An interventional study of Acupuncture and Conventional Medical Treatment in Knee Osteoarthritis, Kidney Yin Deficiency and Kidney Yang Deficiency, sponsored by Svijetlana Perculija Durdevic. Completed at 1 site in Croatia. Open to participants aged 50 Years and older. Per ClinicalTrials.gov, last updated 2025-07-29.
Sponsored by Svijetlana Perculija Durdevic · Not applicable, Interventional, and Treatment
The thirty-nine-week open-label clinical study investigates the efficacy of acupuncture for Knee Osteoarthritis (KOA) as adjunctive therapy to analgesics compared to analgesics only and assesses the effects after 9 and 24 weeks, with safety assessment provided.
The study seeks to find possible additional benefits of acupuncture on Kidney Deficiency (KD) while treating KOA with an acupuncture protocol designed to treat KOA following Traditional Chinese Medicine (TCM) theory, which connects KOA with KD as its root cause. The points prescription uses local and Kidney-related points to treat KOA.
The chronic conditions require a higher number of acupuncture treatments. This study will provide acupuncture treatments in three cycles, each three weeks long, with frequency three times weekly. Twenty-seven acupuncture treatments of KOA during fifteen weeks tend to improve KOA and KDS; symptoms are assessed in 10 successive time points, and treatment effects and effect persistence are analysed.
64 patients with symptomatic KOA are randomly allocated into the Acupuncture (A) or Control (C) group according to their permanent, unique, and coincidental Personal Identification Number, which is randomly given to all citizens in Croatia. Before the experiment starts, demographics and disease parameters of all participants are compared. To objectify acupuncture effects, the enrolled physiatrist's measures included knee measures at 3 time points: baseline, at the end of acupuncture (Week 15), and nine weeks later (Week 24). Subjective evaluations of symptoms are assessed by Western Ontario and McMaster University Arthritis Index (WOMAC) total and subscales scores, Numeric Rating Scale (NRS), and Kidney Deficiency Syndrome Questionnaire (KDSQ) every 3 weeks till the 24th week (9 assessments). Analgesics taken by participants (DRUG) in the last three days before the assessments are recorded. Acupuncture treatment was promised to all participants. Therefore, at Week 25, the between-group analysis ended, and the C group crossed over to receive the identical acupuncture protocol. The 10th assessment in Week 39 was used to estimate, by within-group analysis, the immediate effects of the acupuncture in group C and the effect persistence in group A.
The Lequesne index was introduced additionally at Week 24 as another measure of the knee's functional state.
KOA's high prevalence assures the trial's participation motivation of patients regarding associated pain and functional impairment. Besides pain and stiffness, patients experience muscle weakness, poor balance, and joint distortion in an advanced stage. KOA attacks the diseased ones at the age of 50. Pain worsens with joint loading and becomes relieved by rest. KOA supposes bones remodelling, cartilage thinning, synovial thickening, and joint space narrowing. The advanced stage is presented by joint instability, squaring, and even subluxation.
KOA involves both knees and the contributing symptoms of old age from the scope of Kidney deficiency syndromes, such as weakness, insomnia, depression, tinnitus, forgetfulness, feeling cold, hot, low back pain, thirst at night, and disturbed urination could be manifested.
The acupuncture treatment of KOA follows syndrome differentiation. The treatment principle distinguishes the deficient root (primary Kidney deficiency and secondary Blood deficiency) as the cause, and the excessive branch (knee bone Bi syndrome) when in empty Cou Li spaces, the external factor becomes entraped, consequently. An aspiration with treatment is to tonify the Kidney, nourish Qi, tonify and invigorate Blood, remove Damp and Cold by transferring them toward the deficiency rather than expelling, and relieve the channels and collaterals from the obstruction. Moreover, knee meridians should be dredged to improve knee symptoms by a simultaneous reinforcing-reducing technique on local points and reinforcing on KD-related points. Eventually, the improvements of KD indicate better life quality.
