Lee, Seung-Hwon
(Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine)
,
Kwon, Gi-Sun
(Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine)
,
Kang, Min-Soo
(Department of Orthopaedic Surgery, Dong-Eui Medical Center)
,
Yoon, Hyun-Min
(Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine)
,
Kim, Cheol-Hong
(Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine)
Objectives: The purpose of this study is to compare the effects of bee venom pharmacopuncture (BVP) therapy according to the methods used to treat knee osteoarthritis (OA): intra-acupoint combined with intra-articular injection, intra-acupoint injection, and intra-articular injection. Methods: A tot...
Objectives: The purpose of this study is to compare the effects of bee venom pharmacopuncture (BVP) therapy according to the methods used to treat knee osteoarthritis (OA): intra-acupoint combined with intra-articular injection, intra-acupoint injection, and intra-articular injection. Methods: A total of 69 patients were recruited by the Department of Acupuncture & Moxibustion at Dong-Eui Oriental University Hospital from February 1 to July 23, 2012. The patients were assigned to 3 groups: the first group with intra-acupoint combined with intra-articular BVP Injection (the experimental group), the 2nd group with intra-acupoint BVP injection (control group II), and the 3rd group with intra-articular BVP injection (control group II). The participants were assigned in the order in which they were recruited. Treatments were done twice a week, for a total of 9 times. The effectiveness was assessed by using the visual analouge scale (VAS) and the Korea Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC). Results: All three groups exhibited significant VAS and KWOMAC effects. Moreover, the 4 week follow-up after the final treatment showed a persistence of BVP effects. However, when the groups were compared, no statistically significant differences in VAS and KWOMAC were noted, but when improvement was considered, the results showed that intra-articular injection was more effective than intra-acupoint injection. Especially, intra-acupoint combined with intra-articular injection was the most effective among the three treatments. Conclusions: Combining intra-acupoint with intra-articular injection, depending on the patient's symptoms, may produce better results when conservatively treating knee OA.
Objectives: The purpose of this study is to compare the effects of bee venom pharmacopuncture (BVP) therapy according to the methods used to treat knee osteoarthritis (OA): intra-acupoint combined with intra-articular injection, intra-acupoint injection, and intra-articular injection. Methods: A total of 69 patients were recruited by the Department of Acupuncture & Moxibustion at Dong-Eui Oriental University Hospital from February 1 to July 23, 2012. The patients were assigned to 3 groups: the first group with intra-acupoint combined with intra-articular BVP Injection (the experimental group), the 2nd group with intra-acupoint BVP injection (control group II), and the 3rd group with intra-articular BVP injection (control group II). The participants were assigned in the order in which they were recruited. Treatments were done twice a week, for a total of 9 times. The effectiveness was assessed by using the visual analouge scale (VAS) and the Korea Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC). Results: All three groups exhibited significant VAS and KWOMAC effects. Moreover, the 4 week follow-up after the final treatment showed a persistence of BVP effects. However, when the groups were compared, no statistically significant differences in VAS and KWOMAC were noted, but when improvement was considered, the results showed that intra-articular injection was more effective than intra-acupoint injection. Especially, intra-acupoint combined with intra-articular injection was the most effective among the three treatments. Conclusions: Combining intra-acupoint with intra-articular injection, depending on the patient's symptoms, may produce better results when conservatively treating knee OA.
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문제 정의
Therefore, the amount of bee venom was maintained because the effects of bee venom treatment are not related to the volume of the injected BVP, but to the amounts of the bee venom ingredients [16]. The intent was to decrease the discomfort of the patient by reducing the volume of BVP injected while maintaining the amounts of bee venom ingredients. Especially in the case of edema, reducing the volume of the BVP injected may relatively decrease the discomfort of the patient.
제안 방법
After a brief telephone screening, participants were asked to visit the hospital for a demographic survey examination, a history of disease duration, a consent statement, physical examination and a knee X-ray. Subsequently, after the safety from allergic responses to bee venom had been ensured, the first treatment was administered.
The VAS (score range: 0-10 cm) was used as the primary outcome measurement [17]. For bilateral OA participants, the side with more pain at baseline was evaluated throughout the study:before the 1st treatment (V1), before the 3rd treatment (V2), before the 5th treatment (V3), before the 7th treatment (V4), before the 9th treatment (V5), and 4 weeks from the 9th treatment (V6), for a total of six evaluation. The Secondary outcome measurement was a patient global assessment of the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert scale version; score range: 0-96) [18].
In comparing the effects among groups after the final treatment and at the four-week follow-up after the final trea-tment, the VAS was not consistent with the KWOMAC pattern due to the subjective assessment of the participants own pain with the VAS, and the KWOMAC being composed of sub-items of pain, stiffness, and function. In addition, the pain KWOMAC score was not consistent with the VAS pattern because the results were estimated from a KWOMAC questionnaire which might have been difficult for most elderly participants to complete.
