Acupuncture & moxibustion for osteoarthritis of the knee: a component analysis approach

This project investigates the use of acupuncture and moxibustion for osteoarthritis of the knee. The project includes a pilot study which tests a protocol for a randomised controlled trial. Two pieces of primary research that develop new knowledge regarding acupuncture in practice: expert interviews and practitioner survey. A systematic review of clinical trials investigating warm needle acupuncture for osteoarthritis of the knee. A narrative review of the theoretical approaches to treating knee pain with acupuncture. The first phase of the project reviews the literature on the methodological challenges of research into acupuncture. A new framework for acupuncture research is developed. Key issues identified are: a placebo acupuncture technique is inherently impossible; there is no ‘theory of traditional East Asian medicine’ that can be falsified. Component analysis is proposed as a potential solution to these challenges. Moreover, clinical research can only be well designed and properly interpreted if triangulated with knowledge of theory and practice. The knowledge of acupuncture in practice, developed in this project, is used to re-evaluate the evidence-base. The external validity of acupuncture protocols and the risk of bias from the sham procedures are both shown to be problematic. This suggests that previous interpretations underestimate the efficacy of acupuncture. The research also indicates that acupuncture styles, e.g. TCM, cannot be clearly delineated, which has implications for evaluating and reporting clinical trials. In phase 3 of the project, the relationship between physical and psychological components is found to be highly complex. Subsequently, the research framework is further refined to account for this complexity. The pilot study identified problems with the protocol and solutions are proposed The phases of the project are guided by the framework. Therefore, the project not only develops new knowledge regarding osteoarthritis of the knee, but also serves as a demonstration of the component analysis approach which could be utilised to investigate other conditions.