The study's design involves two groups: an acupuncture (A) group that receives acupuncture treatment adjunctive to analgesics, and a control (C) group that receives only analgesics. Participants were recruited from the target population of patients over 50 from 2 Family Medicine practices with confirmed KOA. The study sample was formed with inclusion and exclusion criteria. 64 patients were recruited. All medical data of the participants were available to the investigator. After fulfilling the SOAP form (Subjective, Objective, Assessment, Plan) and getting informed written consent, the study sample was randomly allocated into two groups by size of their permanent, unique eleven-digit long Personal Identification Numbers (OIB), which is assigned to all Croatian citizens. Its first ten digits are accidentally chosen, and the last is a control number. Every second participant ordered by the size of OIB belongs to the same group; odd ones belong to the A group, and even ones to the C group. Demographic and disease parameters are compared at baseline to determine if the groups are comparable. All study participants received analgesics and could modify dosages according to their needs. Analgesics were nonsteroidal anti-inflammatory drugs (NSAIDs) and/or tramadol. Taken analgesics were recorded at Weeks 0, 3, 6, 9, 12, 15, 18, 21, 24, and 39. The dose represents an average daily dose of analgesics from the last three days. The dose was recorded after conversion to the comparable dose of the selected representative (ibuprofen), the most prescribed one. The given data will be statistically processed and analyzed.
Patients in the A group started with acupuncture treatment in September 2021, with the first treatment cycle. Each of the 3 treatment cycles, in total, is three weeks long, each consists of 9 treatments, patients will receive acupuncture three times per week and the two adjacent acupuncture cycles are separated by three weeks without acupuncture.
Acupuncture treatment protocol includes local treatment points Dubi (ST-35), Neixiyan (EX-LE-4) and Heding (EX-LE-2), Xuehai (SP-10), Yanglingquan (GB-34), Yinlingquan (SP-9), Zusanli (ST-36), Sanyinjiao (SP-6), and points targeting Kidney deficiency syndrome Taixi (KI-3), Guanyuan (CV 4), and Shenshu (BL-23).
Disposable sterile acupuncture needles 0.30 × 40 mm are used. The depth and angle procedure predicted straight needling on 1-1.5 inches deep, with a mild reinforcing-reducing method for local points, further straight and 0.5-1 inch deep with the reinforcing method for points based on KD syndromes. Complete treatment lasts 30 minutes, and the manipulations are provided every 10 minutes, three times in total.
The sample size was calculated based on the Berman et al. (1999) study. The sample size was calculated by envisioning a two-sided test with unequal variances: type I error 0,05, power 0,95. Group sample sizes of 16 and 16 (i.e. complete study population of 32 subjects) achieve 95,78% power to reject the null hypothesis of equal means and with a significance level (alpha) of 0,050 using a two-sided two-sample unequal-variance t-test.
From a longer treatment period of this study and higher participants' drop-off expected, the population was doubled to 64 subjects in total.
Research methods were determined upon the clinical question "Could the prolonged design of acupuncture treatments on patients with knee osteoarthritis (KOA) decrease pain and improve the function of the knee joints and additionally achieve positive effects on the debilitating symptoms of a Kidney deficiency as a root cause of KOA, measured by recognized questionnaires?".
Evaluation of the therapeutic effects of acupuncture on KOA included WOMAC, VAS, KDSQ scores, and DRUG at Weeks 0, 3, 6, 9, 12, 15, 18, 21, 24, and 39. WOMAC is a renowned questionnaire for KOA evaluation. It measures 5 items for pain, 2 for stiffness, and 17 for functional limitation. VAS is a continuous numeric rating scale of 100 mm in length that is widely used for pain intensity assessment. The KDSQ questionnaire is a valid and reliable measure constructed in 2012 to evaluate Kidney Yin and Yang deficiency syndromes of Hong Kong Chinese middle-aged women by Chen et al. KDSQ represents a valid questionnaire for KD assessment in this study population.
From a total of 10 assessments, the first 9 compared scores between groups A and C. Participants were promised to receive equal acupuncture treatment if they were randomised into the C group. So, group C crossed over to receive the identical protocol from Week 25 to 39, and the 10th assessment was added to both groups of participants to estimate the immediate effects of the acupuncture treatment in the C group and estimate treatment effect persistence in the A group over 24 weeks, in a within-group manner. The physiatrist's assessments at 3 time-points (baseline, 15th Week, and 24th Week) include the standard physiatrist KOA measurements (knee and thigh circumference, range of motion of the knee). The Lequesne index was added as the knee's functional state measure in Week 24.
