Quantitative assessment of acupuncture’s effectiveness in osteoarthritis: a model-based meta-analysis

Abstract

Objective: This study aimed to quantitatively analyze the clinical efficacy of acupuncture for osteoarthritis and its influencing factors. It compared the effects of different types of acupuncture with sham acupuncture, as well as sham acupuncture with oral placebos, to elucidate the efficacy characteristics of acupuncture and provide quantitative data to support its use in the treatment of osteoarthritis. Methods: Randomized controlled trials on acupuncture for osteoarthritis were retrieved from the PubMed, Cochrane Library, Wanfang, and CNKI databases, including studies published up to October 31, 2025. Using time-course and covariate models, we quantitatively assessed the clinical efficacy and influencing factors of warm acupuncture, traditional acupuncture, electroacupuncture, and sham acupuncture. Subgroup analyses were conducted to explore trends related to potential factors affecting acupuncture efficacy. Furthermore, the effects of sham acupuncture were compared with previously established oral placebo responses to evaluate whether sham acupuncture confers therapeutic benefits. Results: A total of 72 articles involving 4,919 participants were included. The findings indicated that warm acupuncture significantly outperformed sham acupuncture in Visual Analogue Scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC stiffness, and WOMAC function scores. Electroacupuncture and traditional acupuncture exhibited similar efficacy, with both treatments showing numerical improvements over sham acupuncture; however, these improvements were not statistically significant. Comparisons with oral placebo responses suggested that sham acupuncture was effective, with nonacupoint sham acupuncture slightly outperforming nonpenetrating sham acupuncture. Subgroup analyses indicated that higher baseline values of outcome measures, a lower proportion of female participants, shorter disease duration, and higher acupuncture frequency were associated with greater efficacy of acupuncture for osteoarthritis. Conclusion: This study establishes a time-course model for acupuncture in the treatment of osteoarthritis, clarifying its efficacy characteristics and clinical advantages while providing essential quantitative data for clinical practice and future trials.

Keywords

Acupuncture / Model-based meta-analysis / Osteoarthritis / Placebo / WOMAC

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