Rédacteurs : Olivier Goret, Johan Nguyen, Claude Pernice, Henri Truong

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--- acupuncture:evaluation:rhumatologie - orthopedie:18. genou douloureux [22 Feb 2022 16:56]
Nguyen Johan [1.2.7. Qu 2021]
+++ acupuncture:evaluation:rhumatologie - orthopedie:18. genou douloureux [06 Mar 2024 07:59] (Version actuelle)
Nguyen Johan [1.2.12.1. Shi 2021]
@@ Ligne 1: / Ligne 1: @@
 /*English:Knee Pain*/
-=======  Knee Pain  =======
+=======  Knee Pain, Knee Osteoarthritis  =======
-====== Genou douloureux : évaluation de l'acupuncture  ======
+====== Genou douloureux, Gonarthrose  ======
 | articles connexes : - [[acupuncture:evaluation:rhumatologie - orthopedie:03. arthrose|arthrose]] - [[acupuncture:evaluation:rhumatologie - orthopedie:20. traitements de reference en rhumatologie#Gonarthrose|traitements de référence]] - [[acupuncture:conduites therapeutiques:rhumatologie:18. genou douloureux|conduites thérapeutiques]] - [[qigong et taijiquan medical:evaluation:rhumatologie-orthopedie:18. genou douloureux|taiji-qigong]] - |
@@ Ligne 15: / Ligne 15: @@
 ==== Generic Acupuncture ====
+=== Kwak 2023 ☆☆===
+Kwak SG, Kwon JB, Seo YW, Choi WK. The effectiveness of acupuncture as an adjunctive therapy to oral pharmacological medication in patient with knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Mar 17;102(11):e33262.  https://doi.org/10.1097/MD.0000000000033262.
+^Background| We aimed to find out whether the combined treatment of acupuncture and oral medication is more effective than sole oral medication in reducing pain and improving knee function at the end of treatment and after short-term period (4-6 weeks after treatment). Second, if it is effective, we investigated whether the effect surpasses the minimal clinically important difference.|
+^Methods| Articles published between January 1, 1992, and August 31, 2022, were searched in PubMed, Cochrane, and Embase. The PICO (population, intervention, comparison, and outcome) of this study are as follows: Population: knee osteoarthritis patients; Intervention: acupuncture (non-sham acupuncture) + oral medication (analgesic or non-steroidal anti-inflammatory drugs); Comparison: oral medication (analgesic or non-steroidal anti-inflammatory drugs); Outcome: visual analog scale (VAS) or Western Ontario and McMaster University (WOMAC) osteoarthritis index.|
+^Results| The combined treatment of oral medication and adjuvant acupuncture showed statistically significant improvement in VAS and WOMAC scores at the end of acupuncture treatment and short-term follow-up time (between 4 and 6 weeks after acupuncture). In addition, the degree of improvement of VAS and WOMAC index showed effects beyond minimal clinically important differences compared to pretreatment at both the end of acupuncture treatment and the short-term follow-up of acupuncture treatment.|
+^Conclusion| The existing evidence suggests that adjuvant acupuncture may play a role in the treatment of knee osteoarthritis. However, physicians should be aware of adverse effects such as hematoma in adjuvant acupuncture treatment.|
+=== Lee 2023 ☆☆☆ ===
+Lee B, Kim TH, Birch S, Alraek T, Lee HW, Nielsen A, Wieland LS, Lee MS. Comparative effectiveness of acupuncture in sham-controlled trials for knee osteoarthritis: A systematic review and network meta-analysis. Front Med (Lausanne). 2023 Jan 9;9:1061878.  https://doi.org/10.3389/fmed.2022.1061878.
+^Objectives|Although many trials have assessed the effect of acupuncture on knee osteoarthritis (KOA), its efficacy remains controversial. Sham acupuncture techniques are regarded as representative control interventions in acupuncture trials and sometimes incorporate the use of sham devices (base units) to support a non-penetrating needle. To achieve successful blinding, these trials also use acupuncture base units in the verum acupuncture group. Base units are not used in real-world clinical settings. We aimed to assess the effect sizes of verum and sham acupuncture for KOA in sham-controlled trials with or without base units.|
+^Methods|A total of 10 electronic databases for randomized controlled trials (RCTs) comparing the efficacy of verum manual acupuncture and sham acupuncture for the treatment of KOA were searched for articles published before April 12, 2022. The primary outcome was pain intensity, and the secondary outcomes included physical function. The first assessment after the end of treatment was chosen for analysis. Effect sizes are reported as standardized mean differences (SMDs) with 95% confidence intervals (95% CIs). The risk of bias was assessed using the Cochrane risk of bias tool, and publication bias was evaluated using a funnel plot and Egger's test. The quality of evidence for estimates was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.|
+^Results|**Fifteen RCTs** were included. There was generally a low risk of bias except for the difficulty in blinding acupuncture therapists (performance bias). Compared to verum acupuncture in sham-controlled trials using base units, verum acupuncture in sham-controlled trials without base units was more effective for improving pain (SMD -0.56, 95% CI -1.09 to -0.03) and function (SMD -0.73, 95% CI -1.36 to -0.10) in KOA. The quality of evidence for network estimates was moderate to low due to the risk of bias and imprecision.|
+^Conclusion|These findings suggest that verum acupuncture in different types of sham-controlled trials has different effect sizes for KOA. Because base units are not used in clinical settings, the results of verum acupuncture in sham-controlled trials with base units need to be interpreted carefully.|
+=== Tian 2022 RETRACTED ===
+<color #ed1c24>RETRACTED</color>. Tian H, Huang L, Sun M, Xu G, He J, Zhou Z, Huang F, Liu Y, Liang F. Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. Biomed Res Int. 2022 Apr 21;2022:6561633.  https://doi.org/10.1155/2022/6561633
+^Background|Knee osteoarthritis (KOA) can cause chronic pain and seriously affect the quality of patient lives. The continued emergence of high-quality RCTS requires us to update the quality of evidence. This study aims to evaluate the efficacy of acupuncture for KOA patients and calculate the required information size (RIS) to determine whether further clinical studies are required.|
+^Methods| We searched PubMed, Embase, WOS, CBM, CNKI, VIP, WHO ICTRP, ChiCTR, and Grey literature to collect randomized controlled trials (RCTs) of acupuncture for KOA from inception to December 2021. A meta-analysis was performed according to the Cochrane systematic review method by using Review Manager 5.4 and TSA 0.9.5.10 beta, and GRADE was used to evaluate the quality of the evidence. Trial sequential analysis was used to control random errors and calculate the required information size.|
+^Results|**Eleven RCTs with 2484 patients** were included in our meta-analysis, meeting the inclusion criteria for the meta-analysis. The meta-analysis indicated that acupuncture had beneficial effect on knee osteoarthritis in reducing pain [n = 2387; SMD = -0.12, 95% CI (-0.20, -0.04); I 2 = 0%] and improved patients function activities [n = 2408; MD = -1.25, 95% CI (-1.97, -0.53); I 2 = 0%], but true acupuncture showed no significant effect in relieve patient's stiffness [n = 1337; MD = -0.07, 95% CI (-0.30, 0.15); I 2 = 0%]. We pooled the studies which found no significant difference in improving the quality life of mental [n = 1462; SMD = 0.02, 95% CI (-0.23, 0.27); I 2 = 78%] and patients physical health (SF-36 or SF-12) [n = 1745; SMD = 1.01, 95% CI (-0.08, 2.11); I 2 = 0%] compared with sham acupuncture. The pain and function TSA graphs indicated that cumulative Z-curves intersected with the traditional level of statistical favoring acupuncture, and more RCTs will required in the future studies.|