Data is stored electronically with secured and restricted access. Data transfer will be encrypted, and all data that could identify individuals has been removed.
Study analysis serves to process the effects of acupuncture treatment. Baseline data are obtained before the experiment starts. Besides immediate effects, effects persistence was assessed at Weeks 24 (9 weeks after acupuncture of group A ended) and 39. WOMAC total score at the end of the acupuncture protocol (Week 15) is a primary outcome, while WOMAC subscales, VAS, and KDSQ scores, DRUG at Weeks 15, 24 and 39, and persistence of WOMAC total were secondary and supportive of the primary one. Secondary outcome measures include physiatrists' measures and the Lequesne index as well. Effect sizes are calculated from data comparison to the control group up to Week 24 or baseline at Week 39. Analyses were performed on 64 participants, randomised for the intention-to-treat (ITT) analysis using the maximum available data set (i.e. excluding the missing values) from repeated measures of variables of interest and their variances. ITT analysis, excluding missing values, was selected regarding dropouts that emerged in the study, completely random without any causal clustering. Dropouts produced missing values. Omitting missing values can compromise the statistics and produce bias. Therefore, sensitivity analyses were provided to compare those who dropped out and those who completed the study to determine if data significantly differed. Also, a test calculation with the Last observation carried forward technique (LOCF) with the imputed last observed value in the missing one was performed to check if the obtained effects still stand. All statistical tests are two-sided. The Shapiro-Wilk test tests the normality distribution. The non-parametric Mann-Whitney U test was used for comparability testing with 95% power and α=0,05. The main efficacy indicators tested the comparability of the groups with the Mann-Whitney U test and quantified observed effects by mean differences and Cohen's d.
A participant will be considered to have withdrawn from the trial when consent is revoked or if the participant cannot be contacted or located. Participants will not be withdrawn from the trial for protocol violations. Withdrawal due to an adverse event should be distinguished from withdrawal due to insufficient response.
All adverse events will be recorded in the Adverse Event Report Form at every treatment. If this happens, an adverse event will be followed until its resolution. The serious adverse event must be reported to the Medical Ethics Committee.
It is expected to relieve pain and increase joint mobility, along with alleviating KD and reducing the use of analgesics and confirming the safety of acupuncture.
This is a prospective, interventional, randomized, open-label, controlled trial. It is supported by recent scholarly, peer-reviewed literature. The research method reflects the approach needed to answer the research questions. Research is addressing a gap in the literature that would contribute new findings. The research topic is based on a tangible and cited problem. The research collects and analyses the data, any deviations are documented and approved by NJUCM. The study was designed originally. The acupuncture treatment plan for KOA is designed with the assistance of Professor Xueping Zhou. The study will be conducted in a Family Medicine practice by the experimenter. All financial and operating burdens will be funded from practice resources.
3,302 studies on the registry are indexed under Osteoarthritis, Knee; 608 are open to participants now.
This study's enrollment of 64 is close to the median of 70 across 2,731 interventional studies indexed under Osteoarthritis, Knee.
Browse Osteoarthritis, Knee studies →This is the only study on the registry with Svijetlana Perculija Durdevic as lead sponsor.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Participants in Acupuncture group will get acupuncture treatments to their symptomatic knee/knees according to the study protocol. Acupuncture will be provided to participants in three cycles, each three weeks duration, with frequency three times weekly. Period between the cycles is three weeks long. Participants will get acupuncture as adjunctive therapy to conventional medical treatment (analgesic therapy) which dose could vary according to participant symptoms intensity. Participants and investigator are not blinded for treatment type.
Procedure: Acupuncture · Drug: Conventional Medical Treatment
Participants in Control group will get their standard conventional treatment (analgesics) which dose could vary according to participant symptoms intensity. Participants and investigator are not blinded for treatment type.
Drug: Conventional Medical Treatment
Acupuncture treatment includes pricking the skin with acupuncture needles 0.3 x 40 millimetres in size, in the places of prescribed acupuncture points. Placed needles should be manipulated three times, every ten minutes, three times in total. The complete time of treatment is 30 minutes. All treatments will be equal.
