS: 52.1 vs. 52.8; adjusted difference −0.6 (95% CI −5.4 to 4.2)

Opioid use: 2% (1/71) vs. 0% (0/70)

Jubb, 2008²⁴¹

1 month

Duration of pain: mean 10 years

Fair

A. Acupuncture (n=34): manual acupuncture (10 minutes, total of 9 points; depth of 1-1.5 cm; elicitation of de qi) and electro-acupuncture (10 minutes each on anterior and posterior part of the knee (20 minutes total); low frequency, delivered at 6 Hz at a constant current)

B. Sham (n=34): sham needles, did not penetrate the skin; electrical stimulation apparatus produced sound signals but no electrical current.

Both groups received 30 minute treatments, 2/week for 5 weeks, with 10 sessions in total

A vs. B

Age: 64 vs. 66 years

Female: 85% vs. 76%

Caucasian: 74% vs. 85%

Duration of symptoms: 10 vs. 9.6 years

Baseline WOMAC function (0-1700): 1028 vs. 979

Baseline WOMAC pain (0−500): 294 vs. 261

Baseline Total body pain, VAS (0-100): 49 vs. 49

Baseline Night pain knee, VAS (0-100): 61 vs. 52

Baseline Overall pain knee, VAS (0-100): 63 vs. 53

Baseline Weight-bearing pain knee, VAS (0-100): 71 vs. 60

Baseline EuroQoL VAS (0-100): 63 vs. 54

A vs. B

1 month

WOMAC function: change from baseline, 137 (95% CI 20 to 255) vs. 134 (95% CI 9 to 258); difference, 4 (95% CI −163 to 171)

WOMAC pain: change from baseline, 59 (95% CI 16 to 102) vs. 13 (95% CI −22 to 50); difference, 46 (95% CI −9 to 100)

Weight-bearing knee pain (VAS), change from baseline, 19 (95% CI 9 to 30) vs. 8 (95% CI −1 to 16); difference, 11 (95% CI −2 to 25)

Overall knee pain (VAS), change from baseline, 14 (95% CI 5 to 24) vs. 2 (95% CI −6 to 10); difference, 12 (95% CI −1 to 24)

Nighttime knee pain (VAS), change from baseline, 10 (95% CI −1 to 22) vs. 5 (95% CI −3 to 14); difference, 5 (95% CI −9 to 19)

General body pain (VAS), change from baseline, 5 (95% CI −5 to 15) vs. −8 (95% CI −1 to 18); difference: 13 (95% CI 0 to 27)

EuroQoL-VAS: mean 63 vs. 52, p=0.98

Lansdown, 2009²⁴²

9.5 months

Duration of pain NR

Poor

A. Acupuncture + usual care (n=15): once per week for up to 10 weeks, with maximum of 10 sessions, which varied in length and content (mean number of acupoints was 12, range 4-24; de qi was usually elicited; variety of stimulation methods used including tonification and reduction; retention time for needles ranged from 10-30 minutes); auxiliary treatment included moxibustion (3/14, 21%) and acupressure massage (3/14, 21%); life style advice 11/14 (79%)

B. Usual care (n=15): any appointments, medications prescribed or over the counter) and interventions sought by participants from any health practitioner

A vs. B

Age: 63 vs. 64 years

Female: 60% vs. 60%

Caucasian: 100% vs. 100%

Duration of symptoms: NR

Baseline WOMAC total (0-96): 31 vs. 37.5

Baseline WOMAC function (0-68): 20.5 vs. 26.3

Baseline OKS (12-60): 30.9 vs. 30.6

Baseline WOMAC pain (0-20): 7.3 vs. 7.4

A vs. B

9.5 months

WOMAC total: 24.8 vs. 25.6, adjusted difference −2.9 (95% CI 9.5 to −15.4)

WOMAC function: 17.4 vs. 17.6, adjusted difference −1.4 (95% CI 8.7, −11.4)

WOMAC pain: 4.7 vs. 5.3 (3.9), adjusted difference −1.4 (95% CI 0.8 to −3.6)

OKS: 24.5 vs. 28.1; difference −3.6 (95% CI −9.8 to 2.6)

A vs. B

9.5 months

(SF-36 scales are 0-100 for all)

SF-36 physical functioning: 54.2 vs. 55.6, difference −1.4 (95% CI −21.8 to 19.0)

SF-36 social functioning: 81.3 vs. 76.6, difference 4.7 (95% CI −10.6 to 20.0)

SF-36 role physical: 71.4 vs. 57.8, difference 13.6 (95% CI −6.3 to 33.5)

SF-36 role mental: 79.2 vs. 67.7, difference 11.5 (95% CI −5.8 to 28.8)

SF-36 mental health: 73.1 vs. 65.0, difference 8.1 (95% CI −5.4 to 21.6)

SF-36 vitality: 58.2 vs. 46.9, difference 11.3 (95% CI −0.22 to 22.8)

SF-36 pain: 65.2 vs. 65.9, difference −0.7 (95% CI −15.6 to 14.2)

SF-36 general health: 67.7 vs. 62.4, difference 5.3 (95% CI −4.8 to 15.4), EQ5D: 0.7 vs. 0.63, difference 0.03 (95% CI −0.13 to 0.19)

Suarez-Almazo, 2010²⁴³

1.5 months

Duration of pain: mean 8 years

Good (sham)

Fair (waitlist)

A. Electro-acupuncture (n=153): Traditional Chinese Medicine points; TENS equipment emitted a dense disperse wave (50Hz, dispersed at 15 Hz, 20 cycles/minute); voltage increased from 5V to 60V until maximal tolerance achieved. Patients rested for 20 minutes with needles retaining and with continuing TENS.