+^Conclusion| Acupuncture has beneficial effect on pain relief and improves function activities, and this treatment can be recommended as a beneficial alternative therapy in patients with KOA, particularly for chronic patients and those currently undergoing long-term pain and help them increasing quality of life. But it should be further verified through more RCTs in function. Available studies suggested that acupuncture was superior to sham acupuncture in reduce pain and function as verified by TSA.|
 === Fan 2020 ☆☆===
@@ Ligne 252: / Ligne 281: @@
 === Comparison of acupuncture techniques ===
+== Lee 2023 (acupotomy vs acupuncture) ==
+Lee CJ, Luo WT, Tam KW, Huang TW. Comparison of the effects of acupotomy and acupuncture on knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2023 Feb;50:101712.  https://doi.org/10.1016/j.ctcp.2022.101712|
+^Background and purpose| Acupotomy and acupuncture are both treatments for knee osteoarthritis symptoms. However, acupotomy also has the additional anatomical effect of dissecting inflamed tissue. The problem this study aims to address is whether acupotomy is a better treatment than acupuncture in treating knee osteoarthritis.|
+^Methods| We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Airiti Library, and Wanfang Data databases from inception to March 2022 for randomized controlled clinical trials (RCTs) comparing the effects of acupotomy and acupuncture in patients with knee osteoarthritis.|
+^Results|In total, we identified **43 RCTs** in this meta-analysis. Compared to the acupuncture group, acupotomy had a higher cure rate (odds ratio (OR) 2.94, 95% confidence interval (CI) 2.36 to 3.65), indicating a better improvement in daily activity function. Acupotomy was also more effective in pain relief and knee score improvement. However, some RCTs indicated that adverse events in the acupotomy group were greater than in the acupuncture group (OR 1.23, 95% CI 0.42 to 3.60).|
+^Conclusion| Our findings indicated that acupotomy was a more effective treatment for knee osteoarthritis than acupuncture. However, most of the included RCTs had moderate risk of bias, meaning that more high-quality RCTs were needed.|
+== Ma 2023 (Network meta-analysis) ==
+Ma W, Zhang CY, Huang X, Cheng W. Network meta-analysis of 7 acupuncture therapies for knee osteoarthritis. Medicine (Baltimore). 2023 Oct 27;102(43):e35670.  https://doi.org/10.1097/MD.0000000000035670.
+^Objective| With the progression of society aging demographic, the prevalence of knee osteoarthritis (KOA) continues to rise steadily, exerting a significant impact on individuals' quality of life. Acupuncture therapy has garnered extensive utilization in the management of osteoarthritis; however, a comprehensive systematic review integrating acupuncture with traditional Chinese medicine remains absent. This study compared the clinical efficacy of 7 acupuncture methods (electroacupuncture, conventional acupuncture, warm needle, floating needle, fire needle, needle knife, and silver needle) for the treatment of KOA through a network meta-analysis.|
+^Methods| This study examined the databases-PubMed, EMbase, The Cochrane Library, the China Biology Medicine, Chinese Journal Full-text Database, Wanfang Database, and VIP Database-for randomized controlled trials of the 7 methods for KOA treatment. The search time spanned from the database establishment to March 5, 2022. The primary outcome indicator was the total effective rate, and the secondary outcome indicator was the visual analog scale. After the layer-by-layer screening, the quality of the literature was assessed using the Cochrane systematic reviewer manual 5.1.0 bias risk assessment tool for randomized controlled trials. After data extraction, the R4.0.1 software was used for network meta-analysis.|
+^Results| Based on the network meta-analysis, the ranking of interventions based on the surface under the cumulative ranking curve for the total effective rate is as follows: silver needle (0.99) > floating needle (0.97) > needle knife (0.66) > fire needle (0.56) > warm needle (0.44) > conventional acupuncture (0.35) > electroacupuncture (0.13). Regarding the improvement in visual analog scale scores, the surface under the cumulative ranking curve ranking is as follows: silver needle (0.97) > conventional acupuncture (0.67) > needle knife (0.64) > floating needle (0.51) > warm needle (0.44) > fire needle (0.14) > electroacupuncture (0.09).|
+^Conclusion| Based on the network meta-analysis, silver needle therapy emerged as the most efficacious and analgesic intervention for KOA. Nevertheless, given the notable variations in the quality and quantity of studies encompassing diverse treatment modalities, the findings of this research necessitate further substantiation through forthcoming high-quality multicenter, large-sample, randomized double-blind trials.|
+== Wang 2023 ==
+Wang Z, Xu H, Wang Z, Zhou H, Diao J, Zhang L, Wang Y, Li M, Zhou Y. Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis. Front Immunol. 2023 Dec 14;14:1309751.  https://doi.org/10.3389/fimmu.2023.1309751
+^Backgound| With the continuous development of clinical medicine, an increasing number of non-pharmacological interventions have been applied for the treatment of knee osteoarthritis (KOA), with the results of several recent randomized controlled trials (RCTs) showing that a variety of externally-applied, non-pharmacological interventions (EANPI) can improve symptoms and inflammation in patients with KOA. However, the relative benefits and disadvantages of non-drug therapies remain uncertain, and an optimal treatment strategy has not yet been determined.|
+^Objective| This study applied network meta-analysis (NMA) to compare and rank the effectiveness of EANPI on the short- and long-term clinical symptoms and inflammatory cytokine levels in patients with KOA.|
+^Methods| Two independent researchers searched online databases and performed manual retrieval of related citations to identify RCTs that met the selection criteria for the network meta-analysis. These researchers retrieved studies indexed from database inception to August 2023 and performed data extraction and assessment of the risk of bias.|
+^Results| The analysis included 80 RCTs involving 8440 participants and nine externally-applied, non-pharmacological therapies, namely extracorporeal shock wave, radiofrequency, acupotomy, laser therapy, Tuina therapy, kinesio taping, electroacupuncture, platelet-rich plasma injection, and ozone therapy. The treatment courses ranged from 1 to 12 weeks, with follow-up periods ranging from 4 to 24 weeks. The results of the NMA indicated that each non-drug therapy was superior to sham intervention in improving all outcome indicators. Except for the visual analog scale (VAS) and Western Ontario MacMaster (WOMAC) pain outcomes, all non-drug therapies had better efficacy than pharmacological treatments. For short-term VAS and tumor necrosis factor-alpha (TNF-α), extracorporeal shock wave performed better than other therapies (90.2% and 85.2% respectively). Radiofrequency therapy may be the most promising method to reduce long-term VAS, short- and long-term WOMAC pain, and interleukin (IL)-1β level (84.8%, 97.8%, 90.1%, 94.8% respectively). Tuina therapy may be a significant choice for short- and long-term outcomes of WOMAC function and range of motion (ROM).|
+^Conclusions| The results of the comprehensive comparison of the outcome indicators in 9 different EANPI indicated that radiofrequency and Tuina therapy were more effective and consistently ranked high in improving clinical symptoms in the short and long term. Radiofrequency is effective at relieving pain, and Tuina therapy can be given priority for treatment when hypofunction is the main symptom. EANPI to improve pain symptoms may be related to the regulation of inflammatory cytokine levels, which may be a potential mechanism of action.|