Participants could take their standard conventional medical treatment or analgesics. Analgesics therapy is prescribed by their general practitioner. The dose of analgesics could be modified according to participants' symptoms intensity.
Also known as: Analgesics
WOMAC Total in Week 15
The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) total score is the sum of the three subscales: pain, stiffness, and functional disability. The minimum value is 0, and the maximum value is 96, where the lower score/value represents a better outcome, and the higher score/value represents a worse outcome.
Time frame: Week 15
WOMAC Pain in Week 15
Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, separated from the WOMAC index, evaluates knee OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better outcome.
Time frame: Week 15
WOMAC Stiffness in Week 15
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, and evaluate knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale between the range from minimal 0 to maximal 8 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
Time frame: Week 15
WOMAC Functional Disability in Week 15
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items for functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting and difficulties in domestic duties.
Time frame: Week 15
VAS in Week 15
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome.
Time frame: Week 15
KDSQ in Week 15
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of Kidney deficiency (KD) symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This measure represents the effect of acupuncture treatment on KD.
Time frame: Week 15
DRUG in Week 15
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
Time frame: Week 15
Active Extension L and R Knees in Week 15
The active extension of the left (L) and right (R) knees in Week 15 is an objective measure taken by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle as units. Knee active extension ranges between 0 and 5 degrees: the higher scores represent knee laxity/instability, and the negative scores represent knee flexion contraction. The higher values represent worse outcomes, and the lower values represent better outcomes.
Time frame: Week 15
Active Flexion L and R Knees in Week 15
Active flexion of left (L) and right (R) knees in Week 15 is an objective measure provided by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle (units). Knee active flexion ranges from 0 to a maximum of 135 degrees; the lower score/value represents a worse outcome, and the higher score/value a better one.
Time frame: Week 15
Circumference of L and R Upper Leg in Week 15
Circumference of the left (L) and right (R) upper leg in Week 15 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
Time frame: Week15
Circumference of L and R Knees in Week 15
Circumference of left (L) and right (R) knees at Week 15 is an objective measurement taken by an independent physiatrist; the measure includes the difference in circumference of the knees measured with a tape measure at the middle of the patellae. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents knee inflammation and joint deformation (abnormal bone growth). Increased values indicate worse outcomes from a higher level of knee inflammation/deformation, and decreased values indicate better outcomes from a lower level of knee inflammation/deformation.
Time frame: Week 15
WOMAC Total in Week 24
Western Ontario and McMaster University Osteoarthritis (WOMAC) index's total score is a sum of all three subscales for pain, stiffness, and functional disability, the minimum value is 0, and the maximum value is 96; the lower score/value represents a better outcome, and a higher score/value represents a worse outcome
Time frame: Week 24
WOMAC Pain in Week 24
Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, separated from the WOMAC index, evaluates OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale, ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better one.
Time frame: Week 24
WOMAC Stiffness in Week 24
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, evaluates knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale ranging from minimal 0 to maximal 8 points. A bigger score represents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
Time frame: Week 24
WOMAC Functional Disability in Week 24
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items of functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting, and difficulties in domestic duties.
Time frame: Week 24
VAS in Week 24
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome.
Time frame: Week 24
KDSQ in Week 24
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of kidney deficiency symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This measure represents the effect of acupuncture treatment on Kidney deficiency (KD).
Time frame: Week 24
DRUG in Week 24
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
Time frame: Week 24
Active Extension L and R Knee in Week 24
The active extension of the left (L) and right (R) knees in Week 15 is an objective measure taken by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle as units. Knee active extension ranges between 0 and 5 degrees: the higher scores represent knee laxity/instability, and the negative scores represent knee flexion contraction. The higher values represent worse outcomes, and the lower values represent better outcomes.
Time frame: Week 24
Active Flexion L and R Knees in Week 24
Active flexion of left (L) and right (R) knees in Week 15 is an objective measure provided by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle (units). Knee active flexion ranges from 0 to a maximum of 135 degrees; the lower score/value represents a worse outcome, and the higher score/value a better one.
