A Randomised Controlled Trial Of Acupuncture For Osteoarthritis Of The Knee

Evaluation of Introduction Section

Discuss about the randomised controlled trial of acupuncture for osteoarthritis of the knee.

The article from the Arthritis care and research on “A randomised controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication” is taken as conflicting evidence exists on the efficacy of the traditional method of Chinese acupuncture as well the role of placebo effects. A trial consisting of three months and randomized was conducted in order to find the impact of communication styles of acupuncturists. The article illustrates the results of the study as well as the validity of the analysis methods and techniques used.

Several steps were performed. A three month randomised clinical trial was conducted. The aim was to compare efficiency of TCA with the sham acupuncture to examine the communication styles. The training of the acupuncturists was conducted and they were asked to interact in two or more information styles. The results connect to the effects of the conducted acupunctures.

Acupuncture is a traditional Chinese method of inserting needles into the body in order to relieve people of the pressure. 

One of the most important forms of Chinese medicine is acupuncture. Human health is often ignored and several diseases occur as a result. Body pain is extremely common in case of elderly but it is also found in case of the youngsters as well. Health is maintained with the help of the vital energy flow through the paths called meridians. In case this flow of vital energy is obstructed diseases are caused. Due to cure of pain, it can be said that the evolution of the acupuncture technique has been huge. The modes of acupuncture have changed gradually from manual stimulation of the past to the electro acupuncture. The number of clinical randomised trials in the theory of efficacy of acupuncture is only two in number. The impact of acupuncture in case of knee arthritis is very varied. There may be expectations of improvement in the fields of acupuncture. There are two communication styles discussed in the question. In order to understand the contribution of the different communication styles corresponding to the responses which are therapeutic in nature, a randomised trial was performed. A nested factorial design was also used to understand the effects of the communication styles of the acupuncturists.

The methods section has been segregated into several parts which clearly explain the methods utilised to determine the effects of the behaviour of the persons practicing acupuncture as well as the patient’s responses to the different natures of the Chinese medicine. The aim is also to clearly understand the differences between the two different modes of the medicine.

Evaluation of Methods Section

At first for a basic assessment of the people, the patients were divided into three groups consists of waiting list, high expectations or neutral expectations. To ensure that the results were genuine, six special acupuncturists were trained as well as their experiences were also checked. After this the randomisation of the patients were again performed and they were asked to be treated in any one of the two styles of either the Traditional Chinese or the Sham Acupuncture. It is also to be noted that all the techniques and methods used were appreciated by the Review Boards as well as special and genuine health care centres.

Randomisation is basically a statistical procedure of choosing statistical participants in a random manner. Treatments are also randomly assigned to the participants. In random techniques every individual has an equal chance of being selected. Randomisation was done in unequal blocks. Sealed and opaque envelopes were consecutively numbered in order to assign each method of the acupuncture to each of the participants. Subgroup analysis was also conducted to better understand the effects of communication styles on the placebo effects.

Only those individuals are chosen who are more than 50 years of age and have certain problems in the knee. Also the people have knee osteo-arthritis participated in the trial. People who took stable treatment with non-steroidal anti-inflammatory drugs as well as analgesics were considered. That is, it formed part of the inclusion criteria. Also people who would participate should not have taken any intra-articular injections in the past 2 months. A few other criteria were also kept in mind while choosing the participants.

The possibility of individual patterns of communication for the acupuncturists was bound to be different. So the acupuncturists were also randomised with a different expectations style were randomised as well. One of them had to leave in order to make the design balanced. The numbers of acupuncturists participating in the second half of the survey were four in number.

The acupuncturists who performed a high level of performance as well as high expectations of improvement were included in the high expectations style. The results for those people which were good contributed to this section.

Those acupuncturists who conveyed uncertainty were included under this category. A brochure with the requirements for neutral impacts was also provided to the participants. Those participants also had an advisor who was also a research coordinator. He or she was trained in the neutral expectations style. After the completion of the first half of the training the advisors were trained again. The acupuncturists contributed an important part to the trial and its results.

