The Impact of Electroacupuncture Combined with Extracorporeal Ultrasound on Knee Osteoarthritis: A Random Clinical Study

doi:10.21203/rs.3.rs-5252498/v1

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The Impact of Electroacupuncture Combined with Extracorporeal Ultrasound on Knee Osteoarthritis: A Random Clinical Study

https://doi.org/10.21203/rs.3.rs-5252498/v1

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Objective

Traditional Chinese Medicine (TCM) represents a rich repository of empirically developed traditional medicines. Electroacupuncture(EA) therapy is an important part of traditional Chinese medicine. It calls for more rigorous study into the efficacy, safety, and mechanisms of action of TCM remedies to strengthen the evidence base. This study aims to evaluate the therapeutic efficacy of electroacupuncture (EA) combined with Extracorporeal Ultrasound (EU) in patients with Knee Osteoarthritis (KOA).

Methods

A cohort of 110 KOA patients, admitted to The Second People's Hospital of Yichang from February 2024 to August 2024, were randomly assigned to either a control group or an observation group, each consisting of 55 individuals. 10 patients were excluded due to tuberculosis, tumor and intolerance to acupuncture treatment or EU. The control group received standard care for KOA, while the observation group underwent EA and EU intervention for a period of 2 weeks. Parameters such as pain level, knee joint function, symptom score, therapeutic efficacy were assessed pre- and post-intervention to determine the efficacy of the interventions.

Results

Initially, there were no significant differences in pain level, knee joint function, symptom score, therapeutic efficacy between the two groups (all P > 0.05). Post-intervention, both groups showed improvements in these parameters, with the observation group demonstrating superior outcomes. Specifically, pain VAS scores and symptom scores in the observation group was significantly lower than in the control group (P < 0.05), but KOOS scores and clinical efficacy in the observation group was significantly higher than in the control group (P < 0.05).

Conclusion

The combination of EA and EU can significantly alleviate the symptoms of joint pain in patients with KOA, improve knee joint function, enhance the quality of life, and has superior therapeutic effects compared to celecoxib and sodium hyaluronate.

Electroacupuncture

Extracorporsal Ultrasound

Knee Osteoarthritis

pain

Knee osteoarthritis (KOA) is a common degenerative joint disease with a high prevalence rate of 18% in China^[1–3]. The etiology of this disease is complex and difficult to cure, and its clinical manifestations such as joint pain, swelling, and limited mobility can easily lead to anxiety or depression in KOA patients, severely affecting the quality of life. Currently, KOA has become one of the main reasons for the loss of mobility in middle-aged and elderly people in China, causing a huge burden on the society's medical and economic aspects^[4]. At present, the clinical treatment of KOA mainly focuses on relieving pain, improving joint function, and enhancing the quality of life. In recent years, acupuncture and extracorporeal ultrasound, as representatives of non-pharmacological therapies, have been recommended by authoritative societies and most guidelines as the first-line treatment measures for KOA^[5–8].

KOA belongs to the category of "Bi Syndrome and Bone Bi" in traditional Chinese medicine. Internally, it is caused by insufficient liver and kidney, and externally, it is invaded by wind, cold, and damp evils, leading to blocked meridians. The treatment should be to strengthen the body and dispel evil, treat both the symptoms and the root cause, and adjust both internally and externally. "Suwen" states: "Wind, cold, and dampness are the three Qi that mix together to form Bi," and "Zhang's Medical Communication" also states: "Knee pain is always caused by liver and kidney deficiency, and when they are deficient, wind, cold, and dampness will invade." Wind, cold, and dampness are the consensus of generations of medical scholars on the etiology and pathogenesis of Bi syndrome, and the most common syndrome type is cold and damp Bi blockage. The spleen is weak and the kidney is deficient, unable to nourish the bones, joints, and tendons, and are easily disturbed by damp and cold evils, leading to bone and meridian blockage, and the qi and blood are not beneficial, resulting in swelling and pain. Therefore, the main treatment principles should be to dredge the meridians, eliminate dampness, disperse cold, and activate blood circulation. Statistical analysis of literature shows that the Dubi (this term seems to be incomplete or incorrect in the original text), Yanglingquan, Yinlingquan, Neixigyan, and Ashi points around the knee joint are the core acupoints with high frequency of use in acupuncture treatment of KOA.

