Inspired by Ton et al 2020.[1]
CHD – Coronary Heart Disease
OA – Osteoarthritis
This week another large retrospective cohort study from Taiwan. In this paper the target group was patients with osteoarthritis (OA) identified from the LHID 2000 – the Longitudinal Health Insurance Database 2000. The LHID 2000 is a random sample of 1 million subjects drawn from the entire National Health Insurance Research Database (NHIRD) in the year 2000 and followed as a cohort. The NHIRD covers almost the entire Taiwanese population.
LHID 2000 was studied between the years 2000 and 2012, and those patients with a new diagnosis of OA were identified (n=84 773). Of these, 2 263 had had at least 10 sessions of acupuncture starting within 6 months of diagnosis. That left 727 359 in the database who had no diagnosis of OA and had not had acupuncture between 2000 and 2012.
Exclusions were applied to these three cohorts, and then they were each matched in turn based on age, sex, index year (start of acupuncture) and diagnosis year of OA. This process left 3 cohorts of 1 682 each: OA-acupuncture; OA-non-acupuncture; and non-OA non-acupuncture.
Whilst there was a degree of matching to create the cohorts, there was no matching performed for CHD-relevant co-morbidities and drug use, as has been performed previously, see the blog: CHD incidence in RA and acupuncture.
As a result there were highly significant differences between cohorts in a number of these, and whilst the acupuncture cohort was better in some, it was worse in others, and there is no way of knowing whether they balance out at all. Fortunately the results were adjusted to take account of these factors (see the adjusted hazard ratios in the paper).
As we have seen in previous cohorts,[2,3] acupuncture use was associated with a lower risk of CHD in both rheumatoid arthritis (RA)[2] and fibromyalgia (FM),[3] and we see the same result here in OA.
FM – 0.43
RA – 0.64 / 0.46 / 0.36
OA – 0.19 / 0.34
these are adjusted hazard ratios for CHD, so less than 1 means a reduced incidence in the patients who received acupuncture
There are a couple more papers I want to mention this week…
First, we have a useful survey from Japan that assessed lifetime prevalence of the use of certain CAM therapies: ‘Judo therapy’, ‘acupuncture and moxibustion’, and ‘Japanese traditional massage and finger pressure’.[4] It turns out that the lifetime prevalence was 28.0%, 17.8% and 15.8%, respectively, among males, and 44.5%, 18.4%, and 27.3%, respectively, among females. Women do more of everything then, including judo, so watch out!
The second additional paper is from our GP acupuncturist colleagues in Norway, and a pragmatic RCT (n=171) on in the effect of adding a single acupuncture session (WMA) to usual care in the management of acute low back pain.[5] The usual (Norwegian guideline-based) care group recovered in a median of 14 days and the acupuncture group recovered in a median of 9 days; however, this did not reach significance. The lead author is a fellow amateur photographer called Trygve, and he can be found on Instagram as trygvets.
References
1 Ton G, Yang Y-C, Lee L-W, et al. Acupuncture Decreased the Risk of Coronary Heart Disease in Patients with Osteoarthritis in Taiwan: A Nationwide Matched Cohort Study. J Altern Complement Med 2020;18:acm.2020.0153. doi:10.1089/acm.2020.0153
2 Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5
3 Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7
4 Shibata Y, Nakamura M, Nakamura H, et al. Lifetime use of complementary and alternative medicine therapies among community-dwelling older people in Japan. J Phys Ther Sci 2020;32:428–32. doi:10.1589/jpts.32.428
5 Skonnord T, Skjeie H, Brekke M, et al. Acupuncture for acute non-specific low back pain: a randomised, controlled, multicentre intervention study in general practice-the Acuback study. BMJ Open 2020;10:e034157. doi:10.1136/bmjopen-2019-034157
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