B. Sham (n= 302): 40Hz adjustable wave; voltage increased until the patient could feel it and then immediately turned off. Patients rested for 20 minutes with the needles retained, but without TENS stimulation; nonrelevant acupoints used and depth of needle placement was shallow

C. Waitlist (n=72)

A vs. B vs. C

Age: 65 vs. 65 vs. 64

Female: 66% vs. 65% vs. 58%

Caucasian: 70% vs. 68% vs. 65%

Mean duration of chronicity: 9.2 vs. 8.6 vs. 11.5 years

Baseline WOMAC function (0-100): 42.9 vs. 44.6 vs. 40.1

Baseline WOMAC pain (0-100): 44.5 vs. 45.0 vs. 44.1

Baseline VAS pain (0-100): 58.3 vs. 57.4 vs. 54.6

Baseline J-MAP (1-7): 4.4 vs. 4.4 vs. 4.3

A vs. B

1.5 months

WOMAC function: 31.2 (vs. 32.1; difference −0.9 (95% CI −4.4 to 2.6)

WOMAC pain: 30.8 vs. 31.0; difference −0.2 (95% CI −3.8 to 3.4)

VAS pain: 36.2 vs. 36.7; difference −0.5 (95% CI −6.1 to 5.1)

J-MAP: 3.3 vs. 3.4; difference −0.1 (95% CI −0.39 to 0.19)

A vs. C

1.5 months

WOMAC function: 31.2 vs. 41.7; difference −10.5 (95% CI −15.6 to −5.5)

WOMAC pain: 30.8 vs. 42.4; difference −11.6 (95% CI −16.5 to −6.7)

VAS pain: 36.2 vs. 53.2; difference −17.0 (95% CI −24.7 to −9.3)

J-MAP: 3.3 vs. 4.2; difference −0.9 (95% CI −1.3 to −0.5)

A vs. B

1.5 months

SF-12 PCS (0-100): 39.5 vs. 38.7; difference 0.8 (95% CI −1.1 to 2.7)

SF-12 MCS (0-100): 54.1 vs. 53.2; difference 0.9 (95% CI −0.8 to 2.6)

A vs. C

1.5 months

SF-12 PCS: 39.5 vs. 35.8; difference 3.7 (95% CI 1.0 to 6.4)

SF-12 MCS: 54.1 vs. 51.6; difference 2.5 (95% CI 0.04, 5.0)

Williamson, 2007⁶⁷

1.5 months

Duration of symptoms: NR

Poor

A. Acupuncture (n=60): conducted by a physiotherapist in a group setting (6-10 patients); needles inserted into 7 acupoints until de qi was achieved and left in place for 20 minutes; treatments were once per week for 6 weeks, with 6 sessions in total

B. Combination Exercise (Physiotherapy) (n=60): supervised group (6-10 people) exercise comprised of strengthening, aerobic, stretching, and balance training; 60 minutes, once per week for 6 weeks;

C. Usual care (n=61): exercise and advice leaflet; told they were enrolled in the “home exercise group”

A vs. B vs. C

Age: 72 vs. 70 vs. 70 years

Female: 55% vs. 52% vs. 54%

BMI: 30.9 vs. 32.8 vs. 32.7

Baseline WOMAC total (scale unclear): 50.9 vs. 50.2 vs. 51.1

Baseline OKS (12-60): 40.2 vs. 39.3 vs. 40.5

Baseline pain VAS (0-10): 7.3 vs. 6.8 vs. 6.9

Baseline HAD Anxiety (0-21): 7.3 vs. 7.5 vs. 6.7

Baseline HAD Depression (0-21): 7.1 vs. 7.1 vs. 7.4

A vs. B

1.5 months

WOMAC: 48.4 vs. 49.4, difference −1.0 (95% CI −6.7 to 4.7)

OKS: 38.1 vs. 38.8, difference −0.7 (95% CI −3.5 to 2.1)

Pain VAS: 6.6 vs. 6.4, difference 0.22 (95% CI −0.67 to 1.11)

A vs. C

1.5 months

WOMAC: 48.4 vs. 52.3, difference −3.9 (95% CI −9.5 to 1.6)

OKS: 38.1 vs. 40.8, difference −2.6 (95% CI −5.4 to 0.1)

Pain VAS: 6.6 vs. 7.2, difference −0.66 (95% CI −1.45 to 0.12)