Therefore, this study uses a randomized controlled method, with conventional Western medicine treatment as the control, to observe the clinical efficacy of acupuncture combined with extracorporeal ultrasound in the treatment of KOA, to provide a basis and reference for its clinical application and promotion.

General Information and Grouping

According to the results of the pre-experiment, the effective rate of the treatment group was 95%, and the effective rate of the control group was 70%. Assuming that the probability of class I error in the study is ɑ=0.05 and the power (1-β) = 90%, try to estimate the sample size required for the study. According to the design of the clinical trial study, the sample size estimation was made using the following formula, taking into account the primary efficacy outcome measures.

$$\:\text{n}=\frac{{p}_{1}\times\:\left(1-{p}_{1}\right)+{p}_{2}\times\:(1-{p}_{2})}{{({p}_{1}-{p}_{2})}^{2}}\times\:{（{\mu\:}_{\alpha\:\backslash\:2}+{\mu\:}_{\beta\:}）}^{2}$$

Where P1 = 95%, P2 = 70%, ɑ=0.05, β = 0.1 are substituted into the formula.

$$\:n=\frac{0.95\times\:\left(1-0.95\right)+0.5\times\:(1-0.7)}{{(0.95-0.7)}^{2}}\times\:{(1.96+1.28)}^{2}$$

According to the above calculations, 31 cases are needed per group. Considering a 40% dropout rate, 55 cases should be enrolled per group. A total of 110 cases were reported in both groups.

A total of 110 patients with KOA were selected in the The Second People's Hospital of Yichang from February 2024 to August 2024. 10 patients were excluded due to tuberculosis, tumor and intolerance to acupuncture treatment or EU. According to the random number table method, 100 patients were divided into a control group and a therapy group, with 50 cases in each group. All patients met the relevant diagnostic criteria for KOA in our hospital. There was no statistically significant difference between the two groups of patients in general information such a sage, course of disease, and pathological location(P > 0.05), (Table 1).

Table 1

Patient's General Information
Group	number of cases	Male	Female	Age/years	Duration /months	Knee Kellgren-Lawrence Grading
Group	number of cases	Male	Female	Age/years	Duration /months	I	II	III
Control group	50	23	27	54.4 ± 7.3	11.3 ± 4.1	10	33	7
Treatment group	50	26	24	54.0 ± 5.5	12.7 ± 4.1	8	32	10

(cases, x ± s)

Inclusion and Exclusion Criteria

Inclusion Criteria

Table 2

**Diagnostic criteria for KOA**^[9]
items	Symptoms/Signs
①	Recurrent knee joint pain over the past month
②	X-ray shows narrowing of the joint space, subchondral bone sclerosis and/or cystic changes, and osteophyte formation at the joint margins
③	Synovial fluid is clear and viscous (at least 2 times), with WBC < 2000 cells/ml
④	Age ≥ 40 years old
⑤	Morning stiffness ≤ 30 minutes
⑥	Presence of crepitus with movement (a sensation of grating)

①Meet the above KOA diagnostic criteria; ②Age between 40 and 70 years old; ③ Disease course ≥ 6 months; ④Knee joint X-ray examination shows Kellgren-Lawrence (K-L)^[10] grading of I to III; ⑤Average knee joint pain visual analog score (Visual analogue score, VAS) ≥ 4 points in the past 1 week, (Table 2).

Exclusion Criteria

①Those with severe diseases; ②Those with knee joint tuberculosis, tumors, fractures, abscesses, or other acute knee joint injuries; ③Those who have received acupuncture treatment or EU treatment (within the last month); ④ Those who cannot tolerate acupuncture treatment; ⑤ Pregnant or nursing women.

Dropout and Withdrawal Criteria

①Those who voluntarily withdraw from the study; ②Those who experience serious adverse reactions; ③Those who do not follow the prescribed treatment and evaluation during the trial process, affecting the determination of effectiveness and safety.

This study has been approved by the Medical Research Ethics Committee of The Second People's Hospital of Yichang, and all subjects have signed informed consent forms (Fig. 1).

FIGURE 1 | Flowchart of patient recruitment.

Treatment Methods

After admission, medical personnel should give all patients basic health education guidance and body weight control.

