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6TMR Modern Herbal Medicine  2019, Vol. 2 Issue (1): 36-47    DOI: 10.12032/TMRmhm2017B36
Review     
Systematic evaluation and Meta-analysis of acupuncture and collaterals cupping therapy for Knee Osteoarthritis
Zhang Li-Hui1, Zhao Yong-Chen2,*()
1 College of Chinese Medicine, Hebei University, Baoding, Hebei, China
2 Affiliated Hospital of Hebei university, Baoding, Hebei, China.
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Objective: In order to obtain the best treatment program for Knee Osteoarthritis (KOA), to alleviate the pain of patients with KOA, and to systematically evaluate the efficacy of acupuncture cupping therapy for KOA. Methods: we used computer to search the databases of CNKI (1989-2018.10), Wanfang (1989-2018.10), VIP (1989-2018.10), PubMed (1966-2018.10), EMbase (1986-2018.10) and Cochrane Library (the 3rd issue of 2018). And the literature quality was evaluated by Jadad scale. Results: A total of 19 eligible RCT studies were included, and a total of 2,088 patients participated in the eligible clinical study. Meta-analysis results showed that the total effective rate OR combination =2.85[OR =3.98, 95%CI (2.98,5.32), P < 0.00001]. The results showed that the curative effect of acupuncture and collaterals cupping in the treatment of KOA was superior to other therapies. Conclusion: Acupuncture and cupping therapy of traditional Chinese medicine is effective and safe in treating KOA. Due to the impact of the original study on Meta-analysis results, more large samples and high-quality clinical trials are still needed to verify.

Highlights
Knee osteoarthritis (KOA) is one of the most common orthopedic diseases. Most of the patients were elderly, and the clinical manifestations were mainly pain. This paper aims to explore the research progress of TCM acupuncture and cupping therapy for the prevention and treatment of KOA. In this paper, we reviewed the published literature, systematically evaluated and Meta analyzed the efficacy of acupuncture and cupping therapy for the treatment of knee osteoarthritis, and provided better evidence for the clinical treatment of knee osteoarthritis patients.



Key wordsacupuncture and collaterals cupping therapy      Traditional Chinese Medicine      Knee Osteoarthritis      Meta-analysis      Systematic evaluation     
Published: 25 January 2019
Corresponding Authors: Zhao Yong-Chen     E-mail: zhaoyongchen69@163.com
Cite this article:

Zhang Li-Hui, Zhao Yong-Chen. Systematic evaluation and Meta-analysis of acupuncture and collaterals cupping therapy for Knee Osteoarthritis. 6TMR Modern Herbal Medicine, 2019, 2(1): 36-47. doi: 10.12032/TMRmhm2017B36

URL:

https://www.tmrjournals.com/mhm/EN/10.12032/TMRmhm2017B36     OR     https://www.tmrjournals.com/mhm/EN/Y2019/V2/I1/36

