Institutional members access full text with Ovid®

Share this article on:

Factors Influencing Further Acupuncture Usage and a More Positive Outcome in Patients With Osteoarthritis of the Knee and the Hip: A 3-Year Follow-up of a Randomized Pragmatic Trial

Martins, Friederike; Kaster, Theresa MD; Schützler, Lena MSc; Witt, Claudia M. MD, MBA

doi: 10.1097/AJP.0000000000000062
Original Articles

Objective: Considering the chronicity of osteoarthritis-associated pain, we aimed to evaluate long-term outcome differences between patients who received immediate or delayed acupuncture in addition to usual care, and to identify predictors for further acupuncture usage and a better long-term outcome.

Materials and Methods: The Acupuncture in Routine Care study was an open-label randomized pragmatic trial. As adjunct to usual care patients (>40 y, clinical and radiologic diagnosis of primary osteoarthritis of the knee or hip, pain duration >6 mo) received either immediate acupuncture in the first 3 months or delayed acupuncture in the subsequent 3 months. After 36 months 613 of 632 patients were available and asked to complete follow-up questionnaires. Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: A total of 500 (82%) of the contacted patients completed questionnaires. After 36 months the WOMAC Index did not differ significantly between groups (immediate acupuncture 36.53±26.19 vs. delayed acupuncture 38.24±25.54; P=0.420). Further acupuncture treatment during the follow-up period was reported by 202 patients and predicted by previous successful acupuncture treatment at baseline (odds ratio=2.5; 95% confidence interval, 1.6-3.9). Less osteoarthritis symptoms (WOMAC Index) after 36 months were predicted by being an acupuncture responder at 6 months (P<0.001), having higher school education (P=0.005), not wanting to use medications (P=0.016), and using additional therapies (P≤0.001 to P=0.025).

Discussion: No long-term outcome differences were found between patients who received immediate versus those who received delayed acupuncture treatment. Education level and additional therapies were identified as predictors for a better long-term outcome.

Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany

This work was funded within the grant of the Chair for Complementary Medicine Research from the Carstens Foundation, Essen, Germany. The authors declare no conflict of interest.

Reprints: Claudia M. Witt, MD, MBA, Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin. Luisenstr. 57, Berlin 10117, Germany (e-mail:

Received March 18, 2013

Received in revised form January 7, 2014

Accepted December 2, 2013

© 2014 by Lippincott Williams & Wilkins