Control Group

Control group patients received conventional Western medicine treatment: ①Celecoxib capsules (Jiangsu Zhengda Qingjiang Pharmaceutical Co., Ltd., H20193414, 0.2g per tablet), one tablet each time, orally once daily for 2 weeks continuously. Glucosamine hydrochloride tablets (Jiangsu Zhengda Qingjiang Pharmaceutical Co., Ltd., H20060647, 0.75g per tablet), one tablet each time, orally twice daily for 2 weeks continuously^[9]. ②Sodium hyaluronate injection (Shandong BoLun Furuida Pharmaceutical Co., Ltd., H20067379, 25mg/2.5mL), one vial each time, injected into the knee joint cavity once a week for 2 weeks continuously.

Therapy Group

The patients received EA and extracorporeal ultrasound combined treatment.

Electroacupuncture Treatment

Performed by acupuncturists (with a title of attending physician or above) who have been uniformly trained. The location of acupoints and the operation of electroacupuncture refer to the "Evidence-Based Acupuncture Clinical Practice Guidelines·Knee Osteoarthritis" of the China Association of Acupuncture and Moxibustion^[11]. Treatment duration is two consecutive weeks, with a total of 7 treatments.

Extracorporeal Ultrasound Treatment: ① Positioning: Pain points are clearly marked in advance during the flexion and extension of the affected knee, passive traction of ligaments, and pressing. ② Treatment: Frequency: 1–3 MHz; Intensity: Adjusted according to the equipment and patient tolerance; Treatment time: Each treatment usually lasts for 15 minutes, two consecutive weeks, with a total of 7 treatments. Wear a knee brace for 1 week after treatment to reduce the activity of the knee joint. All extracorporeal ultrasound treatments are performed by the same physical therapist.

Therapeutic effect observation: The subjects in the two groups were evaluated by experienced chief therapists (unaware of the group division) before and after treatment.

Observation Indicators

Pain level

The knee joint pain level of KOA subjects before and after treatment is evaluated using the visual analog scale (Visual analogue score, VAS) (0 to 10 points), 0 points: no pain, 10 points: the most severe pain, the higher the evaluation score, the more severe the pain^[12].

Knee joint function

The knee joint function is assessed using the modified Knee injury and osteoarthritis outcome score (KOOS), including 5 dimensions and 42 items. Each dimension score ranges from 0 to 100 points, the higher the score, the lighter the degree of knee osteoarthritis^{[13, 14]}.

Symptom score

The main symptoms and signs of KOA, such as joint pain, joint swelling, joint aversion to cold, joint fever, weakness of the waist and knees, and fatigue, are graded and quantified (0 to 3 points). The total score is 18 points, the higher the score, the more severe the degree of knee osteoarthritis^[15].

Therapeutic Efficacy Judgment Standards

Refer to the "Guiding Principles for Clinical Research of New Chinese Medicines (Trial)", and the clinical efficacy evaluation standard is formulated by combining the Nimodipine method with the quantitative scoring of items in the KOOS score. It can be divided into four levels: cured ≥ 90%, 90%>significant effect ≥ 60%, 60% > effective ≥ 30%, and ineffective < 30%. The therapeutic effect index (Nimodipine method) = (post-treatment score - pre-treatment score) / pre-treatment score × 100%. The total effective rate = (number of cured + significant effect + effective) / total number of cases × 100%^[16].

Safety Evaluation

Record the adverse reactions such as local hematoma, infection, and acupuncture fainting that occur during the treatment of the subjects, and treat them symptomatically by a senior attending physician.

Statistical Analysis

The software Prism 8.0 is used for data statistical analysis. For count data, the X² test is used; for measurement data (x ± s), appropriate selection is made based on the normality of the data and the homogeneity of variance: the t-test is used for those who meet the conditions, and the Wilcoxon rank sum test is used for those who do not meet the conditions; the Mann-Whitney U rank sum test is used for rank data. P < 0.05 indicates a statistically significant difference, P > 0.05 indicates no statistically significant difference.

Comparison of VAS(Visual Analogue Scale) scores between two groups of patients Before and After Treatment

Comparison of VAS scores between the two groups showed no statistically significant difference in VAS scores of KOA patients before treatment (P > 0.05). After treatment, the VAS scores of both groups significantly decreased compared to before treatment (P < 0.05), and the treatment group was significantly lower than the control group (P < 0.05), (Table 3, Fig. 2).