Time frame: Week 24
Circumference of L and R Upper Leg in Week 24
Circumference of the left (L) and right (R) upper leg in Week 24 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
Time frame: Week 24
Circumference of L and R Knee in Week 24
Circumference of the left (L) and right (R) upper leg in Week 24 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
Time frame: Week 24
WOMAC Total in Week 39
Western Ontario and McMaster University Osteoarthritis (WOMAC) total at the Added assessment at Week 39 in the crossover part compared to pre-experimental baseline value. The total score is a sum of all three subscales: pain, stiffness, and functional limitation. The minimum value is 0, and the maximum value is 96, where the lower score/value represents a better outcome, and a higher score/value represents a worse outcome.
Time frame: Week 39
WOMAC Pain in Week 39
The Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, selected from the WOMAC index, evaluates knee OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale, ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better one.
Time frame: Week 39
WOMAC Stiffness in Week 39
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, evaluates knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale ranging from minimal 0 to maximal 8 points. A bigger score represents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
Time frame: Week 39
WOMAC Functional Disability in Week 39
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items for functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting and difficulties in domestic duties.
Time frame: Week 39
VAS in Week 39
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome. This measure estimates the treatment effect of acupuncture on knee pain in Week 39 separately for groups A and C.
Time frame: Week 39
KDSQ in Week 39
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of Kidney deficiency symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This outcome represents the treatment effect of acupuncture on Kidney deficiency symptoms for both groups separately.
Time frame: Week 39
DRUG by Added Assessment in Week 39, Crossover Part
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
Time frame: Week 39
Lequesne Index in Week 24, Between-group Analysis
The Lequesne index is an algofunctional index of knee osteoarthritis that comprises three sections. Its score ranges from a minimal 0 (no pain and disability) to 24 (the greatest pain and disability). This index is added to the study in Week 24 as an additional objective measure. It measures pain severity with 5 questions, walking distance with 2 questions, and activities of daily living with 4 questions.
Time frame: Week 24
The recruitment process was carried out from January 2021 to August 2021. The recruitment was performed at the Family Medicine practice, run by the investigator, who has access to the database of four thousand patients from two practices. From the 4000 patients, 180 made the target population by criteria ≥50 years and confirmed KOA from a computer database. A study population of 64 participants was made by applying the inclusion and exclusion criteria.
| Milestone | Acupuncture Group | Control Group |
|---|---|---|
| Started | 32 | 32 |
| End of acupuncture treatments treatment of a group | 25 | 30 |
| 9 weeks after completing the acupuncture treatment | 25 | 29 |
| Completed | 25 | 29 |
| Not completed | 7 | 3 |
| Withdrew: Withdrawal by subject | 6 | 3 |
| Withdrew: Lost to follow-up | 1 | 0 |
| Milestone | Acupuncture Group | Control Group |
|---|---|---|
| Started | 25 | 29 |
| Completed | 23 | 23 |
| Not completed | 2 | 6 |
| Withdrew: Withdrawal by subject | 0 | 5 |
| Withdrew: Lost to follow-up | 2 | 1 |
The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) total score is the sum of the three subscales: pain, stiffness, and functional disability. The minimum value is 0, and the maximum value is 96, where the lower score/value represents a better outcome, and the higher score/value represents a worse outcome.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| WOMAC Total in Week 15 | 11.6 ± 11.633 | 54.4 ± 19.4 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, separated from the WOMAC index, evaluates knee OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better outcome.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| WOMAC Pain in Week 15 | 2.4 ± 2.4 | 11.3 ± 4.6 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, and evaluate knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale between the range from minimal 0 to maximal 8 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| WOMAC Stiffness in Week 15 | 0.7 ± 0.9 | 4.6 ± 1.9 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items for functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting and difficulties in domestic duties.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| WOMAC Functional Disability in Week 15 | 8.6 ± 8.8 | 38.6 ± 13.9 |
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| VAS in Week 15 | 12.6 ± 12 | 61 ± 19.5 |
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of Kidney deficiency (KD) symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This measure represents the effect of acupuncture treatment on KD.
