Knee pain is the illness that has ranked top in the medical cost and visit number in the Korean Medicine (KM) institutions. With the trend that the older aged population is increasing, it is predicted that people with knee pain is increasing resulting in the life quality degradation and the high social costs. In this situation, KM has strength in the clinical practice of knee pain. The purpose of Clinical Practice Guideline (CPG) was to enhance the reliability of KM by reinforcing the evidence with objective and rational verification, to develop a standardized clinical guideline, and to make a reasonable judgment in the treatment of knee pain.
We assembled committee with experts and established development plan. Committee set up key questions and searched relevant evidence comprehensively by using following databases: Pubmed, Ovid-EMBASE, Cochrane library, CNKI, OASIS, and NDSL. The evidence were reviewed according to the pre-defined selection/exclusion criteria, and the guideline draft was made by using the quality of evidence (4 levels: High, Moderate, Low, and Insufficient) and the grade of recommendation (5 grades: A, B, C, D, and GPP) based on the GRADE method. Official consensus was obtained through the following steps: 1) we used the Delphi method to reach agreement on the draft. 2) draft was further revised through external review and produced into the final guideline. 3) guideline obtained confirmation from relevant academic societies.
We classified knee pain into 4 categories (knee osteoarthritis, knee rheumatoid arthritis, soft tissue injury, and other type) and made guideline according to several KM treatments (e.g. manual acupuncture, electroacupuncture, warm or fire needle acupuncture, moxibustion, herbal medicine, pharmacopuncture, acuputomy, cupping, and others). Among them, it was confirmed that pharmacopuncture had moderate evidence and B recommendation level (high considerable) on knee osteoarthritis. To complement the existing CPG published in 2017, we will expand KM treatments (e.g. physiotherapy, chuna, and manipulation therapy), focus on the disease name (e.g. knee osteoarthritis not knee pain), and create evidence through direct execution of randomized clinical trial.
CPG is expected to provide objectivity, rationality, and standard of KM treatment for knee pain by continuous research and supplementation.