Table 3

Comparison of VAS scores between two groups of patients
Group	number of cases	Before treatment	After treatment
Control group	50	5.5 ± 0.6	5.2 ± 0.5
Therapy group	50	5.6 ± 0.6	5.0 ± 0.6

(scores, x ± s)

FIGURE 2 | Comparison of VAS score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of VAS score of the control group before and after treatment; (B) Comparison of VAS score of the therapy group before and after treatment; (C) Comparison of VAS score of the two groups after treatment.

Comparison of KOOS(Knee Injury and Osteoarthritis Outcome Score) scores between two groups of patients Before and After Treatment

Comparison of KOOS scores between the two groups showed no statistically significant difference in the scores of each dimension of KOOS between the two groups of KOA patients before treatment (P > 0.05). After treatment, the scores of each dimension of KOOS in both groups significantly increased compared to before treatment (P < 0.05), and the treatment group was significantly higher than the control group (P < 0.05), (Table 4, Fig. 3–7).

Table 4

Comparison of KOOS scores between two groups of patients
Group	number of cases	Scoring items	Before treatment	After treatment
Control group	50	Pain	52.4 ± 6.3	55.5 ± 2.8
		Symptoms (except pain)	59.3 ± 3.1	61.7 ± 6
		routines	61.5 ± 5.2	64.0 ± 5.8
		Sports and Recreational Activities	41.2 ± 6.0	44.8 ± 5.0
		Life quality	44.6 ± 6.4	48.2 ± 5.8
Therapy group	50	Pain	53.4 ± 5.8	58.1 ± 3.1
		Symptoms (except pain)	59.0 ± 5.1	65.2 ± 6.1
		routines	61.4 ± 4.9	69.0 ± 5.9
		Sports and Recreational Activities	41.5 ± 5.9	46.6 ± 6.0
		Life quality	43.2 ± 5.4	50.0 ± 5.7

(scores, x ± s)

FIGURE 3 | Comparison of pain score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of pain score of the control group before and after treatment; (B) Comparison of pain score of the therapy group before and after treatment; (C) Comparison of pain score of the two groups after treatment.

FIGURE 4 | Comparison of symptom (except pain) score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of symptom (except pain) score of the control group before and after treatment; (B) Comparison of symptom (except pain) score of the therapy group before and after treatment; (C) Comparison of symptom (except pain) score of the two groups after treatment.

FIGURE 5 | Comparison of routines score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of routines score of the control group before and after treatment; (B) Comparison of routines score of the therapy group before and after treatment; (C) Comparison of routines score of the two groups after treatment.

FIGURE 6 | Comparison of Sports and Recreational Activities score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of Sports and Recreational Activities score of the control group before and after treatment; (B) Comparison of Sports and Recreational Activities score of the therapy group before and after treatment; (C) Comparison of Sports and Recreational Activities score of the two groups after treatment.

FIGURE 7 | Comparison of life quality score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of life quality score of the control group before and after treatment; (B) Comparison of life quality score of the therapy group before and after treatment; (C) Comparison of life quality score of the two groups after treatment.

Comparison of symptom scores between two groups of patients Before and After Treatment

Comparison of symptom scores before and after treatment in the two groups showed no statistically significant difference in symptom scores between the two groups of KOA patients before treatment (P > 0.05). After treatment, the scores of both groups significantly decreased compared to before treatment (P < 0.05), and the treatment group was significantly lower than the control group (P < 0.05), (Table 5, Fig. 8).

Table 5

Comparison of symptom scores between two groups of patients
Group	number of cases	Before treatment	After treatment
Control group	50	11.2 ± 0.6	10.8 ± 0.6
Therapy group	50	11.1 ± 0.5	10.5 ± 0.5

(scores, x ± s)

FIGURE 8 | Comparison of symptom score before and after treatment between the two groups (M ± SD, scores). (A) Comparison of symptom score of the control group before and after treatment; (B) Comparison of symptom score of the therapy group before and after treatment; (C) Comparison of symptom score of the two groups after treatment.

Comparison of clinical efficacy between two groups of patients Before and After Treatment

Comparison of clinical efficacy between the two groups showed a statistically significant difference in the total effective rate between the two groups (P < 0.01), indicating that the treatment group was more effective than the control group, (Table 6, Fig. 9).

Table 6

Comparison of clinical efficacy between two groups of patients
Group	Number of cases	complete recovery	significantly effective	effective	ineffective	total effectiveness
Control group	50	6	13	10	21	29(58.0)
Therapy group	50	9	20	14	7	43(86.0)

(cases, (%))

FIGURE 9 | Comparison of clinical efficacy between control group and therapy group(cases).