| score on a scale | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| KDSQ in Week 15 | 10.8 ± 6.7 | 24.8 ± 12.5 |
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
| milligrams-equivalent of ibuprofen(IBU) | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| DRUG in Week 15 | 96.0 ± 183.7 | 870.0 ± 950.2 |
The active extension of the left (L) and right (R) knees in Week 15 is an objective measure taken by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle as units. Knee active extension ranges between 0 and 5 degrees: the higher scores represent knee laxity/instability, and the negative scores represent knee flexion contraction. The higher values represent worse outcomes, and the lower values represent better outcomes.
| degrees of a goniometer angle | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| L knee active extension | 0.429 ± 1.6 | 0.42 ± 1.35 |
| R knee active extension | 0.607 ± 2.27 | 0.714 ± 1.78 |
Active flexion of left (L) and right (R) knees in Week 15 is an objective measure provided by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle (units). Knee active flexion ranges from 0 to a maximum of 135 degrees; the lower score/value represents a worse outcome, and the higher score/value a better one.
| degrees on a goniometer angle | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| L knee active flexion | 94.1 ± 17.1 | 90.2 ± 18.9 |
| R knee active flexion | 96.1 ± 17.3 | 91.4 ± 18.6 |
Circumference of the left (L) and right (R) upper leg in Week 15 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
| centimeters | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| L upper leg circumference | 55.3 ± 5.84 | 58.3 ± 5.87 |
| R upper leg circumference | 58.7 ± 6.88 | 55.7 ± 9.25 |
Circumference of left (L) and right (R) knees at Week 15 is an objective measurement taken by an independent physiatrist; the measure includes the difference in circumference of the knees measured with a tape measure at the middle of the patellae. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents knee inflammation and joint deformation (abnormal bone growth). Increased values indicate worse outcomes from a higher level of knee inflammation/deformation, and decreased values indicate better outcomes from a lower level of knee inflammation/deformation.
| centimeters | A Group in Week 15 | C Group in Week 15 |
|---|---|---|
| L knee circumference | 43.1 ± 3.9 | 41.8 ± 3.23 |
| R knee circumference | 43.1 ± 4.14 | 41.8 ± 3.0 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) index's total score is a sum of all three subscales for pain, stiffness, and functional disability, the minimum value is 0, and the maximum value is 96; the lower score/value represents a better outcome, and a higher score/value represents a worse outcome
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| WOMAC Total in Week 24 | 20.4 ± 18.4 | 53.4 ± 20.5 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, separated from the WOMAC index, evaluates OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale, ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better one.
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| WOMAC Pain in Week 24 | 4.5 ± 3.7 | 11 ± 4.6 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, evaluates knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale ranging from minimal 0 to maximal 8 points. A bigger score represents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| WOMAC Stiffness in Week 24 | 1.1 ± 1.5 | 3.4 ± 2.2 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items of functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting, and difficulties in domestic duties.
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| WOMAC Functional Disability in Week 24 | 14.7 ± 13.7 | 39.0 ± 14.5 |
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome.
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| VAS in Week 24 | 13.8 ± 13.9 | 59.5 ± 23.9 |
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of kidney deficiency symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This measure represents the effect of acupuncture treatment on Kidney deficiency (KD).
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| KDSQ in Week 24 | 13.9 ± 8.9 | 25.0 ± 12.4 |
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
| milligrams-equivalent of ibuprofen(IBU) | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| DRUG in Week 24 | 184.0 ± 395 | 765.5 ± 783 |
The active extension of the left (L) and right (R) knees in Week 15 is an objective measure taken by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle as units. Knee active extension ranges between 0 and 5 degrees: the higher scores represent knee laxity/instability, and the negative scores represent knee flexion contraction. The higher values represent worse outcomes, and the lower values represent better outcomes.
| degrees of a goniometer angle | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| Active extension of L knee at Week 24 | 0 ± 0 | 0 ± 0 |
| Active extension of R knee at Week 24 | 0 ± 0 | 0 ± 0 |
Active flexion of left (L) and right (R) knees in Week 15 is an objective measure provided by an independent physiatrist with a goniometer, expressed on a scale with degrees of a goniometer angle (units). Knee active flexion ranges from 0 to a maximum of 135 degrees; the lower score/value represents a worse outcome, and the higher score/value a better one.
