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.