Abstract 739: A Randomized Controlled Trial of Acupuncture for Osteoarthritis of the Knee: Effects of Provider Communication Style
Alan Baer
Authors:
Maria Suarez-Almazor1, Carol Looney1, Richard Street, Jr.2, Yanfang Liu3, Vanessa Cox1, Kenneth Pietz4, Donald Marcus4. 1UT MD Anderson Cancer Center, Houston, TX; 2Texas A&M University, College Station, TX; 3American College of Acupuncture and Oriental Medicine, Houston, TX; 4Baylor College of Medicine, Houston, TX
Background:
The therapeutic benefit of acupuncture in osteoarthritis of the knee remains uncertain, despite multiple previous clinical trials. This 3-month randomized clinical trial was conducted in 560 patients with knee osteoarthritis (OA) in order to compare the efficacy of traditional Chinese acupuncture with sham acupuncture, and to examine the role of the acupuncturists’ communication style on patients’ outcomes.
Methods:
Patients 50 years of age or older with symptomatic osteoarthritis of the knee were randomized to one of 3 groups: one included patients on a “waiting list” for the acupuncture while the other two groups included patients who received acupuncture, either from an acupuncturist trained to interact with patients with a high expectation style or from one with a neutral expectation style. Patients in the treatment groups were randomized to receive 12 sessions of traditional Chinese or sham acupuncture over 6 weeks. Sham acupuncture was performed in non-meridian points, with shallow needles and minimal stimulation. The primary outcome measures were pain severity and satisfaction, assessed with the Joint-specific Multidimensional Assessment of Pain (J-MAP), the Western Ontario and McMaster Universities Osteoarthritis Index pain scale, and the SKIP satisfaction scale. Secondary outcomes were measures of function, assessed with the WOMAC function scale and the SF-12.
Results:
No significant differences were observed between traditional Chinese or sham acupuncture in the primary or secondary outcomes. However, patients in both intervention groups had significant pain reduction compared to the waiting list group. The patient group treated by an acupuncturist who communicated ‘high’ expectations experienced less pain and more satisfaction as compared to the group treated by an acupuncturist with only 'neutral' expectations.
The patients were asked to guess whether they received traditional Chinese or sham acupuncture. The proportion of patients who guessed incorrectly or who stated that they were unsure was comparable in both treatment groups. Thus, the patients were effectively blinded to their treatment group assignment.
Conclusions:
In this study, traditional Chinese acupuncture was not superior to sham acupuncture in the treatment of knee OA. The acupuncturists’ communication style had a significant effect on pain reduction and satisfaction, suggesting that the perceived benefits of acupuncture may be partially mediated through placebo effects related to the acupuncturist’s bedside skills.
Editorial:
The therapeutic benefit of acupuncture for patients with osteoarthritis of the knee has been difficult to establish. A recent meta-analysis of eleven previous trials of acupuncture for knee osteoarthritis did not provide evidence for superiority of acupuncture over sham controls. The current study supports this conclusion. Importantly, it provides additional insight into the placebo effects of acupuncture. Patients who were treated by an acupuncturist who conveyed high expectations for the procedure had more pain relief than patients treated by an acupuncturist who conveyed neutral expectations for the procedure. Thus, this study re-emphasizes the importance of the placebo effect in the therapeutic relationship between a doctor and his/her patients.