+== Ye 2022 RETRACTED ==
+  * <color #ed1c24>Retracted</color>: The Effectiveness Comparison of Different Acupuncture-Related Therapies on Knee Osteoarthritis: A Meta-Analysis. Evid Based Complement Alternat Med. 2023 Jul 19;2023:9892726.  https://doi.org/10.1155/2023/9892726
+  * Ye C, Zhou J, Wang M, Xiao S, Lv A, Wang D. The Effectiveness Comparison of Different Acupuncture-Related Therapies on Knee Osteoarthritis: A Meta-Analysis. Evid Based Complement Alternat Med. 2022 Jun 30;2022:2831332.  https://doi.org/10.1155/2022/2831332
+^Objective| This meta-analysis aims to assess the efficacy of acupuncture-related therapy on knee osteoarthritis (KOA) patients.|
+^Method| We searched PubMed, Embase, and CNKI databases to screen eligible trials between 2017 and 2022. All trials that used acupuncture/moxibustion of KOA patients were included. Study selection and data extraction were performed by 2 researchers independently. The statistics was performed by using R 4.1.1.|
+^Results| A total of 17 trials were included in our meta-analysis. Meta-analysis results showed the evidence of the relation of several common acupunture/moxibustion treatments by network meta-analysis. In the fixed effect model, acupuncture/moxibustion has superior therapy efficacy than sham treatment (mean difference = -0.34, 95% confidence interval = (-0.52,-0.16), P=0.95). In fixed effect model, specific acupuncture/moxibustion has superior therapy efficacy than usual acupuncture/moxibustion (mean difference = -0.45, 95% confidence interval = (-0.62, -0.29), P < 0.01).|
+^Conclusion| Acupuncture/moxibustion has superior therapy efficacy than sham treatment. Specific acupuncture/moxibustion has superior therapy efficacy than usual acupuncture/moxibustion.|
 == Liu 2021 (Network Meta-Analysis) ==
@@ Ligne 263: / Ligne 334: @@
 ^Conclusion|This study shows that fire needle is superior to warm needle and electro-acupuncture, whereas warm needle and electro-acupuncture are better than conventional acupuncture, western medicine, sham moxibustion and sham acupuncture.|
+== Li 2018 (Network Meta-Analysis) ==
+Li S, Xie P, Liang Z, Huang W, Huang Z, Ou J, Lin Z, Chai S. Efficacy Comparison of Five Different Acupuncture Methods on Pain, Stiffness, and Function in Osteoarthritis of the Knee: A Network Meta-Analysis. Evid Based Complement Alternat Med. 2018. https://www.hindawi.com/journals/ecam/2018/1638904/  [189184].
+^ Objective|The principal objective of this present study was to compare the effects of different acupuncture methods on pain, stiffness, and physical function for osteoarthritis of the knee by the pairwise and network meta-analysis (NMA). |
+^Methods|A network meta-analysis of randomized controlled trials (RCTs) was searched from three English databases and one Chinese database until January 2018. A pairwise meta-analysis was performed with a random effects model. Then we carried out the NMA within a Bayesian framework. Mean difference (MD) and its 95% confidence interval (CI) were calculated by R 3.4.1, Stata 14.0, and RevMan 5.3 software to assess the relief of pain, the effectiveness for stiffness, and physical function recovery. Node-splitting method was used to calculate the inconsistency. Rank probabilities were assessed and clustered by the surface under the cumulative ranking curve (SUCRA). |
+^Results| 16 trials mostly researched short-term effectiveness and showed that fire needle and electro-acupuncture were statistically significant to decrease WOMAC pain and physical function scores when compared with other treatments, but there was no significant difference in stiffness calculations. |
+^Conclusions|Our NMA demonstrated that acupuncture with heat pain or electrical stimulation might be suggested as the better choices in all acupuncture methods to osteoarthritis of the knee. |
+== Xin 2023 (acupuncture vs moxibustion) ==
+Xin S, Liu J, Yang Z, Li C. Comparative effectiveness of moxibustion and acupuncture for the management of osteoarthritis knee: A systematic review and meta-analysis. Heliyon. 2023 Jul 4;9(7):e17805.  https://doi.org/10.1016/j.heliyon.2023.e17805
+^Background| Moxibustion, a traditional Chinese medicine approach, stimulates blood circulation by burning wormwood at acupuncture points and is frequently used in conjunction with acupuncture for managing knee osteoarthritis. This review aims to compare the effectiveness of moxibustion and acupuncture in the management of knee osteoarthritis.|
+^Methods| Our team conducted a comprehensive search across several databases: PubMed Central, EMBASE, MEDLINE, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and the Cochrane Library, covering the timeframe from January 1964 up until April 2022. We implemented a meta-analysis, utilizing a random-effects model, and we've presented the pooled standardized mean difference (SMD) and risk ratio (RR) inclusive of the 95% confidence intervals (CIs), in accordance with the nature of the outcome.|
+^Results| 21 studies were included, of which, half were identified as having high risk of bias. The pooled SMD for the pain score was found to be -0.53 (95% CI: -0.91 to -0.15). In-depth analysis focusing on the kind of moxibustion indicated that fire needle moxibustion was more effective in pain reduction (SMD = -0.56; 95% CI: -1.10 to -0.01) compared to alternative moxibustion methods (SMD = -0.47; 95% CI: -0.80 to -0.13). The pooled RR for the success rate in treatment was 1.39 (95% CI: 1.19 to 1.62). Subgroup analysis demonstrated that fire needle moxibustion reported a superior success rate (RR = 1.43; 95% CI: 1.19 to 1.72) in comparison to other types of moxibustion (RR = 1.33; 95% CI: 1.02 to 1.74).|
+^Conclusion| Moxibustion, specifically fire needle moxibustion, demonstrated superior effectiveness in managing knee osteoarthritis compared to acupuncture. |
@@ Ligne 276: / Ligne 364: @@
 ^Results| **Thirty-three randomized controlled trials** involving **3,954 patients** were included. Meta-analysis showed that ORR [odds ratio (OR) =5.41; 95% confidence interval (CI): (4.38, 6.68); P<0.00001], VAS score [mean difference (MD) =-1.86; 95% CI: (-2.44, -1.29); P<0.00001], WOMAC score [MD =-13.05; 95% CI: (-21.70, -4.41); P=0.003], and Lysholm score [MD =10.47; 95% CI: (5.21, 15.72); P<0.0001] in the combination group were significantly superior to those in the control group.|
 ^Discussion| Compared with acupuncture alone or CHM/Western drug alone, acupuncture combined with CHM can effectively alleviate knee pain, improve knee function, and increase the quality of life. Thus, this combination can be used as a conservative treatment for KOA. However, due to the small number of high-quality articles and possible biases in our analysis, our conclusions need to be further verified in more and higher-quality studies.|
+=== Combined with massage ===
+== Wang 2022 ==
+Wang Z, Wang Y, Wang C, Li X, Zhou Z, Zhang L, Li M, Pan Y, Jiao T, Shi X, Liu Q. Systematic Review and Network Meta-analysis of Acupuncture Combined with Massage in Treating Knee Osteoarthritis. Biomed Res Int. 2022 Aug 13;2022:4048550.  https://doi.org/10.1155/2022/4048550
+^Background| Knee osteoarthritis is a common clinical disease with frequent occurrence. More and more studies have shown that external therapies such as acupuncture and massage are beneficial to the treatment of knee osteoarthritis.|
+^Objective| The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTS) was to evaluate the efficacy and safety of acupuncture and massage combined with treatment of KOA and to provide some reference for clinical treatment of KOA.|