Randomisation

Electro acupuncture was chosen as the modality of choice as the method is the most commonly used where transcutaneous electrical nerve stimulation equipment was used.  In many cases TCA is performed taking samples of many students. In order to get standardised results on the analysis a well-suited panel is appointed to understand the procedure well.

A figure is provided where the points which are chosen for the Chinese acupuncture are given. These are shown both for the Chinese acupuncture as well as for the sham acupuncture. There are certain very subtle differences between both the methods. The details of the needles which are provided for the acupuncture methods are also given. All the necessary steps to be taken are conducted with utmost accuracy.

The outcome measures were collected at baseline, then four weeks, six weeks and finally three months after treatment. The point worth noting regarding this analysis is that no stone was left unturned to ensure the unbiasedness of the procedure. The key words were not used in order to obtain an unbiased approach. The patients after several periods of treatment were asked whether they noticed positive effects from the treatments they received or not.

One of the most accurate measures of statistical analysis namely ANOVA or the analysis of variance was conducted to assess the changes over time and this was done repeatedly over different time periods.

In the results section we are provided with several tables indicating the statistical results of the conducted surveys as well as the experiments. The total sample number denoted by n has the value of 580. Out of this total number the number of participants randomised in the high expectations group was 238. The number randomised in the neutral expectations group was 242 and finally in the waiting list group the number was 80. The subsequent removals as well as additions were also mentioned.

The first table shows the baseline demographic as well as the clinical characteristics of the participants as well as their division into various groups was shown. This was done on the basis of educational degree, the nature of origin, educational level as well as the nature of the medications given. It can been seen that not much of a significant difference was observed between the two acupuncture groups.

The next table shows the measures of outcome by the acupuncture treatment group. Every nature of collected outcome for specific time periods including baseline, 4 weeks, 6 weeks as well as 3 months were divided into two categories namely the TCA and the sham method of acupuncture. The table and a close study of the two columns under each of the time periods shows that there is no significant difference between the two methods namely the sham and the TCA. All the results are statistically significant as the p-vale is less than or equal to 0.05. The results are statistically significant. Thus it can be said that the conducted results are appropriate.

Participants and Participation Criteria

The third table shows the outcomes by the style of communication groups. This table also has the 4 subdivisions in terms of the time after which the participants are examined. Each segment has two subdivisions, namely the high and the neutral communication groups. In case of the baseline, 4-week and the 6-week time periods it was seen that the neutral responses were more in values. Only in case of the 3-month time period the high-response time was higher.

Finally it can be said that the results of all the values are genuine. The outcomes of the communications received are unbiased as well as the analysis results, statistically significant. The tables are lucid, clearly understood and the results of the outcomes clearly visible to the statistician. From the detained write-up of the study the results linked to the analysis and the numbers and figures in the tables as well as their significance are clearly understood by the layman as well. Hence the conducted experiment is very scientific as well as lucid. The method is genuinely interesting as well.

Conclusion:

This study was one of a kind in estimating the efficacy of the TCA with sham acupuncture in the knee while controlling as well as measuring the effects of the patient provided interactions in the acupuncture responses. Very few surveys of this kind, in fact none at all were conducted in the earlier times. In a way, the survey can be said to be one of a kind in understanding the impact of the traditional as well a new method of acupuncture for the people suffering from arthritis. The impact of treatments as well as the time gaps after which the patients are tested also helps to analyse the elapsed time’s effect on the mindsets of the people.

The two major findings in this unique survey comprise the following: firstly it can be said that that the traditional method of sham acupuncture which was practised was is no way superior to the sham methods of acupuncture. Secondly, the communication intervention had a small but definitely a significant effect in the satisfaction levels as well as the alleviation of pain in case of the participants. The needling of meridian points in the human body was not more effective than the sham procedure. The communication styles of the acupuncturists were statistically significant and the accuracy of the calculations was high. Thus acupuncture is definitely a safe option and the results received after the treatment are also genuine and closely felt by the patients.