The Effect of Acupuncture and Physiotherapy on Patients with Knee Osteoarthritis: A Randomized Controlled Study

Knee osteoarthritis is one of the most common and disabling conditions affecting the joints and is considered the leading cause of joint pain and physical disability in older adults. This degenerative disease is characterized by progressive cartilage destruction, osteophyte formation, and changes in the subchondral bone, especially in weight-bearing joints such as the knees. Osteoarthritis substantially compromises patients' quality of life, causing persistent pain, joint stiffness, reduced range of motion, and functional limitation. With a growing aging population, the public health impact of this condition is becoming increasingly relevant, demanding effective and safe therapeutic approaches.

Management of knee osteoarthritis traditionally includes anti-inflammatory drugs, analgesics, physical therapy, and, in more severe cases, surgery. However, prolonged use of medications can cause significant side effects such as gastric ulcers, gastrointestinal bleeding, and renal damage. For this reason, many patients seek alternative and complementary treatments, such as acupuncture, which has been recognized by the World Health Organization as effective for various conditions, including osteoarthritis.

This study aimed to compare the efficacy of acupuncture versus conventional physical therapy in the treatment of knee osteoarthritis, specifically assessing the effects on pain, physical function, and quality of life. The investigators conducted a randomized controlled clinical trial, considered the gold standard for evaluating medical interventions. The study was carried out at a university hospital in Turkey, between January and September 2018, with approval from the local ethics committee and informed consent from all participants.

The methodology involved 100 patients with a diagnosis of knee osteoarthritis confirmed by American College of Rheumatology criteria, aged 38–80 years and with chronic pain of more than six months' duration. Participants were randomly divided into two groups of fifty each: one group received acupuncture treatment and the other received conventional physical therapy. Both treatments were performed twice weekly for six weeks, for a total of twelve sessions. The acupuncture group received needle application at thirteen specific points, including local points around the knee and distal points, for twenty minutes per session.

The physical therapy group received a combination of modalities including therapeutic ultrasound, transcutaneous electrical nerve stimulation, and hot packs. Both groups also performed home strengthening exercises.

To assess outcomes, the investigators used scientifically validated instruments. Pain intensity was measured with the Visual Analog Scale, on which patients mark their pain on a line from zero to ten centimeters. Physical function was assessed by the WOMAC index, an osteoarthritis-specific questionnaire that measures pain, stiffness, and functional capacity through twenty-four items. Quality of life was measured by the SF-36 questionnaire, which assesses eight dimensions of health including physical function, bodily pain, general health, and emotional well-being.

All assessments were performed before treatment, immediately after the end of sessions, and twelve weeks later.

The main results showed that both treatments were equally effective in reducing pain and improving physical function. There were no statistically significant differences between acupuncture and physical therapy in pain levels, total WOMAC score, and quality of life at post-treatment and 12-week follow-up assessments. In the acupuncture group, pain on the visual analog scale decreased from 8.32 to 5.54 points, while in the physical therapy group it decreased from 7.86 to 5.68 points. Both groups also showed significant improvements in physical function, with WOMAC improving from 63.8 to 53.72 in the acupuncture group and from 59.04 to 52.28 in the physical therapy group.

An interesting difference was that the acupuncture group showed earlier improvement, with benefits already evident immediately after treatment, whereas the physical therapy group showed more pronounced improvements only at the 12-week follow-up. This suggests that acupuncture may have a faster onset of effect, while physical therapy demonstrates more durable benefits. Both treatments maintained their beneficial effects over the three-month follow-up period, indicating sustained benefits even after the end of sessions.

The clinical implications of these findings are relevant for both patients and health professionals. For patients, the results provide evidence that both acupuncture and physical therapy represent valid and effective therapeutic options for the management of knee osteoarthritis. Both treatments produced significant pain relief and functional improvement without side effects, presenting themselves as safe alternatives to anti-inflammatory drugs. The choice between acupuncture and physical therapy can be based on the patient's personal preferences, local availability of treatments, and individual characteristics of the condition.

For health professionals, the study provides solid scientific evidence to guide therapeutic decisions. The similar efficacy between modalities suggests that both should be considered in treatment planning and can be used individually or in combination. The results also support clinical guidelines that recommend nonpharmacologic treatments as first-line therapy for knee osteoarthritis, especially in patients who cannot or prefer not to use medications.

The study has some important limitations that should be considered when interpreting the results. The main limitation is the absence of placebo or sham acupuncture control groups, which may have influenced the results due to placebo effect. In addition, both groups performed home exercises, making it difficult to determine how much of the improvement is specifically attributable to acupuncture or physical therapy versus exercise. The patient–therapist contact time also differed between groups, potentially influencing the results.

In conclusion, this study demonstrates that both acupuncture and physical therapy are effective treatments for knee osteoarthritis, providing significant and durable benefits in pain reduction and functional improvement. The results suggest that patients can choose between these modalities based on their personal preferences and availability, knowing that both offer clinically relevant benefits. Future research with placebo control groups and longer follow-up periods will be important to confirm and expand on these promising findings.