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J Acupunct Res > Volume 32(3); 2015 > Article
Kim, Lee, Choi, Kim, Yook, Lee, and Kim: Moxibustion Treatment for Knee Pain: A Systematic Review

Abstract

Objectives:

This study was designed to evaluate clinical evidence of moxibustion treatment for knee pain.

Methods:

All processes were independently carried out by three investigators. A literature search was performed in 3 databases from their inception to May 2015. Ten reports were found based on their title, abstract and text. Following this, data extraction and analysis were done using a risk of bias(ROB) and through an assessment of multiple systematic reviews(AMSTAR).

Results:

10 studies(6RCT, 2SR, 2CR) were included. Generally, indirect moxibustion was used for knee pain, but only one study indicated the use of direct moxibustion. Moxibustion was shown to be effective in treating knee pain, and the number of required treatments was fourteen on average. In assessing risk of bias, indefinite and uncertain information made all included trials subject to a high risk of bias. On the other hand, SR showed all evaluation items in the assessment of multiple systematic reviews, with the exception of an included or excluded studies list.

Conclusions:

Because of deficient study design or limited research planning, there is not sufficient evidence to allow for any conclusion about the efficacy of moxibustion for knee pain. Therefore, well-designed high quality trials are needed from now on.

Fig. 1
Flowchart of trial selection process
acupunct-32-3-135f1.tif
Table 1
Summary of Studies of Moxibustion in Knee Pain with Systematic Review
Year/author Patient/problem Study/design Treatment points Treatment duration Rating scale Results
2003/Park19) DA RCT A16, A12, A8, E38, F9, I33, J7, M26, N9, I19, M28(moxibustion on hand) Once a day for 10 days ROM
GRS
T>C
2005/Choi20) OA CR Hak-Jeong(Heding, M-LE-27)
Yang-Seul-Ahn(Xiyan, MN-LE-16)
Once a day for 2 weeks VAS, MPQ
Circumference of knee
Valid
2006/Park21) DA RCT Dokbi(ST35), Yang-Seul-Ahn(Xiyan, MN-LE-16) Once a day for 15 days NRS, ROM, ADL T>C
2009/Doh22) DA RCT Dokbi(ST35), Yang-Seul-Ahn(Xiyan, MN-LE-16), Bokto(ST32), Hyeolhae(SP10), Gokcheon(LR8), Yangneugcheon(GB34), Eumneungcheon(SP9) Three times a week for 4 weeks VAS, LSS T>C
2011/Choi23) RA SR Mox+med>med
Mox>med
2012/Choi24) OA SR Mox>med
2012/Oh25) DA CR Yangneugcheon(GB34), Dokbi(ST35), Yangneugcheon(GB34), Eumneungcheon(SP9), Hyeolhae(SP10), Yanggu(ST34), Joksamni(ST36) and one or two Ashi points Three times a day for 12 days VAS, WOMAC Valid
2014/Kim26) OA RCT Dokbi(ST35),Yanggu(ST34), Joksamni(ST36), Eumneungcheon(SP9), Hyeolhae(SP10) and two Ashi points Three times a week for 4 weeks WOMAC, SF-36(Short-Form 36)
BDI(Beck Depression Inventory)
PNRS(Pain Numerical Rating Scale)
The Physical Functional Test Patient Global Assessment The Safety Assessment
T=C
(BDI)
T>C (other rating scale)
2014/Zhao27) OA RCT Dokbi(ST35), Yang-Seul-Ahn(Xiyan, MN-LE-16) and Ashi points Three times a week for 6 weeks WOMAC T>C
2015/Ren28) OA RCT Dokbi(ST35), Yang-Seul-Ahn(Xiyan, MN-LE-16) and Ashi points Three times a week for 6 weeks SF-36(Short-Form 36) T>C

DA : degenerative arthritis. OA : osteoarthritis. RA : rheumatoid arthritis. RCT : randomized controlled trial. SR : systematic review. CR : case report. Mox : moxibustion.

Med : medication. GRS : graphic rating scale. VAS : visual analogue scale. MPQ : McGil pain questionnaire. NRS : numerical rating scale. ROM : range of motion.

ADL : activities of daily living. LSS : Lysholm scoring scale. WOMAC : Western Ontario and McMaster Universities Osteoarthritis Index. SF-36 : short-form 36.

BDI : beck depression inventory. PNRS : pain numerical rating scale.

Table 2
‘Risk of Bias’ Assessment in Included RCT
Q1 Q2 Q3 Q4 Q5 Q6 Q7
Park 200319) U U H L H L U
Park 200621) U U H L L L U
Doh 200922) U U H L L L U
Kim 201426) L L H L L L U
Zhao 201427) L H L L L L U
Ren 201528) L H L L L L U

L : low risk of bias. H : high risk of bias.

U : uncertain risk of bias.

Table 3
‘Assessment of Multiple Systematic Reviews’ Assessment in Included SR
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11
Choi 201123) Y Y Y Y N Y Y Y Y Y Y
Choi 201224) Y Y Y Y N Y Y Y Y Y Y

Y : yes. N : no. CA : can’t answer. NA : not applicable.

VI.
VI.

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