+^Methods|Network meta-analysis was used to evaluate the efficacy of acupuncture combined with massage in the treatment of knee osteoarthritis. PubMed, Cochrane Library, Web of Science, Embase, Chinese Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang were searched by computer for randomized controlled trials on acupuncture combined with massage in the treatment of knee osteoarthritis. All researchers independently screened the literature, extracted data, and evaluated quality, and studies that met the quality criteria were analyzed using Stata16.0 software.|
+^Results| A total of 3076 articles were retrieved, and finally, 49 studies involving 10 acupuncture combined with massage methods were included. The total sample size was 4458, including 2182 in the experimental group and 2276 in the control group. The results of network meta-analysis showed the following: in terms of effective rate, the optimal first three interventions were floating needle+massage, needle knife+massage, and silver needle+massage; in terms of reducing VAS score, the optimal first three interventions were common acupuncture+massage, needle knife+massage, and warm needle+massage; in terms of improving total Lysholm index score, the optimal first three interventions were silver needle+massage, electroacupuncture+massage, and needle knife+massage; in terms of reducing total WOMAC score, the optimal first three interventions were silver needle+massage, electrothermal needle+massage, and common acupuncture+massage; in terms of reducing WOMAC stiffness score, the optimal first three interventions were warm needle+massage, silver needle+massage, and common acupuncture+massage; and in terms of reducing WOMAC joint function score, the optimal first three interventions were silver needle+massage, warm needle+massage, and common acupuncture+massage.|
+^Conclusion| The results showed that acupuncture combined with massage could improve the clinical therapeutic effect of patients with knee osteoarthritis. Limited by the quality of the included studies, the conclusions obtained still need to be further validated.|
 === Combined with intra-articular injection of sodium hyaluronate ===
@@ Ligne 322: / Ligne 424: @@
 ^Results |**10 papers were included in the related study, a total of 1052 patients**. Correlation analysis showed that combination of acupuncture with medicine treatment of knee osteoarthritis was efficient in difference is statistically significant. And after six months, 1 year and 2 years of following-up, the recurrence rate had statistical differences. |
 ^Conclusion| Combination of acupuncture with medicine in the treatment of knee osteoarthritis has high efficient, low recurrence rate and good security, while needs to be verify by high quality randomized controlled trials. |
+=== Combined with sodium vitrate injection ===
+== Jiang 2023 ==
+Jiang R, Zhang T, Zhen M. Traditional Chinese medicine external treatment combined with sodium vitrate injection for the treatment of knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2023 Dec 15;102(50):e36632.  https://doi.org/10.1097/MD.0000000000036632
+^Background| Osteoarthritis of the knee is a clinically common degenerative joint disease that has a high prevalence and, if left untreated, can seriously affect a patient's quality of life. The objective of this article is to systematically evaluate the efficacy and safety of the combination of traditional Chinese medicine external treatment with sodium vitrate injection in the treatment of osteoarthritis of the knee.|
+^Methods| By searching China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database (WF), Chinese Biomedical Literature Database (CBM), Embase, Pubmed, Cochrane Library. The search time was set from 2010 to March 2023. Revman 5.4 software was used for data analysis. The protocol was registered in the PROSPERO database (ref. CRD42023426707).|
+^Results| A total of 3239 patients from 31 RCTs were finally included. Meta-analysis showed significant differences in the Total clinical Efficiency (mean difference (MD) = 4.62, 95% Confidence Interval (CI) = 3.52-6.08, P < .01), WOMAC score (MD = 6.57, 95% CI = 5.78-7.36, P < .01), VAS score (MD = 0.26, 95% CI = 0.14-0.37, P < .0001), Lysholm scores (MD = 5.21, 95% CI = 4.51-5.90, P < .0001), and Lequesne index (MD = 5.21, 95% CI = 4.51-5.90, P < .0001) between the Traditional Chinese Medicine External Treatment combined with sodium vitrate injection group and control group.|
+^Conclusion| The efficacy of traditional Chinese external treatment combined with sodium vitrate injection for osteoarthritis of the knee was superior to that of sodium vitrate injection only in all cases. Due to the limitations of the quantity and quality of the included literature, more high-quality literature is needed to validate this conclusion at a later stage.|
+=== Combined with active exercise training ===
+== Chen 2023 ==
+Chen J, Guo H, Pan J, Li H, Wang Y, Liu Z, Xie Y, Jin S. Efficacy of acupuncture combined with active exercise training in improving pain and function of knee osteoarthritis individuals: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Dec 2;18(1):921.  https://doi.org/10.1186/s13018-023-04403-2
+^Objective| To conduct a systematic review and meta-analysis to investigate the clinical efficacy of acupuncture combined with active exercise training in improving pain and function of knee osteoarthritis (KOA) individuals.|
+^Methods| Data sources. PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, Technology Periodical Database and China Biology Medicine were searched from their inceptions to April 5, 2023. Review methods: We analyzed trials of acupuncture combined with active exercise training for KOA.  The included studies were of high quality (Jadad ≥ 4) and RCTs. Study selection, data extraction, risk of bias and quality assessment were independently performed by two reviewers. We performed systematic analyses based on different outcome measures, including total efficiency rate, visual analogue scale (VAS), the Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), the Lysholm Knee Scale (LKS) and range of motion (ROM). We used Review Manager 5.3 and Stata/MP 14.0 to analyze the data. And it was verified by trial sequence analysis (TSA). If I2 > 50% and p < 0.05, we performed sensitivity analysis and subgroup analysis to find the source of heterogeneity. Publication bias was studied by funnel plot and Egger’s test was used to verify it.|
+^Results| Full **11 high-quality studies** (Jadad ≥ 4) including 774 KOA individuals were included in this review for meta-analysis. The results showed that acupuncture combined with active exercise training (combined group) was superior to the acupuncture group in improving the total effective rate [RR = 1.13, 95%CI (1.05, 1.22), I2 = 0%, P = 0.70], reducing the pain level (VAS) [MD = − 0.74, 95%CI (− 1.04,  − 0.43), I2 = 68%, P < 0.05], improving knee joint function (WOMAC) [MD =  − 6.97, 95%CI (− 10.74, − 3.19), I2 = 76%, P < 0.05] and improving joint range of motion (ROM) [MD = 6.25, 95%CI (2.37, 10.04), I2 = 0%, P = 0.71]. Similarly, the combined group showed significant improvements in the total effective rate [RR = 1.31, 95% CI (1.18, 1.47), I2 = 48%, P = 0.10], pain (VAS) [MD = 1.42, 95% CI (− 1.85, − 1.00), I2 = 65%, P = 0.02] and knee function (WOMAC) [MD = 7.05, 95% CI (− 11.43, − 2.66), I2 = 86%, P < 0.05] compared with the non-acupuncture group.|
+^Conclusion| The combined effect of all studies showed significant benefits of acupuncture combined with active exercise training in improving the total effective rate, reducing pain, promoting recovery of knee function and expanding range of motion. However, some evaluation indicators are highly subjective and need to be further confirmed by more objective and evidence-based high-quality RCTs in future.|
 === Combined with manipulation ===
@@ Ligne 352: / Ligne 482: @@
+== Lin 2023 (ultrasound-guided acupotomy) ==
+Lin S, Lai C, Wang J, Lin Y, Tu Y, Yang Y, Zhang R. Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2023 Jan 13;102(2):e32663.  https://doi.org/10.1097/MD.0000000000032663.
