Efficacy and safety of moxibustion for knee osteoarthritis: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Although several reviews have examined moxibustion for knee osteoarthritis (KOA), they have some methodological limitations. This systematic review aims to synthesize current evidence on various moxibustion interventions for KOA pain relief.

METHODS

We conducted a comprehensive search across seven databases up to June 2024. The Cochrane risk of bias tool (ROB2) was used to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criterion approach was employed to evaluate the certainty of evidence for primary outcomes. Primary outcomes included Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), stiffness, physical function, and total effective rate. Secondary outcomes encompassed adverse events (AEs) and treatment regimen of moxibustion for KOA. Meta-analysis was performed using STATA 17.0 and RevMan 5.4.1.

RESULTS

A total of 43 studies with 4008 participants were included in this review. Moxibustion significantly reduced WOMAC (-0.91, 95 % CI: -1.12, -0.70) and VAS scores (-0.95, 95 % CI: -1.18, -0.73). Electronic moxibustion was the most effective intervention. Treatment frequencies exceeding three times per week were more effective than fewer sessions. The total effective rate was 93.11 % for the moxibustion group versus 76.41 % for the controls. AEs were reported in sixteen studies, with one serious AE.

CONCLUSION

Moxibustion is more effective for pain relief than other treatments and has a lower incidence of AEs. Further high-level evidence is warranted to validate these findings.