| degrees of a goniometer angle | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| L knee | 98.6 ± 16.4 | 99.5 ± 24.8 |
| R knee | 101.6 ± 22.1 | 99.8 ± 21.5 |
Circumference of the left (L) and right (R) upper leg in Week 24 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
| centimeters | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| Circumference of L Upper Leg at Week 24 | 58.8 ± 5.59 | 57.2 ± 6.61 |
| Circumference of R Upper Leg at Week 24 | 59.3 ± 5.93 | 57.2 ± 6.83 |
Circumference of the left (L) and right (R) upper leg in Week 24 is an objective measure, assessed by an independent physiatrist, at the thigh 15 centimetres above the patellar superior margin, measured with a tape measure. The unit of measure is a centimetre (unit) on the measuring tape (scale) with a range from 0 to 100 centimetres. This measure represents a measure of muscular strength or atrophy. Higher values indicate better outcomes from higher muscular volume, and decreased values indicate worse outcomes from weaker muscular volume.
| centimeters | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| Circumference of L knees at Week 24 in between-groups | 43.6 ± 4.62 | 42.4 ± 4.14 |
| Circumference of R knees at Week 24 in between-groups | 44.0 ± 4.38 | 42.4 ± 4.08 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) total at the Added assessment at Week 39 in the crossover part compared to pre-experimental baseline value. The total score is a sum of all three subscales: pain, stiffness, and functional limitation. The minimum value is 0, and the maximum value is 96, where the lower score/value represents a better outcome, and a higher score/value represents a worse outcome.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| WOMAC Total in Week 39 | 22.0 ± 20.7 | 18.2 ± 17.62 | 56.4 ± 18.91 | 57.3 ± 20.2 |
The Western Ontario and McMaster University Osteoarthritis (WOMAC) pain subscale, selected from the WOMAC index, evaluates knee OA pain by participants. It comprises 5 questions for pain assessed by a 5-point Likert scale, ranging from minimal 0 to maximal 20 points. A bigger score presents a worse outcome, and a lower score relates to a better one.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| WOMAC Pain in Week 39 | 5.3 ± 4.72 | 4.7 ± 3.77 | 11.5 ± 4.61 | 11.7 ± 4.37 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) stiffness subscale, separated from the WOMAC index, evaluates knee OA stiffness by participants. It comprises 2 questions for stiffness assessed by a 5-point Likert scale ranging from minimal 0 to maximal 8 points. A bigger score represents a worse outcome, and a lower score relates to a better result. WOMAC stiffness measures the stiffness of the knees.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| WOMAC Stiffness in Week 39 | 1.2 ± 2.17 | 1.2 ± 1.95 | 3.8 ± 1.51 | 4.2 ± 2.20 |
Western Ontario and McMaster University Osteoarthritis (WOMAC) functional disability subscale, separated from the WOMAC index, evaluates knee OA functional disability by participants' estimation. It comprises 17 items for functional disability assessment by a 5-point Likert scale ranging from minimal 0 to maximal 68 points. A bigger score presents a worse outcome, and a lower score relates to a better result. WOMAC functional disability measures climbing, rising from a chair/bed, standing, bending, walking, getting in/out of a car/bath/toilet, shopping, putting on socks, sitting and difficulties in domestic duties.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| WOMAC Functional Disability in Week 39 | 15.5 ± 14.3 | 12.3 ± 12.83 | 40.8 ± 14.12 | 41.9 ± 14.88 |
Visual Analogue Scale (VAS) assesses knee OA pain intensity, ranging from 0 to 100; the lower value represents a better outcome, and the higher a worse outcome. This measure estimates the treatment effect of acupuncture on knee pain in Week 39 separately for groups A and C.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| VAS in Week 39 | 18.3 ± 22.59 | 28.0 ± 21.36 | 59.5 ± 22.77 | 59.1 ± 18.1 |
The Kidney Deficiency Syndrome Questionnaire (KDSQ) assesses the intensity of Kidney deficiency symptoms; the minimum value is 0, and the maximum is 69. A lower score/value represents a better outcome, and a higher score/value represents a worse outcome. This outcome represents the treatment effect of acupuncture on Kidney deficiency symptoms for both groups separately.