+^Background| This systematic review aimed to evaluate the effectiveness and safety of ultrasound-guided acupotomy (UGAT) therapy in the treatment of patients with knee osteoarthritis (KOA).|
+^Methods|We conducted online researches in the databases including PubMed, the Cochrane Library, EMBASE, China national knowledge infrastructure, China biomedical literature database, and Wan Fang data. All data were collected until January 1, 2022. Relevant randomized controlled trials on the effectiveness of UGAT for the treatment of KOA were included. Meta-analyses were carried out by RevMan 5.3 software. Evidence quality was evaluated by the grading of recommendations, assessment development, and evaluation.|
+^Results|**Eight studies** including **543 participants** were analyzed in this study. The pooled analysis indicated that UGAT was significantly more efficient than the control group in decreasing the visual analogue scale score (mean difference = -0.81, 95% confidence interval (CI) = [-1.15, -0.47], P < .00001, 8 studies), improving knee function on the Lysholm knee score (mean difference = 8.26, 95% CI = [1.56, 14.97], P = .02, 2 studies), and increasing clinical effective rate (relative risk = 1.14, 95% CI = [1.06, 1.23], P = .0005, 6 studies). For adverse events, UGAT was also associated with lower incidence of adverse event (odds ratio = 0.27, 95% CI = [0.12, 0.63], P = .002, 4 studies) compared to traditional acupotomy.|
+^Conclusion|Current evidence suggested that UGAT therapy was effective and safe in the clinical treatments of KOA, thus could be suggested in the clinical managements of KOA. However, considering the unsatisfactory quality of the available trials, more large-scale, and better quality randomized controlled trials were recommend in future.|
+== Wu 2023 (combined with sodium hyaluronate) ==
+Wu Q, Wu Z, Lu Z. Efficacy of acupotomy combined with sodium hyaluronate versus sodium hyaluronate alone in the treatment of knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2023 Sep 15;102(37):e34930.  https://doi.org/10.1097/MD.0000000000034930.
+^Background| The efficacy of acupotomy combined with hyaluronic sodium acid in the treatment of knee osteoarthritis (KOA) is unclear. Therefore, this meta-analysis aims to evaluate the efficacy of acupotomy combined with hyaluronic sodium acid compared with hyaluronic sodium acid alone in the treatment of KOA.|
+^Methods| Studies from 8 Online databases were searched on KOA treatment using acupotomy combined with sodium hyaluronate until May 2022. The primary outcome indicator was clinical effectiveness, and the secondary outcome indicators included the visual analogue scale scores and Lysholm scores. We calculated the weighted mean difference (WMD) or relative risk for all relevant outcomes.|
+^Results| **Nine studies were identified, involving 644 cases**. The results showed that acupotomy combined with intra-articular sodium hyaluronate injection for KOA was superior to sodium hyaluronate injection alone in terms of clinical effectiveness (relative risk = 1.17, 95% confidence interval [CI]: 1.09-1.25, P < .001) and visual analogue scale (WMD = -2.1, 95% CI: -2.25 to 1.95, P < .001), Lysholm score (WMD = 13.83, 95% CI: 3.47-24.19, P = .009).|
+^Conclusion| Acupotomy combined with intra-articular sodium hyaluronate injection for KOA is superior to sodium hyaluronate injection alone. Limited by the number and quality of included studies, this conclusion still needs to be verified by more high-quality Research.|
+== Yin 2022 ==
+Yin X, Liu Y, Liu W, Liang W, Liang Q. Blade needle therapy versus conventional acupuncture for knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2022 Jul 29;101(30):e29647.  https://doi.org/10.1097/MD.0000000000029647
+^Background| This study investigated the hypothesis that the efficacy of blade needle therapy for the treatment of knee osteoarthritis (KOA) is superior to that of conventional acupuncture. In addition, the efficacy of blade needle therapy versus conventional acupuncture for the treatment of KOA was analyzed in a meta-analysis.|
+^Methods| Randomized controlled trials (RCTs) of blade needle therapy and conventional acupuncture for treating KOA were retrieved from the electronic databases CNKL, Wanfang, VIP, PubMed, EMBASE and the Cochrane Library from the commencement of each database to July of 2021. Data were extracted and evaluated by 2 reviewers independently. RevMan 5.3 software was used to conduct the meta-analysis after the studies were evaluated.|
+^Results| A total of **11 RCTs** were included, all from China, involving **1142 patients**. The meta-analysis results showed that the effective rate of the blade needle group was better than that of the conventional acupuncture group (OR = 3.61, 95% CI [2.56-5.10], P < .00001).|
+^Conclusion| The efficacy of blade needle treatment for KOA is superior to that of conventional acupuncture, but more high-quality studies are needed for future validation due to the low proportion of high-quality studies included and the possible bias factor.|
 == Lee 2021 ==
@@ Ligne 410: / Ligne 568: @@
 === Warm Needles ===
+== Jin 2022 ==
+Jin S, Guan X. A systematic review and meta-analysis of the comparative curative effects of warm acupuncture and other traditional Chinese medicines in the treatment of knee osteoarthritis. Ann Palliat Med. 2022 Feb;11(2):708-716.  https://doi.org/10.21037/apm-21-3972
+^Background| Knee osteoarthritis (KOA) is more common in middle-aged and elderly people, and seriously affects the quality of life of those affected. Traditional Chinese medicine (TCM) treatment of KOA has been widely recognized. In recent years, warm needling acupuncture (WNA) has been used to treat KOA and has achieved good results. However, there is a lack of comparison of the efficacy of WNA and other TCM treatments for KOA.|
+^Methods| We conducted a search for reports of WNA and/or TCM treatment of KOA in English- and Chinese-language databases. The data was retrieved from inception of the database until October 2021. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and the network meta-analysis was performed using the software RevMan 5.20.|
+^Results| A total of **8 articles** met the inclusion criteria, including 399 patients treated with WNA (WNA group), and 396 patients treated with other TCM (TCM group). The results of meta-analysis showed that compared with patients in the TCM group, the effective rate [relative risk (RR)] was 1.18, 95% confidence interval (CI): 1.06 to 1.33, the last follow-up osteoarthritis index [mean difference (MD)] was -6.93, 95% CI: -12.14 to -1.72, and the last follow-up knee pain visual analogue scale (VAS) MD was -1.06, 95% CI: -1.61 to -0.51, which were all statistically significant. However, the difference in daily activities (MD: -4.31, 95% CI: -10.90 to 2.28) was not statistically significant.|
+^Discussion| Compared with other TCM treatments for KOA, WNA has better overall patient efficacy. However, further randomized controlled studies are needed to compare WNA and other TCM treatments individually to confirm the efficacy of WNA.|
+== Li 2022 ==
+Li J, Yang H, Hu T. Comparison of Warming Needle Moxibustion and Drug Therapy for Treating Knee Osteoarthritis: A Systematic Review and Meta-analysis. Comput Math Methods Med. 2022 Jul 27;2022:3056109.  https://doi.org/10.1155/2022/3056109
+^Objective| To compare the efficacy of warming needle moxibustion (WNM) with that of drug therapy for treating knee osteoarthritis (KOA), so as to provide evidence-based reference for the treatment of knee osteoarthritis. |