Factors causing KOA joint pain include age, obesity, gender, osteophyte formation, etc. The main mechanism of KOA joint pain is the nociceptive input caused by tissue damage, and there may be a relationship between pain and changes in joint structure^[17]. Bhattacharya A et al. found that knee joint pain can reflexively cause inhibition of muscle activity, especially in the quadriceps^{[18, 19]}. At the same time, a decrease in muscle strength of the lower limbs, mainly the quadriceps, has been proven to be a risk factor for causing knee joint pain^[20]. Bokaeian HR et al. found that the reduction of joint pain and the improvement of function are independent of the increase in quadriceps strength in KOA, indicating that the decline in quadriceps strength is only a risk factor for KOA joint pain, not the main cause^[21]. However, strength training of the quadriceps and aerobic exercise have significant therapeutic effects on reducing joint pain and movement disorders in KOA patients^{[22, 23]}.

KOA is characterized by high incidence, high disability rate, and difficulty in cure. The main clinical treatment goals are to alleviate joint pain, improve joint function, and enhance the quality of life^{[24, 25]}. Currently, there are relatively many treatment methods for KOA, mainly including medication, non-drug therapy, and surgical therapy. It advocates for a step-by-step, personalized, and precise treatment of KOA^[26]. For mild to moderate cases, a combination of traditional Chinese and Western medicine conservative treatment is mainly advocated. For severe cases, surgical treatment is only recommended after conservative treatment has been ineffective^{[27, 28]}. However, long-term oral medication can have adverse reactions to the gastrointestinal tract, heart, liver, and kidneys. Western medicine intra-articular injections are prone to infection and the benefits are not clear, and surgical intervention has a large trauma, high cost, and low patient acceptance. Non-drug therapy, due to its safety, effectiveness, small side effects, cost-effectiveness, and easy acceptance, is widely recognized by KOA patients. Evidence-based medical evidence also shows that it has significant therapeutic effects on KOA^[29–32]. Therefore, non-drug therapy has become the first choice for KOA treatment, among which acupuncture and extracorporeal ultrasound therapy are typical representatives. In the "Clinical Practice Guidelines for Rehabilitation in Traditional Chinese Medicine · Knee Osteoarthritis", the evidence levels for treating KOA with acupuncture and extracorporeal ultrasound therapy are 1a and 1b, respectively, and the recommendation levels are both A-level^[33]; the "Evidence-based Acupuncture Clinical Practice Guidelines · Knee Osteoarthritis" ^[34] strongly recommends fine needles, warm needles, electroacupuncture, and fire needles; the "Clinical Practice Guidelines for the Integration of Traditional Chinese and Western Medicine for Knee Osteoarthritis (Knee Bi)"^[35] also lists extracorporeal ultrasound as a first-line treatment measure.

Acupuncture can directly reach the disease site, effectively dredge the local qi and blood, play a role in relaxing muscles, dredging meridians, reducing swelling, and relieving pain, and is combined with syndrome differentiation and meridian selection to achieve the purpose of nourishing the liver and kidney, and dispelling wind, cold, and damp evils. Acupuncture is a commonly used therapy for KOA treatment. Acupuncture at Liangqiu has the effect of reducing swelling and relieving pain; acupuncture at Yanglingquan can relax muscles, activate collaterals, and strengthen the meridians and bones; acupuncture at Neixigyan has the effect of promoting qi and relieving pain; acupuncture at Zusanli can activate blood circulation and strengthen qi, dispel wind, and eliminate dampness; acupuncture at Xuehai has the effect of activating blood circulation and reducing swelling; acupuncture at Hetou has the effect of activating blood circulation and relieving pain; acupuncture at Yinlingquan can nourish the kidney and spleen, regulate the meridians and qi. Clinical studies have shown that EA has significant therapeutic effects in the treatment of KOA, and Meta-analysis studies have shown that its clinical efficacy is better than that of Western medicine^{[36, 37]}. It has anti-inflammatory and analgesic effects, promotes blood circulation, can effectively restore the strength of the quadriceps, reduce knee joint pain and stiffness symptoms, promote the absorption of inflammatory substances, and is conducive to tissue metabolism and repair^{[38, 39]}. Individualized extracorporeal ultrasound not only relieves pain but also enhances the strength of the muscles around the knee joint, thereby enhancing the stability of the knee joint and improving proprioception, thus delaying the progression of the disease, which is an important measure for consolidating the therapeutic effect and promoting the autonomous recovery of patients^{[40, 41]}. The combination of the two can synergistically treat KOA from different angles, better improve the condition, and promote the recovery of knee joint function.