The total WOMAC score was a summation of the scores for each individual domain: pain (score range: 0-20), stiffness (score range: 0-8), and physical function (score range: 0- 68). The Korean version of WOMAC was used in this trial [19], before the 1st treatment (W1), before the 5th treatment (W2), before the 9th treatment (W3), and 4 weeks after the 9th treatment (W4), for a total of four evaluations. X-ray examinations were done at Orthopedic Surgery Department at Dong-Eui Medical Center before treatment, to show the degree of regression on the Kellgren-Lawrence scale (K-L score).
Thus, randomized controlled trials on treatment methods are needed. The aim of this study is to compare intra-acupoint injection, intra-articular injection, and intra-acupoint injection combined with intra-articular injection with BVP and to analyze the efficacy of each for the treatment of knee OA.
Moreover, combining intra-acupoint with intra-articular injection properly, depending on the patient's symptoms, may produce better results when conservatively treating knee OA. The limitations of this study were as follows: the completion of the questionnaire was difficult for elderly participants; limited concentration and capacity were used without considering the severity of the symptoms; there were relatively few participants; no detailed investigation regarding hypersensitivity reactions was done.
The purpose of this study is to compare the effects of BVP therapy according to the treatment methods for three groups: BVP injection at intra-acupoints combined with intra-articular injection (experimental group); BVP injection at intra-acupoints (control groupⅠ); and BVP intraarticular injection (control groupⅡ). The partici-pants were assigned in the order in which they were recruited.
대상 데이터
Fourty-nine participants were between 49 and 74 years old, and 93% were women. Table 2 shows general characteristics and the baseline VAS and KWOMAC scores for the three groups.
Sixty-nine patients were recruited by the Department of Acupuncture and Moxibustion at Dong-Eui Oriental University Hospital from February 1 to July 23, 2012. Inclusion criteria included an age of at least 40 years but below 80 years, presence of knee OA diagnosed by an orthopedist based on the American College of Rheumatology classification criteria, knee pain in one or both knees rated ≧ 4 on the Visual Analog Scale (VAS).
데이터처리
The effects, depending on the progress of treatment, were evaluated by using the repeated measure ANOVA test. Statistical differences in improvement among the groups were evaluated by using the one-way ANOVA test. P values < 0.
We evaluated for the baseline characteristics of the groups by using the chi-square test and the one-way ANOVA. Statistical differences of improvement in each group were evaluated by using the paired t-test. The effects, depending on the progress of treatment, were evaluated by using the repeated measure ANOVA test.
Statistical differences of improvement in each group were evaluated by using the paired t-test. The effects, depending on the progress of treatment, were evaluated by using the repeated measure ANOVA test. Statistical differences in improvement among the groups were evaluated by using the one-way ANOVA test.
0 for Window was used. We evaluated for the baseline characteristics of the groups by using the chi-square test and the one-way ANOVA. Statistical differences of improvement in each group were evaluated by using the paired t-test.
이론/모형
For bilateral OA participants, the side with more pain at baseline was evaluated throughout the study:before the 1st treatment (V1), before the 3rd treatment (V2), before the 5th treatment (V3), before the 7th treatment (V4), before the 9th treatment (V5), and 4 weeks from the 9th treatment (V6), for a total of six evaluation. The Secondary outcome measurement was a patient global assessment of the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert scale version; score range: 0-96) [18]. The total WOMAC score was a summation of the scores for each individual domain: pain (score range: 0-20), stiffness (score range: 0-8), and physical function (score range: 0- 68).
The Korean version of WOMAC was used in this trial [19], before the 1st treatment (W1), before the 5th treatment (W2), before the 9th treatment (W3), and 4 weeks after the 9th treatment (W4), for a total of four evaluations. X-ray examinations were done at Orthopedic Surgery Department at Dong-Eui Medical Center before treatment, to show the degree of regression on the Kellgren-Lawrence scale (K-L score). A statistical analysis with SPSS 18.
성능/효과
In comparing the effects among groups after the final treatment and at the four-week follow-up after the final trea-tment, the VAS was not consistent with the KWOMAC pattern due to the subjective assessment of the participants own pain with the VAS, and the KWOMAC being composed of sub-items of pain, stiffness, and function. In addition, the pain KWOMAC score was not consistent with the VAS pattern because the results were estimated from a KWOMAC questionnaire which might have been difficult for most elderly participants to complete.
In this study, the results showed that intra-articular injection was more effective than intra-acupoint injection. Especially intra-acupoint combined with intra-articular injection was the most effective among the three treatments.
The results showed that all three groups experienced significant changes in the VAS and the KWOMAC at the 1 - week assessment and according to the progress of the treatment. Moreover, the four-week follow-up after the final treatment showed a persistence of BVP effects.
The three groups showed no significant differences in improvement at each stage, but the order of the level of improvement of the groups was the experimental group, control group Ⅱ, and control groupⅠ at the end of the trial, and at the four week follow-up after the trial ended (Table 4).
The Secondary outcome measurement was a patient global assessment of the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert scale version; score range: 0-96) [18]. The total WOMAC score was a summation of the scores for each individual domain: pain (score range: 0-20), stiffness (score range: 0-8), and physical function (score range: 0- 68). The Korean version of WOMAC was used in this trial [19], before the 1st treatment (W1), before the 5th treatment (W2), before the 9th treatment (W3), and 4 weeks after the 9th treatment (W4), for a total of four evaluations.
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