+^Methods| PubMed, Embase, Cochrane Library, VIP, WanFang, and CNKI were searched from inception to March 23, 2022. Literature selection was processed in strict accordance with inclusion and exclusion criteria. Cochrane Risk of Bias Assessment tool was applied for quality assessment of included studies. Data analysis and publication bias assessment were performed using Stata 15.0. |
+^Results|There were **30 RCTs included, with 1324 participants** in the WNM group and 1293 in the control group. Meta-analysis showed that the WNM group yielded more excellent effect than the control group (RR = 1.22, 95% CI (1.17, 1.27), p = 0), improvement in WOMAC scores was greater in the WNM group than in the control group (WMD = -8.48, 95% CI (-13.13, -3.83), p = 0.002), activity of daily living (ADL) score was higher in the WNM group than in the control group (WMD = -7.66, 95% CI (-10.22, -5.09), p = 0.01), improvement in joint stiffness scores was greater in the WNM group than in the control group (WMD = -1.72, 95% CI (-2.50, -0.93), p = 0.005), and improvement in pain scores was greater in the WNM group than in the control group (SMD = -1.09, 95% CI (-1.38, -0.79), p = 0.001). |
+^Conclusions|WNM would be more effective in improving quality of life, decreasing WOMAC score, promoting knee function recovery, and alleviating the joint pain and stiffness, compared with orally taken drug therapies. Therefore, WNM could be given prior consideration for the treatment of KOA. |
 == Hui 2019 (+ Sodium Hyaluronate) ==
@@ Ligne 477: / Ligne 655: @@
 === Electro-acupuncture ===
+== Shi 2021 ==
+Shi X, Yu W, Zhang W, Wang T, Battulga O, Wang L, Guo C. A comparison of the effects of electroacupuncture versus transcutaneous electrical nerve stimulation for pain control in knee osteoarthritis: a Bayesian network meta-analysis of randomized controlled trials. Acupuncture in Medicine. 2021;39(3):163-174.   [221950]. https://doi.org/10.1177/0964528420921193
+^Background|To compare the effectiveness of electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) for pain control in knee osteoarthritis (KOA). |
+^Methods|Four English (MEDLINE, EMBASE, Cochrane Library and Web of Science) and three Chinese (China Science Journal Citation Report (VIP), Wanfang and China National Knowledge Infrastructure (CNKI)) language databases were searched for eligible randomized controlled trials (RCTs), comparing four approaches: EA, TENS, medication and sham/placebo controls. The primary outcome was pain intensity, measured by visual analogue scale (VAS), numeric-rating scale (NRS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. Classic pairwise and Bayesian network meta-analyses were conducted to integrate the treatment efficacy/effectiveness through direct and indirect evidence. |
+^Results|Thirteen studies were included. In the direct meta-analyses, there was no statistically significant overall effect of EA (mean difference (MD) -4.77, 95% confidence interval (CI) -12.51 to 2.96), while the overall effects of high-frequency transcutaneous electrical nerve stimulation (H-TENS) (MD -16.63, 95% CI -24.57 to -8.69) and medication (MD -7.12, 95% CI -12.07 to -2.17) were statistically significant. In the network meta-analyses, the relative effect of the EA and H-TENS groups (MD 5.07, 95% CI -11.33 to 21.93) on pain control did not differ. Meanwhile, H-TENS demonstrated the highest probability of being the first best treatment, and EA had the second highest probability. |
+^Conclusion| The present analysis indicated that both EA and TENS exert significant pain relieving effects in KOA. Among the four treatments, H-TENS was found to be the optimal treatment choice for the management of KOA pain in the short-term, and EA the second best treatment option. Given that the application of TENS is recommended by various international guidelines for the treatment of KOA, EA may also represent a potentially effective non-pharmacologic therapy.|
 == Chen 2020 ☆==
@@ Ligne 652: / Ligne 841: @@
 ^Reviewer's conclusions|TENS and AL-TENS are shown to be effective in pain control over placebo in this review. Heterogeneity of the included studies was observed, which might be due to the different study designs and outcomes used. More well designed studies with a standardized protocol and adequate number of participants are needed to conclude the effectiveness of TENS in the treatment of OA of the knee.|
-=== Comparison of Acupuncture Techniques ===
+=== Dry Needling ===
-== Li 2018  ==
+== Lin 2022 ==
+Lin X, Li F, Lu H, Zhu M, Peng TZ. Acupuncturing of myofascial pain trigger points for the treatment of knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2022 Feb 25;101(8):e28838.  https://doi.org/10.1097/MD.0000000000028838
+^Background|Osteoarthritis of the knee is one of the major disorders leading to social dysfunction, economic loss and social development. This study was conducted to systematically evaluate the efficacy and safety effectiveness of acupuncture inactivation of myofascial pain trigger points in the treatment of osteoarthritis of the knee.|
+^Methods| Randomized Controlled Trials (RCTs) on the treatment of knee pain were searched by computer from PubMed, The Cochrane Library, China journal full-text database (CNKI), Chinese biomedical literature database (CBM), China academic journal database (Wanfang Data) databases from the date of creation to December 2021, and the data were analyzed by Reman 5.3 software for data analysis.|
+^Results|A total of **724 patients from 9 RCTs** were finally included, and the results of meta-analysis showed that the acupuncture myofascial pain trigger point group was better than the control group in terms of total effective rate, cure rate, VAS score, Lysholm score, and WOMAC score.|
+^Conclusion| The efficacy and safety of acupuncturing myofascial pain trigger points in the treatment of knee osteoarthritis is positive, but due to the limited number of literature included in this study and the low quality of the included literature, there is still a need for high-quality and large sample size RCTs for the analysis of this treatment option.|
+=== Oriental Medicine ===
+== Park 2023 ==
+Park YC, Park KJ, Goo BH, Kim JH, Seo BK, Baek YH. Oriental medicine as collaborating treatments with conventional treatments for knee osteoarthritis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2023 Jul 21;102(29):e34212.  https://doi.org/10.1097/MD.0000000000034212
+^Background| We aimed to evaluate the effectiveness and safety of oriental medicine (OM) treatments as monotherapy and add-on therapy compared to conventional treatments for knee osteoarthritis and assess the quality of evidence for these results. OM treatment included acupuncture, herbal medicine, pharmacoacupuncture, and moxibustion.|
+^Methods| PubMed, Embase, Cochrane, Google Scholar, 4 Korean medical databases (KoreaMed, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System), and one Chinese database (China National Knowledge Infrastructure) were searched for articles published between January 1, 2000, and January 1, 2021. Randomized controlled trials (RCTs) investigating the effect of OM interventions, single or combined with conventional treatments, on knee osteoarthritis were searched. The risk of bias and quality of evidence of the included studies were evaluated using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluation methods, respectively.|
+^Results| A total of 3911 relevant studies were retrieved and only **23 studies** were included for systematic review. Most of the studies showed a significant effect on knee osteoarthritis. 21 studies comparing single OM treatment with conventional treatment were included in the meta-analysis. The effect size of standardized mean difference (SMD) was analyzed as a "small effect" with 0.48 (95% CI -0.80 to -0.16, Z = 2.98, P = .003). In addition, a meta-analysis of 4 studies comparing integrative treatment with conventional treatment showed a "very large effect" with 1.52 (95% CI -2.09 to -0.95, Z = 5.19, P < .001).|