In addition, cyclooxygenase-2 inhibitors (such as celecoxib) are a type of highly selective non-steroidal anti-inflammatory drugs. In recent years, they have often been recommended by domestic and foreign diagnostic and treatment guidelines for the treatment of mild to moderate KOA. This type of drug has the advantages of small toxic side effects and strong specificity. Therefore, this study uses celecoxib as a positive drug control group to explore the clinical efficacy of EA combined with extracorporeal ultrasound in the treatment of KOA patients.

Pain VAS score, KOOS score, and symptom score quantification are all commonly used methods for evaluating the main symptoms of KOA, which have been widely adopted by researchers^{[42, 43]}. The results of this study show that after the intervention, the VAS score of knee joint pain on the affected side, the score of each dimension of KOOS, and the symptom score quantification of the treatment group significantly improved compared to before treatment, indicating that EA combined with extracorporeal ultrasound can significantly improve the joint pain and function of KOA patients. At the same time, compared with the control group, the improvement in the above scores of the treatment group is more obvious, and the total effective rate is better than that of the control group, indicating that the therapeutic effect of EA combined with extracorporeal ultrasound on KOA is better than that of simple Western medicine treatment, and the operation is simple and easy to perform, with no obvious adverse reactions, and is worth promoting in clinical practice.

There are still many shortcomings in this study, such as not conducting follow-up visits and not including patients with severe KOA. In future studies, the design will be further improved to obtain reliable evidence-based medical evidence.

TCM

Traditional Chinese Medicine

Electroacupuncture

Extracorporeal Ultrasound

KOA

Knee osteoarthritis

VAS

Visual Analogue Scale

KOOS

Knee Injury and Osteoarthritis Outcome Score

DATA AVAILABILITY STATEMENT

The original contributions detailed in the research are featured within the article and its supplementary materials. For additional queries, please reach out to the corresponding author(s).

ETHICS STATEMENT

The research involving human subjects received clearance from the ethics committee at The Second People's Hospital of Yichang. Participants in the study provided their written consent after being fully informed about the study's procedures.

AUTHOR CONTRIBUTIONS

Luoyang Cai: Writing – original draft, Validation, Supervision. Yu Li: Writing– original draft, Data curation. Yue Xu: Writing – original draft, Software. Jianguo Xu, Hai Huang and Lijun Zhang: Writing – review & editing, Writing– original draft, Conceptualization, Funding acquisition.

Ethics approval and consent to participate Not applicable.

Competing interests The authors declare no competing interests

Founding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Foundation of Hubei Educational Committee（D20232803 to Lijun Zhang）,Foundation of Hubei University of Science and Technology （BK202418 to Lijun Zhang）. Natural Science Foundation of Hubei Province (2023AFD170 to Hai Huang), Shuguang Project of Wuhan Science and Technology Bureau (2022020801020507 to Hai Huang).

Clinical Trial Number

Clinical trial registration: http://itmctr.ccebtcm.org.cn/

Clinical Registration No. ITMCTR2024000359

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No competing interests reported.

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The Impact of Electroacupuncture Combined with Extracorporeal Ultrasound on Knee Osteoarthritis: A Random Clinical Study

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Abstract

Objective

Methods

Results

Conclusion

Figures

INTRODUCTION

MATERIALS AND METHODS

General Information and Grouping

(cases, x ± s)

Inclusion and Exclusion Criteria

Inclusion Criteria

Exclusion Criteria

Dropout and Withdrawal Criteria

Treatment Methods

Control Group

Therapy Group

Observation Indicators

Pain level

Knee joint function

Symptom score

Therapeutic Efficacy Judgment Standards

Safety Evaluation

Statistical Analysis

RESULT

Comparison of VAS(Visual Analogue Scale) scores between two groups of patients Before and After Treatment

(scores, x ± s)

(scores, x ± s)

Comparison of symptom scores between two groups of patients Before and After Treatment

(scores, x ± s)

Comparison of clinical efficacy between two groups of patients Before and After Treatment

(cases, (%))

DISCUSSION

Abbreviations

Declarations

References

Additional Declarations

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