Scrutiknee study findings

Scrutinising treatments for knee pain

Knee osteoarthritis is a major cause of pain and disability in the UK. Acupuncture is used and studies have shown it can reduce pain. Giving acupuncture in a group reduces costs, but may have a different effectiveness from individual acupuncture. Our eventual aim is to find how effective and cost-effective is group acupuncture. Our pilot study was undertaken to find out whether we could identify suitable patients from GP databases; whether the study was acceptable to participants; whether the questionnaires were completed satisfactorily, particularly those measuring use of health and social services resources; and to provide information on how many patients would be needed in the main study.

Patients were identified from GP computer databases, invited to take part in the study, and screened by questionnaires and telephone interview. Those who were eligible and gave consent were divided randomly into three arms: standardised care (SC), SC plus group acupuncture, or SC plus individual acupuncture. SC consisted of an information, exercise and advice booklet. Acupuncture was given for six to ten sessions over 12 weeks, adding electroacupuncture if necessary. All participants were asked to comment on experiences at various points in the study, and some were invited for interview. Participants were sent questionnaires after 14 weeks: the main one, known as WOMAC, assessed knee pain, stiffness and function. Other questionnaires were used to support WOMAC. Importantly, there were not enough people in this pilot study to test whether acupuncture is effective.

From 63,670 people registered at seven GP surgeries, 860 were identified, 459 invited, and 60 recruited. 14 participants did not complete the study, three receiving group acupuncture, four individual acupuncture, and seven SC. WOMAC scores improved in both the acupuncture arms, but only marginally in the SC arm.

Recruitment was on target and on schedule; improvements to symptoms were as expected; interviews revealed a gap in treatment for knee pain, willingness to try acupuncture, and acceptability of the study. Study procedures were suitable, with minor revisions, viz: modified searches, phased invitations, revised invitation letter to target those with OA knee, and simplified recruitment procedure. Since many dropped out from the SC arm SC would not be acceptable in a definitive study.

This unit receives National Institute for Health and Care Research CTU Support Funding. This funding has been awarded to support the unit in developing and supporting NIHR trials.