Figure 1 Extraction process of included literature
Quality of evidence Definition of the quality of evidence
High quality (A) Further studies will not alter the reliability of the efficacy evaluation results of the included studies
Medium quality (B) Further studies are likely to affect the reliability of efficacy evaluation results of the included studies and may alter the evaluation results of the included studies
Low quality (C) Further studies are likely to affect the reliability of efficacy evaluation results of the included studies, and the evaluation results of the included studies are likely to change
Very low quality (D) Any evaluation of efficacy in the included studies is highly uncertain
Table 1 GRADE evidence quality grading and its definition
Author Year Title
Zhang [1] 2014 Clinical observation of chifeng yingyuan method combined with acupuncture and collaterals cupping therapy for knee osteoarthritis
Gao [2] 2014 Evaluation of the Efficacy of Pricking-cupping Bloodletting Method plus Glucosamine Hydrochloride in Treating Knee Osteoarthritis
Xu [3] 2015 Effects Observation of Blood-letting and Cupping Combined with Electropuncture on Knee Osteoarthritis
Fan [4] 2011 fifty cases of knee osteoarthritis were treated by acupuncture and cupping combined with manipulation
Bian[5] 2017 Curative effect observation on 30 cases of knee osteoarthritis treated by acupuncture and cupping therapy combined with huma ointment
Jin [6] 2016 Clinical Observations on Pricking-cupping Bloodletting Therapy for Knee Osteoarthritis
Liu [7] 2016 Curative effect of acupuncture and cupping therapy combined with massage on knee osteoarthritis
Wang [8] 2017 Clinical study on the treatment of chronic traumatic knee synovitis with acupuncture and moxibustion
Zheng [9] 2014 Observation on the curative effect of pricking blood therapy combined with cupping therapy for knee osteoarthritis
Xu [10] 2014 Observation on therapeutic effect of electroacupuncture combined with acupuncture and cupping therapy for knee osteoarthritis
Xu [11] 2009 Observation on the curative effect of electroacupuncture combined with acupuncture and cupping therapy for knee osteoarthritis
Fu [12] 2011 Close and warm needling plus pricking-cupping therapy for treating knee osteoarthritis
Zhang [13] 2017 68 cases of knee synovitis were treated by modified fire acupuncture combined with blood-pricking cupping therapy
Zheng [14] 2008 Clinical observation on the treatment of osteoarthritis with plum-blossom needle tapping and cupping therapy
Qing [15] 2018 Clinical observation of cupping and bloodletting therapy in Mongolian medicine for knee osteoarthritis
Zhang [16] 2013 Observations on the Efficacy of Yang's Needle Tapping-cupping Bloodletting Method in Treating Knee Osteoarthritis
Ma [17] 2014 Clinical discussion on knee osteoarthritis by YANG'S Hi-pipe acupuncture and cupping plus community intervention
Pan [18] 2005 58 cases of knee osteoarthritis were treated by acupuncture and cupping therapy
Yang [19] 2016 Clinical Study on Knee Osteoarthritis Treated with Shallow Puncture with Chinese Herbs-Bamboo for Cupping Combining with Oral Chinese Medicine Decoction
Table 2 basic information of included literatures
Inclusion study Total cases (C/T) Effective cases (C/T) M/F Age Control group treatment plan Experimental group treatment plan Time
Zhang 2014 30/30 24/28 C:7/23
T:9/21
C:58.5±6.6
T:61.6±6.5
Ordinary needle Chifeng Yingyuan method combined with
pricking cupping treatment
1 M
Gao 2014 34/32 18/30 C:5/29
T:6/26
C:64±11
T:64±11
Oral glucosamine
hydrochloride capsules
Oral glucosamine hydrochloride capsule
+ pricking cupping
6 W
Xu
2015
30/45 25/41 C:5/25
T:8/37
C:60.4±5.6
T:61.3±5.6
Electroacupuncture Pricking cupping combined with electroacupuncture 4 W
Fan
2011
50/50 44/48 C:14/36
T:16/34
C:56.42±7.13
T:57.36±10.48
Oral futalin sustained release tablets Pricking and cupping combined method 23 D
Bain 2017 30/30 18/24 30/30 50~60 Electroacupuncture Pricking cupping combined with ebony cream 3 W
Jin
2016
30/30 24/26 C:10/20
T:9/21
C:57±4
T:59±6
Acupoint acupuncture combined with affected area microwave Pricking cupping 2 W
Liu 2
016
160/160 140/155 C:65/95
T:67/93
C:62.5±7.7
T:64.5±8.7
Traditional acupuncture treatment Cuizhong acupuncture cupping and four-step massage 14 D
Wang 2017 40/40 27/38 38/42 34.78±1.56 Futalin Bloody cupping plus acupuncture 9 D
Zheng 2014 56/60 47/56 C:18/38
T:20/40
C:59.3±4.8
T:59.4±5.1
Common acupuncture Pricking cupping 2 W
Xu
2014
54/54 42/50 C:19/35
T:16/38
C:57.1
T:57.6
Computer intermediate frequency with Chinese medicine iontophoresis Electro-acupuncture combined with pricking cupping 22 D
Xu
2009
54/54 42/50 C:19/35
T:16/38
C:57.1
T:57.6
Computer intermediate frequency with Chinese medicine iontophoresis Electro-acupuncture combined with pricking cupping 22 D
Fu 2
011
62/68 50/63 C:24/38
T:26/42
C:60
T:62
Simple warm acupuncture Short thorn warm acupuncture combined with pricking cupping 20 D
Zhang 2017 68/68 59/66 C:22/46
T:20/48
C:47±7
T:48±6
Electroacupuncture Improved fire needle + Bloody cupping 45 D
Zheng 2008 45/90 38/85 C:15/30
T:33/57
C:51
T:52
Oral diclofenac sodium Plum blossom needle pricking and cupping 20 D
Qing 2018 96/98 60/88 Not reported Not reported Oral Mongolian medicine Mongolian medicine cupping bloodletting therapy 35 D
Zhang 2013 30/30 28/29 C:12/13
T:14/16
C:57
T:60
Conventional acupuncture "Yang's" flocculation cupping method 9 D
Ma
2014
60/60 53/57 C:29/31
T:33/27
C:60.74±5.67
T:61.77±6.12
Conventional acupuncture Puncture cupping 12 D
Pan
2005
42/53 27/50 C:8/34
T:15/43
C:50~75
T:52~73
Conventional acupuncture Acupuncture + pricking cupping 3 W
Yang 2016 32/33 23/31 C:32/12
T:9/24
C:61.4±5.6
T:59.7±6.3
Oral medicine Bamboo cans 3 M
Table 3 Treatment regimens included in the literature
Figure 2 risk of bias: judgment of all bias risk items included in the study
Figure 3 risk of bias ratio: judgment on the percentage of all included studies that generate risk of bias
Inclusion study random hide Blind method Withdrawal and loss of follow-up Possible degree of
bias
Jadad score quality
level
Zhang 2014 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Gao 2014 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Xu 2015 random Not mentioned Not mentioned mentioned Moderate 2 B
Fan 2011 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Bain 2017 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Jin 2016 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Liu 2016 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Wang 2017 random Not mentioned Not mentioned mentioned Moderate 2 B
Zheng 2014 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Xu 2014 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Xu 2009 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Fu 2011 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Zhang 2017 random Not mentioned Not mentioned mentioned Moderate 2 B
Zheng 2008 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Qing 2018 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Zhang 2013 random Not mentioned Not mentioned mentioned Moderate 2 B
Ma 2014 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Pan 2005 random Not mentioned Not mentioned Not mentioned Moderate 1 B
Yang 2016 random Not mentioned Not mentioned Not mentioned Moderate 2 B
Table 4 Jadad quality assessment form
Figure 4 Meta-analysis of total effective rate of acupuncture and cupping
Figure 5 Meta-analysis funnel plot of total effective rate
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