| Knee Osteoarthritis (OA Knee), also known as degenerative osteoarthritis of the knee, is a chronic degenerative disease in those past middle life, which are widely associated with and distributed in "knee pain","phlegm","atrophy","arthralgia","arthritis". The presence of OA knee has caused pain and much inconvenience to patients in their daily activities and economic burden, but the use of Traditional Chinese Medicine (TCM) treatment was well accepted by the patients as it has shown a positive effect on OA knee, particularly the acupuncture, to relieve the adverse reactions. The efficacy of acupuncture is varied and affected by several factors, such as the severity of patients’condition, the location of acupoints, treatment interval, etc. Many local studies in China have extensively researched in the effect of various aspectsof acupuncture treatment to OA knee and most have shown a remarkable result. However, studies focused on the treatment interval of acupuncture were limited but most popular was once a day, every two days or twice a week. Therefore, the effect of acupuncture to OA knee could be maximized if the optimal treatment interval is found.Objective:The present study aims to investigate the effect of different treatment interval of acupuncture on OA knee, and hence providing an optimal interval for clinical application in the treatment of OA knee, which can serve as a reference to standardize a treatment protocols later.Methods:Taking reference from the diagnostic criteria of the treatment guideline of Osteoarthritis published and revised by the Chinese Medical Orthopedics Division in2007, the patients were recruited from a private clinic in Hong Kong to enroll this prospective study. Th ey will be assigned to two treatment groups-alternative day vs. every two days. A total of60subjects were recruited, with half (n=30) assigned to the alternative day while the remaining half (n=30) to the every two days group. Treatment focused on different location of main acupoints such as both Xue Hai(SP10), LiangQiu (ST34),Nei Xi Yan (EX-LE4),Tu Pi (ST35), plus alternative acupoints migratory arthralgia:Feng Chi GB20, Ge She(BL17); cold arthralgia:Shen Shu(BL13),GuanYuan(CV4, RN4); damp arthralgia:Yin Ling Quan(SP9), ZuZan Li(ST36);heat arthralgia:Da Zhui(DU14), Feng Chi GB20.4main acupoints plus2alternative acupoints are used each treatment. Routine disinfection was performed by using1.5-inch needle treatment for30minutes while using TDP,3weeks for a course of treatment and a total of two courses per treatment cycle. After the completion of the treatment period, the following parameters were tested:Lequesne MG, JOA, WOMAC index of0A Scale, MPQ and knee function scale, the two groups before treatment and3weeks and6weeks after treatment symptom score, and count efficiency, measurement data with the mean±standard deviation (x±s), count data with composition ratio (%), the t-test or Wilcoxon rank sum test by using a statistical software SPSS17.00for statistical analysis.Results:(1) In this study,60cases were eligible subjects and completed the clinical trials with no dropout and exclusion case. Among these subjects,8were males and52were females, with age ranging from41to69years old; the shortest duration of disease was from a month up to4years.30cases were selected to the treatment group of alternative day (5males and25females) with mean age61.40±1.338years old whereas another30cases were assigned to the treatment group of every two days (3males and27females) with mean age59.97±1.291years old. No significant difference was observed between two treatment groups in term of their gender, age, duration of disease, LequesneMG scoring, WOMAC Index of0A integration, MPG, JOA and several clinical symptoms such as degree of joint pain, joint stiffness, joint tenderness, joint swelling, joint mobility, more serious in cold weather, soreness of waist and knees, flexion and extension movement, feeling cold and nocturia clinical symptoms.(2) After3weeks of the treatment, the results showed that patients from alternative treatment group (n=30) had a total of73.3%efficiency rate (no case for a complete recovery,10cases with effect,12cases with markedly effect,7cases with no effect) while the treatment group of every2days (n=30) had56.67%efficiency rate (no case for a complete recovery,8cases with effect,9cases with markedly effect and13cases with no effect). Both treatment groups had significantly indicated a positive effect of using acupuncture to treat0A knee in clinical setting. After6weeks of the treatment, the alternative treatment group (n=30) showed a total of92.28%efficiency rate with6cases for a complete recovery,19cases with effect,3cases with markedly effect and2cases with no effect whereas the treatment group of every2days (n=30) had73.33%efficiency rate with one case for a complete recovery,11cases with effect,10cases with markedly effect and8cases with no effect. Again, both treatment groups of using acupuncture had showed a significant effect to treat0A knee.(3) In term of the quantitative calculations (Lequesne MG scoring, JOA, MPQ, WOMAC Index of OA) before and after treatment between groups, the treatment group of alternative day was significantly improved when compared with the other group (once every two days) with p-valve less than0.05.(4) For the reduction rate of the observed clinical symptoms (such as joint pain, joint tenderness, joint swelling, joint mobility, more serious in cold weather, soreness of waist and knees, flexion and extension movement, feeling cold, nocturia), the treatment group of alternative day was significantly better than that of the other group (once every two days) with p-valve less than0.05.Conclusion:The use of acupuncture for OA knee was a safe and effective treatment. In the present study, both treatment groups (alternative day and once every2days) have significantly shown positive improvements in many aspects, such as joint pain, joint mobility and stiffness, and other functions. This might be related to the cumulative effects of acupuncture and its treatment frequency that was proportionally associated with the outcomes measured. In the conclusion, the application of acupuncture on alternative basis might help to increase the patients’tolerance and enhance their acceptance to a long-term treatment effect of acupuncture. |
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