| score on a scale | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| KDSQ in Week 39 | 14.6 ± 9.12 | 14.8 ± 8.92 | 27.2 ± 11.10 | 26.2 ± 11.89 |
DRUG is a measure that represents analgesics taken by participants, including various non-steroid anti-inflammatory drugs (NSAIDS) and/or tramadol. Recorded analgesics' doses from the last three days before assessment were recalculated in the comparable dose of the selective representative (ibuprofen) and converted into equivalent dose of milligrams of ibuprofen-ibuprofen equivalent units (IBU). DRUG's units of measure are IBU (units) on the scale ranging from 0 IBU to 4.500 IBU. DRUG decreasement represents a better therapeutic outcome, and an increase in DRUG represents a worse therapeutic outcome. All participants could self-manage the dosage according to their pain.
| milligrams-equivalent of ibuprofen(IBU) | A Group in Week 39 | C Group in Week 39 | A Group in Week 0 | C Group in Week 0 |
|---|---|---|---|---|
| DRUG by Added Assessment in Week 39, Crossover Part | 276.1 ± 566.46 | 319.6 ± 473.08 | 637.5 ± 1095.96 | 625.0 ± 841.66 |
The Lequesne index is an algofunctional index of knee osteoarthritis that comprises three sections. Its score ranges from a minimal 0 (no pain and disability) to 24 (the greatest pain and disability). This index is added to the study in Week 24 as an additional objective measure. It measures pain severity with 5 questions, walking distance with 2 questions, and activities of daily living with 4 questions.
| score on a scale | A Group in Week 24 | C Group in Week 24 |
|---|---|---|
| Lequesne Index in Week 24, Between-group Analysis | 5.1 ± 3.45 | 12.63 ± 5.06 |
Collected over The whole experiment lasted 39 weeks. The treatment protocol for every participant lasted 15 weeks. The treatment protocol comprises 3 cycles 3 weeks long, and between two cycles was a 3-week break. Participants could participate in 27 acupuncture sessions for 15 weeks in 3-times-weekly rhythm.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Acupuncture Group | 0/32 (0%) | 0/32 (0%) | 2/32 (6.3%) |
| Control Group | 0/32 (0%) | 0/32 (0%) | 1/32 (3.1%) |
| Event | Acupuncture Group | Control Group |
|---|---|---|
| suprapatellar knee jount effusion (M13.1)Injury, poisoning and procedural complications | 1/32 | 0/32 |
| hematoma subcutaneusInjury, poisoning and procedural complications | 1/32 | 0/32 |
| hematoma of upper legInjury, poisoning and procedural complications | 0/32 | 1/32 |
| Age, Continuous(years) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Mean | 64.1 ± 7.94 | 64.7 ± 8.27 | 64.4 ± 8.05 |
| Sex: Female, Male(Participants) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Female | 25 | 24 | 49 |
| Male | 7 | 8 | 15 |
| Race (NIH/OMB)(Participants) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 32 | 32 | 64 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Body Mass Index (BMI), Continuous(kg/m2) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Mean | 31.4 ± 5.45 | 30.6 ± 5.70 | 31.0 ± 5.55 |
| Kellgren-Lawrence (K-L) grade, Categorical(Participants) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| grade 2 | 7 | 9 | 16 |
| grade 3 | 19 | 13 | 32 |
| grade 4 | 6 | 10 | 16 |
| WOMAC total, Continuous(score on a scale) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Mean | 56.4 ± 18.908 | 57.3 ± 20.20 | 56.9 ± 19.414 |
| WOMAC pain, Continuous(score on a scale) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Mean | 11.5 ± 4.607 | 11.7 ± 4.37 | 11.6 ± 4.457 |
| WOMAC stiffness, Continuous(score on a scale) | Acupuncture Group | Control Group | Total |
|---|---|---|---|
| Mean | 3.8 ± 1.505 | 4.2 ± 2.20 | 4.0 ± 1.877 |
8 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — IPD that underlies the results reported in this article after deidentification (text, tables, figures, and appendices) for qualified researchers. Approval of the request is a prerequisite to the sharing of data.
Supporting information: Study protocol, Sap, Icf, Csr
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