Abstract
IntroductionThis study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis (KOA) and evaluated safety.MethodsA multi-centre, non-blinded, parallel-group, randomised controlled trial compared moxibustion with usual care (UC) in KOA. 212 South Korean patients aged 40–70 were recruited from 2011–12, stratified by mild (Kellgren/Lawrence scale grades 0/1) and moderate-severe KOA (grades 2/3/4), and randomly allocated to moxibustion or UC for four weeks. Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s). UC was allowed. Korean Western Ontario and McMaster Universities Questionnaire (K-WOMAC), Short Form 36 Health Survey (SF-36v2), Beck Depression Inventory (BDI), physical performance test, pain numeric rating scale (NRS) and adverse events were evaluated at 5 and 13 weeks. K-WOMAC global score at 5 weeks was the primary outcome.Results102 patients (73 mild, 29 moderate-severe) were allocated to moxibustion, 110 (77 mild, 33 moderate-severe) to UC. K-WOMAC global score (moxibustion 25.42+/−SD 19.26, UC 33.60+/−17.91, p<0.01, effect size = 0.0477), NRS (moxibustion 44.77+/−22.73, UC 56.23+/−17.71, p<0.01, effect size = 0.0073) and timed-stand test (moxibustion 24.79+/−9.76, UC 25.24+/−8.84, p = 0.0486, effect size = 0.0021) were improved by moxibustion at 5 weeks. The primary outcome improved for mild but not moderate-severe KOA. At 13 weeks, moxibustion significantly improved the K-WOMAC global score and NRS. Moxibustion improved SF-36 physical component summary (p = 0.0299), bodily pain (p = 0.0003), physical functioning (p = 0.0025) and social functioning (p = 0.0418) at 5 weeks, with no difference in mental component summary at 5 and 13 weeks. BDI showed no difference (p = 0.34) at 5 weeks. After 1158 moxibustion treatments, 121 adverse events included first (n = 6) and second degree (n = 113) burns, pruritus and fatigue (n = 2).ConclusionsMoxibustion may improve pain, function and quality of life in KOA patients, but adverse events are common. Limitations included no sham control or blinding.Trial RegistrationClinical Research Information Service (CRIS) KCT0000130
Highlights
This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis (KOA) and evaluated safety
Knee osteoarthritis (KOA) is a common disease which is related to the chronic degenerative changes of knee joint structures [1]
Idiopathic KOA was diagnosed according to the clinical guidelines of the American College of Rheumatology: the participants should have pain at one or both knees with a daily average of over 40 points on the 0-to-100 numeric rating scale (NRS) and meet at least 3 of the following 6 conditions: age of 50 to 70 years, stiffness within 30 minutes of waking in the morning, crepitus, bony tenderness, bony enlargement or no palpable warmth [7]
Summary
This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis (KOA) and evaluated safety. Pharmacological treatments are usually recommended for the relief of pain but severe adverse effects related to drug therapy are suggested to be a significant limitation for use [3]. In this point, to discover and to test effectiveness and safety of non-pharmacological interventions is necessary for the vulnerable patients who need long term treatment for KOA. Moxibustion is a method of direct or indirect acupuncture-point stimulation using burned dried mugwort. Moxibustion is not well known in European countries, it may have been used there in the distant past; several soot marks were found on the body of Otzi the ‘Tyrolean Ice Man’, half of which were coincident with classic acupuncture points [4]
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