| Osteoarthritis (OA) is a slow, chronic joint disease characterized by focal degeneration of articular cartilage and alterations of the chemical and mechanical articular function and also a major cause of pain and physical disability. There is clinical evidence that acupuncture and traditional Chinese medicine may be beneficial in terms of pain management and knee joint stiffness in humans but no studies have shown that using acupuncture in comparison to traditional Chinese medicine conclude that which is more effective. There are also no studies to conclude that in using both acupuncture and traditional Chinese medicine is of more beneficial in pain management and knee joint stiffness compared to just using acupuncture or traditional Chinese medicine alone, in the treatment of OA. Besides, the cost effectiveness in treatment in using acupuncture, traditional Chinese medicine or both the methods in treating OA was not studied previously.Aim:The null hypothesis of this study is that acupuncture/traditional Chinese medicine/acupuncture with traditional Chinese medicine has a therapeutic effect (full recovery/obvious effect/effective/not effective) on pain control, knee joint stiffness and markers in activities of daily living (ADL) in patients suffering from OA knee. Thus, the aim of the present work was to test the individual effectiveness level of such treatments in different time frame and follow up by comparing the average readings of different therapeutic rate results of these treatments in different time frame of OA knee patients. In addition, an observation is also made to establish the cost effectiveness of such treatments. From these results deriving the most suitable choice of management for patients that suffers from OA knee in Singapore.(Based on the demanding a fast but economical expectations from the patients).Method:The patients’ population consisted of90subjects with a diagnosis of osteoarthritis of the knee joint with severe pain condition and severe knee joint stiffness. Patients were randomized in a single-blind study comparing the individual therapeutic effects of acupuncture treatment group (acupuncture group30patients) versus comparison group1(traditional Chinese medicine traditional group30patients) versus comparison group2 (Acupuncture with traditional Chinese medicine group30patients). Patients were not allowed their established painkillers.Each individual group’s therapeutic results on the2th,4th and6th week and the3months and6months follow up observation periods were evaluated for:Pain at rest using the WONG Baker’s Score, Knee joint Stiffness index using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. The therapeutic ADL index using Oxford Knee Score scale was also assessed on the6th week,3months follow up and6months follow up periods respectively. Moreover, the total costs of these treatments were assessed at the end of6weeks.Results:The therapeutic results of the above assessments were promising, however, each group’s results was rated at a different level of benefit. Example:For knee joint pain; Acupuncture group2nd week obvious therapeutic effect was3.3%(P0.042) and Acupuncture and traditional Chinese medicine group was10%(P0.045). Traditional Chinese medicine group2nd week effective result was66.6%(P>0.05) and Acupuncture group was60%(P>0.05) etc. These results showed significant values for further observations. The above results prompted a justified comparison on therapeutic results in pain management and knee joint stiffness and ADL index between the three different groups at the end of the6th week and the3months and6months follow up observations period to assess for the best average obvious effect result group. The results showed significant differences between the groups too. The6th week best obvious effect for Traditional Chinese Medicine group was73.7%(Acupuncture group was57.7%; Acupuncture and traditional Chinese medicine group was69.9%). The3months week best obvious effect for Traditional Chinese Medicine group was46.6%(Acupuncture group was42.2%; Acupuncture and traditional Chinese medicine group was46.6%). The6months week best obvious effect for Traditional Chinese Medicine group was19.9%(Acupuncture group was14.4%; Acupuncture and traditional Chinese medicine group was19.9%). These results prompted a further comparison study. The comparison study was conducted between the acupuncture group (treatment group) and traditional Chinese medicine group (comparison group1), the_acupuncture group (treatment group) and Acupuncture with traditional Chinese medicine (comparison group2) and lastly the traditional Chinese medicine group (comparison group1and Acupuncture with traditional Chinese medicine (comparison group2) at the end of6weeks,3months and6months on pain, stiffness and ADL for other level of effects (average) and find out which group is the most suitable choice of treatment for patients in Singapore with OA knee. The results were also showed significant differences between the groups. Example:For average full recovery rate: Acupuncture group6th week was0%and Acupuncture and traditional Chinese medicine group was11%. For average effective rate:Acupuncture group3months follow up observation result was45.5%and traditional Chinese medicine group was39.9%. For average "not effective" rate:traditional Chinese medicine group was16.6%and Acupuncture group was23.3%etc.In general, the average effective rate for a single or all3categories of observations for the traditional Chinese medicine group was in the middle range. The2nd week (fast) effective rate was66.6%(P>0.05). The average total recovery rate on the6month follow up observation was much lower than the Acupuncture and traditional Chinese medicine group (13.3%vs.35.5%) but is higher as compared with the Acupuncture group (8.8%).The average obvious effect rate on the6th week was high (73.3%,46.6%,57.7%) as compared to the Acupuncture group and the Acupuncture and traditional medicine; and achieved the same rating as the Acupuncture and traditional Chinese medicine group on the3month and6month follow up observation (46.6%and19.9%). These ratings were higher as compared to the Acupuncture group (42.2%and14.4%). All other readings were at the medium range. The average obvious effect rate on the6month follow up observation for all3categories was50%which is higher than the Acupuncture group (41.1%). The average "not effective" rate for all3categories was16.6%which is lower than the Acupuncture group (23.3%). The medical fee for6weeks of treatment for the traditional Chinese medicine group was SGD96cheaper as compared with the Acupuncture group, and was SGD348cheaper compared with the Acupuncture with traditional Chinese medicine group.Taken overall, based on the pathogenesis and the duration rate of the disease, the2week (fast) effective readings,6th week therapeutic rate, the average therapeutic effects on the3and6months follow up observation readings, Singapore’s medical system, Singapore’s inflation rate, Singapore’s worker’s wages scale,6weeks medical fees, the financial status of the patients, these above data suggest that the traditional Chinese medicine group (comparison group1) has the potential to be the best choice of management for patients that suffers from OA knee in Singapore. Meanwhile, the clinical evidence had also provided a new direction of thought, which is as based on the long term therapeutic effects as a base of interest, the application of both acupuncture and traditional Chinese medicine was the best of choice after all. The additional medical fee in due had also added to its disadvantage per say. However, areas that could have affected the therapeutic effects of all three forms of treatment; eg. Physical training, Chinese therapeutic diet regime, age and weight, psychological attitude of patients and races etc should also be addressed in future studies. |
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