A vs. B

1.5 months

HAD Anxiety: 6.9 vs. 7.1, difference −0.20 (95% CI −1.89 to 1.49)

HAD Depression: 6.7 vs. 6.8, difference −0.03 (95% CI −1.30 to 1.24)

A vs. C

1.5 months

HAD Anxiety: 6.9 vs. 6.5, difference 0.34 (95% CI −1.11 to 1.8)

HAD Depression: 6.7 vs. 7.1, difference, −0.41 (95% CI −1.63 to 0.8)

Witt, 2005²⁴⁴

4 and 10 months

Duration of pain: mean 9.4 years

Fair

A. Acupuncture (n=150): semi-standardized; patients received at least 6 local and at least 2 distant Traditional Acupuncture points; elicitation of de qi; needles stimulated manually at least once during each session

B. Minimal acupuncture (n=76): superficial insertion of at nonacupuncture sites away from knee; manual stimulation of the needles and provocation of de qi were avoided

Both groups underwent 12 sessions of 30 minutes duration, administered over 8 weeks

A vs. B

Age: 65 vs. 63 years

Female: 70% vs. 65%

Duration of symptoms: 9.1 vs. 9.9 years

Bilateral OA: 74% vs. 77%

Previous acupuncture: 9% vs. 7%

Baseline WOMAC total (scale unclear): 50.8 vs. 52.5

Baseline PDI (Disability) (0-70): 27.9 vs. 27.8

Baseline VAS pain (0-100): 64.9 vs. 68.5

A vs. B

4 months

WOMAC total: 30.4 vs. 36.3; difference −5.8 (95% CI −12.0 to 0.3)

WOMAC physical function: 30.4 vs. 36.5; difference −6.2 (95% CI −12.4 to 0.1)

PDI: 18.6 vs. 22.8; difference −4.2 (95% CI −8.3 to −0.0)

WOMAC pain: 28.9 vs. 33.8; difference −4.8 (95% CI −11.2 to 1.6)

10 months

WOMAC Total: 32.7 vs. 38.4; difference −5.7 (95% CI −12.1 to 0.7)

WOMAC physical function: 33.0 vs. 38.9; difference −5.9 (95% CI −12.5 to 0.7)

PDI: 20.0 vs. 23.6; difference −3.6 (95% CI −7.7 to 0.5)

WOMAC pain: 30.0 vs. 33.5; difference −3.5 (95% CI −10.0 to 3.0)

A vs. B

4 months

SF-36 Physical: 35.1 vs. 33.0; difference 2.1 (95% CI −0·5 to 4.8)

SF-36 Mental: 52.6 vs. 51.7; difference 0.9 (95% CI 2.3 to 4.2)

ADS (Depression): 48.2 vs. 48.7; difference −0·5 (95% CI −3.6 to 2.5)

10 months

SF-36 Physical: 35.0 vs. 32.8; difference 2.2 (95% CI −0.6 to 5,1)

SF-36 Mental: 52.9 vs. 51.1; difference 1.9 (95% CI −1.3 to 5.1)

ADS: 48.6 vs. 49.8; difference −1.2 (95% CI −4.3 to 1.8)

Yurtkuran, 2007²⁴⁵

3 months

Duration of pain: mean 5.4 years

Fair

A. Laser acupuncture (n=28): applied to the medial side of the knee to the acupuncture point on the sural nerve; infrared 27 GaAs diode laser instrument (output 4 mW, 10 mW/cm2 power density, 120-sec treatment time and 0.48 J dose per session); irradiation was pulsed (duration of 1 pulse was 200 nanosecond), and only one point was treated with contact application technique.

B. Sham laser acupuncture (n=27): performed in the same location and under the same conditions as the true laser acupuncture; patients could see a red light but the machine was turned off

Both groups: 20 minutes sessions, 5 days per week for 2 weeks (total duration of therapy was 10 days, 10 sessions total); in addition, all patients received a home-based, standardized exercise program

A vs. B

Age: 52 vs. 53 years

Female: 96% vs. 96%

Duration of symptoms: 5.2 vs. 5.6 months

Baseline WOMAC total: 66.5 vs. 51.3

Baseline WOMAC physical function: 47.5 vs. 35.3

Baseline WOMAC pain: 13.7 vs. 11.6

Baseline VAS pain on movement (0-10): 6.5 vs. 6.1

A vs. B

2.5 months

WOMAC total: 62.4 vs. 50.6, difference 11.8 (95% CI −1.0 to 24.6)

WOMAC physical function: 44.2 vs. 35.3, difference 11.9 (95% CI 2.9 to 20.9)

WOMAC pain: 13.5 vs. 11.5, difference 2.0 (95% CI −1.3 to 5.3)

VAS pain on movement: 5.6 vs. 4.8, difference 0.8 (95% CI −0.9 to 2.5)

A vs. B

2.5 months

NHP (0-38): 7.6 vs. 6.4. difference 1.2 (95% CI −2.1 to 4.4)