+^Conclusion| Our results suggest that single OM treatment and integrative treatment significantly reduce pain in patients with knee osteoarthritis. However, there is a limited number of RCTs considering integrative treatment which implies more related RCTs should be conducted in the future. |
-Li S, Xie P, Liang Z, Huang W, Huang Z, Ou J, Lin Z, Chai S. Efficacy Comparison of Five Different Acupuncture Methods on Pain, Stiffness, and Function in Osteoarthritis of the Knee: A Network Meta-Analysis. Evid Based Complement Alternat Med. 2018.  {{:medias securises:acupuncture:conduites therapeutiques:rhumatologie:li-189184.pdf| [189184].}}
-^ Objective|The principal objective of this present study was to compare the effects of different acupuncture methods on pain, stiffness, and physical function for osteoarthritis of the knee by the pairwise and network meta-analysis (NMA). |
-^Methods|A network meta-analysis of randomized controlled trials (RCTs) was searched from three English databases and one Chinese database until January 2018. A pairwise meta-analysis was performed with a random effects model. Then we carried out the NMA within a Bayesian framework. Mean difference (MD) and its 95% confidence interval (CI) were calculated by R 3.4.1, Stata 14.0, and RevMan 5.3 software to assess the relief of pain, the effectiveness for stiffness, and physical function recovery. Node-splitting method was used to calculate the inconsistency. Rank probabilities were assessed and clustered by the surface under the cumulative ranking curve (SUCRA). |
-^Results| 16 trials mostly researched short-term effectiveness and showed that fire needle and electro-acupuncture were statistically significant to decrease WOMAC pain and physical function scores when compared with other treatments, but there was no significant difference in stiffness calculations. |
-^Conclusions|Our NMA demonstrated that acupuncture with heat pain or electrical stimulation might be suggested as the better choices in all acupuncture methods to osteoarthritis of the knee. |
 ==== Special Clinical Forms ====
@@ Ligne 689: / Ligne 892: @@
 ^Results| The total effective rate was reported in **7 studies**, which showed that the total effective rate of acupuncture for gonarthromeningitis is significantly higher than that of western medicine. 3 studies reported pain and function score, indicating that acupuncture could relieve pain and improve the function compared to the control group. 2 studies reported improvement in synovial index, suggesting that acupuncture was superior to the control group in reducing synovial swelling  and promoting synovial fluid absorption, but it is equivalent to western medicine in promoting the absorption of inflammatory cytokines. 2 studies reported adverse events, and acupuncture had fewer adverse effects.|
 ^Conclusion| Limited evidence suggests that acupuncture has better effect and less adverse reactions compared with western medicine in treating gonarthromeningitis. However, due to the poor quality and large heterogeneity of the included studies, it is recommended that more high-quality and well-designed RCTs be conducted in the future, also studies with better homogeneity should be included to further validate the efficacy of acupuncture in the treatment of gonarthromeningitis.|
+==== Special outcome ====
+=== Contextual effect ===
+== Chen 2021 ==
+Chen AT, Shrestha S, Collins JE, Sullivan JK, Losina E, Katz JN. Estimating contextual effect in nonpharmacological therapies for pain in knee osteoarthritis: a systematic analytic review. Osteoarthritis Cartilage. 2020;28(9):1154-1169.   [220695]. https://doi.org/10.1016/j.joca.2020.05.007
+^Objective| Conduct a systematic review and use meta-analytic techniques to estimate the proportion of total treatment effect that can be attributable to contextual effects (PCE) in adults receiving nonpharmacological, nonsurgical (NPNS) treatments for knee osteoarthritis (OA). |
+^Design| We reviewed the published literature to identify five frequently studied NPNS treatments for knee OA: exercise, acupuncture, ultrasound, laser, and transcutaneous electrical nerve stimulation (TENS). We searched for randomized controlled trials (RCTs) of these treatments and abstracted pre- and post-intervention pain scores for groups receiving placebo and active treatments. For each study we calculated the PCE by dividing the change in pain in the placebo group by the change in pain in the active treatment group. We log transformed the PCE measure and pooled across studies using a random effects model.|
+^ Results|We identified 25 studies for analysis and clustered the RCTs into two groups: acupuncture and topical energy modalities (TEM). 13 acupuncture studies included 1,653 subjects and 12 TEM studies included 572 subjects. The combined PCE was 0.61 (95% CI 0.46-0.80) for acupuncture and 0.69 (95% CI 0.54-0.88) for TEM.  |
+^Conclusion| Our findings suggest that about 61% and 69% of the total treatment effect experienced by subjects receiving acupuncture and TEM treatments, respectively, for knee OA pain may be explained by contextual effects. Contextual effects may include the placebo effect, changes attributable to natural history, and effects of co-therapies. These data highlight the important role of contextual effects in the response to NPNS OA treatments.|
 ===== Overviews of Systematic Reviews =====
+==== Araya-Quintanilla 2022 ====
+Araya-Quintanilla F, Cuyúl-Vásquez I, Gutiérrez-Espinoza H. Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. J Bodyw Mov Ther. 2022 Jan;29:117-126.  https://doi.org/10.1016/j.jbmt.2021.10.012
+^Background|Knee osteoarthritis (OA) is the most common condition that causes pain and disability in adults over 50 years old. The application of acupuncture, as a method of complementary intervention, could be beneficial for pain relief and knee function in patients with knee OA.|
+^Objective| Analyze the effectiveness of acupuncture versus control interventions in patients with knee OA.|
+^Methods| An electronic search was performed in the MEDLINE (via PubMed), EMBASE, PEDro, Cochrane CENTRAL, CINAHL, Web of Science and LILACS databases. The eligibility criteria for selecting systematic reviews included clinical trials that compared acupuncture versus control interventions for pain intensity in patients with knee OA.|
+^Results|A total of **15 systematic reviews** met the eligibility criteria for the quantitative synthesis. In the short term, the mean difference (MD) for pain intensity was -0.32 cm (95% CI = -0.57 to -0.08, p = 0.01). There was a very low quality of evidence according to the GRADE rating. In the short term, the mean difference (MD) for knee function was -8.74 points (95% CI = -13.36 to -4.12, p ≤ 0.001). There was low quality of evidence according to the GRADE rating. All differences were in favor of acupuncture.|
+^Conclusion| At short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.|
 ==== Yin 2022 (moxibustion) ====
@@ Ligne 701: / Ligne 932: @@
 ^Results|Finally, **10 qualified SRs** were included, including **57 randomized controlled trials** and **5,149 participants**. All SRs evaluated by AMASTAR-2 had more than one critical deficiency, so all SRs were rated as critically low. In the PRISMA checklist, the manuscript structures of the included SRs were relatively complete. Including four SRs with a low risk of bias and six with a high risk of bias using the ROBIS tool. In GRADE, two items (6.25%) were rated as high quality, three (9.37%) as medium quality, 17 (53.12%) as low quality and 10 (31.25%) as very low quality. A re-meta-analysis showed that moxibustion and moxibustion combined treatment improved the total effectiveness rate in knee osteoarthritis (risk ratio = 1.17, 95% confidence interval 1.13-1.21, P < 0.001 and risk ratio = 1.13, 95% CI: 1.04-1.23, P < 0.001), with low heterogeneity (I 2 = 36.3%, P = 0.020, and I 2 = 0.0%, P = 0.956). A total of eight SRs reported adverse events, and no serious adverse events occurred in the moxibustion group and control group.|
 ^Conclusion|Moxibustion seems to be effective in treating KOA. Four SRs reported 10 common discomfort symptoms caused by moxibustion, and these adverse events can spontaneously subside, even can be avoided, therefore, moxibustion for KOA appears to be safe. However, the reliability of the results is reduced by the high risk of bias of the original studies and the low methodological quality of SRs. Therefore, future studies should pay more attention to the quality of the original study and the evidence quality of the SRs to provide more powerful and scientific evidence of the effectiveness and safety of moxibustion treatment of KOA.|
+==== Chen 2021 ====
+Chen J, Liu A, Zhou Q, Yu W, Guo T, Jia Y, Yang K, Niu P, Feng H. Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews. Int J Gen Med. 2021 Nov 19;14:8481-8494.  https://doi.org/10.2147/IJGM.S342435
+^Background| Acupuncture has been widely used in the clinical management of osteoarthritis of the knee (KOA). Many systematic reviews (SRs) and meta-analyses (MAs) have reported its effectiveness in relieving pain. This overview aimed to summarize SRs and MAs on the effectiveness and safety of acupuncture for KOA and evaluate their methodological and evidence quality of the included SRs and MAs.|
+^Methods| We conducted a comprehensive literature search for SRs and MAs in four Chinese and four international databases from their inception until August 2021. Two researchers independently searched the reviews, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological quality of the included SRs and MAs. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of the included SRs and MAs.|
+^Results| A total of **14 SRs and MAs** were included. The evaluation results of the AMSTAR 2 tool showed that the methodological quality of all the 14 SRs and MAs was critically low. The principal causes are the lack of a pre-registration proposal and a list of excluded studies and justify the exclusions, the report on the sources of funding, and the reasons for the study designs for inclusion. The results of the GRADE evaluation showed 25 of 46 outcomes were very low-level evidence. Seventeen were of low level, four were of moderate level and none were of high level. Most outcomes were downgraded in quality of evidence mainly because of publication bias and imprecision.|
+^Conclusion| The existing evidence suggests that acupuncture seems to be an effective and safe therapy for KOA. However, the deficiencies in the methodological quality and quality of evidence of the included SRs/MAs have limited the reliability of the conclusions. Therefore, further rigorous and comprehensive studies are warranted to verify the effectiveness and safety of acupuncture in KOA|
 ==== Li 2019 ☆☆ ====
@@ Ligne 750: / Ligne 991: @@
 | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) |
+==== China Association for Chinese Medicine (China) 2023 ⊕ ====
+Zeng L, Zhou G, Yang W, Liu J. Guidelines for the diagnosis and treatment of knee osteoarthritis with integrative medicine based on traditional Chinese medicine. Front Med (Lausanne). 2023 Oct 17;10:1260943. https://doi.org/10.3389/fmed.2023.1260943
+| **Acupuncture**: (Evidence level: Level I, highly recommended). **Acupotomy**:Evidence level: Level II, highly recommended).|
+==== Hong Kong Physiotherapy Association (HKPA, Hong Kong, China) 2023  ⊕ ====
+Al Zoubi FM, Wong AYL, Cheing GLY, Cheung JPY, Fu SN, Tsang HHL, Law RKY, So BCL, Tsang R, Tsang S, Wen C, Wong M, Yau YC, Bussières AE. Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists. Healthcare (Basel). 2023 Nov 15;11(22):2964.  https://doi.org/10.3390/healthcare11222964
+| Acupuncture : conditionnaly recommanded |
 ==== American Academy of Orthopaedic Surgeons (AAOS, USA) 2021 ⊕====
@@ Ligne 757: / Ligne 1014: @@
 |Acupuncture. Acupuncture may improve pain and function in patients with knee osteoarthritis. Strength of Recommendation: Limited (downgrade) Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. Also requires no or only minor concerns addressed in the EtD framework.|
+Brophy RH, Fillingham YA. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition. J Am Acad Orthop Surg. 2022 Apr 5.  https://doi.org/10.5435/JAAOS-D-21-01233
+|Acupuncture. Acupuncture may improve pain and function in patients with knee osteoarthritis. Strength of recommendation: Limited ★★☆☆. (downgrade) Implication: Practitioners should feel little constraint in following a recommendation labeled Limited, exercise clinical judgment, and be alert for emerging evidence that clarifies or helps to determine the balance between benefits and potential harm. Patient preference should have a substantial influencing role |
+==== Société Française de Médecine Physique et de Réadaptation, Société Française de Rhumatologie (SOFMER, SFR, France) 2021 ⊕ ====
+Recommandations de la Société Française de Médecine Physique et de Réadaptation et de la Société Française de Rhumatologie. Traitements non-pharmacologiques dans la gonarthrose. 2021. https://seralpar.aphp.fr/sites/default/files/recommandations_non-pharmacologiques_gonarthrose_nguyen_rannou.pdf
+|//Recommandation 8.// L’acupuncture pourrait être proposée à visée antalgique non spécifique. Grade 1A-A (niveau de preuve 1A, force de recommandation A) |
 ==== Agency for Healthcare Research and Quality (ARQ, USA) 2020 Ø ====
@@ Ligne 776: / Ligne 1042: @@
 VA/DOD clinical practice guideline for the non-surgical management of hip & knee osteoarthritis. Department of Veterans Affairs Department of Defense. 2020;:127P.   [219381]. [[https://www.healthquality.va.gov/guidelines/CD/OA/VADoDOACPG.pdf|URL]]
-|Recommendation  18. There is insufficient evidence to recommend for or against the use of complementary and integrative health interventions for the treatment of osteoarthritis of the hip or knee, including:  Acupuncture  Massage  Light touch  Meditation  Tai chi  Yoga  (Neither for nor against | Reviewed, New-replaced).|
+| Recommendation  18. There is insufficient evidence to recommend for or against the use of complementary and integrative health interventions for the treatment of osteoarthritis of the hip or knee, including:  Acupuncture  Massage  Light touch  Meditation  Tai chi  Yoga  (Neither for nor against. Reviewed, New-replaced).|
@@ Ligne 940: / Ligne 1206: @@
 |Anterior Knee Pain. There are no randomised controlled studies evaluating the effect of acupuncture for relief of patellofemoral pain (No Level I or II evidence)|
+===== Overviews of Clinical Practice Guidelines =====
+==== Gibbs 2023 ====
+Gibbs AJ, Gray B, Wallis JA, Taylor NF, Kemp JL, Hunter DJ, Barton CJ. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage. 2023 Oct;31(10):1280-1292.  https://doi.org/10.1016/j.joca.2023.05.015
+^Objectives| Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines.|
+^Methods| Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154).|
+^Results| **Seven higher-quality and 18 lesser-quality guidelines** were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., **acupuncture**) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty.|
+^Conclusion| Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.|

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