Comparative effectiveness of Ayurveda and conventional care in knee osteoarthritis – a randomized controlled trial
Dr. med. Christian Kessler, MA, Germany
Background: Ayurveda is used to treat knee osteoarthritis (OA) despite limited evidence in international medical databases. We aimed to evaluate the effectiveness of complex multimodality Ayurvedic treatment in comparison to conventional care in OA knee patients.
Methods: 151 patients (mean age 61.2 years; 116 females, 35 males) with OA of the knee according to American College of Rheumatology (ACR) criteria were included in a multicenter, randomized, controlled trial and treated in 2 hospital outpatient clinics and 2 private outpatient clinics with a total of 5 physicians and 20 therapists participating. Patients received either Ayurvedic treatment (n=77) or conventional care (n=74) with 15 treatments over 12 weeks. Customized Ayurvedic treatment included specific manual treatments and massages, diet counseling including specific consideration of selected food items, the nutritional Ayurvedic supplements Ashvagandha and Yogaraja Guggulu, general and specific lifestyle advice, knee specific yoga posture advice and introduction to daily self-applied knee massage. Primary outcome was the change on the Western Ontario and McMaster University Osteoarthritis Index after 12 weeks (validated German version). Secondary outcomes included the WOMAC subscales (pain: range 0-50; stiffness: range 0-20; and function: range 0-170); a pain disability index, numeric rating scales for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood index, rescue medication use, and safety issues.
Results: Changes of the WOMAC Index from baseline to 12 weeks were more pronounced in the Ayurveda group [mean difference 61.0 (95% CI 52.4; 69.6)] than in the conventional group [32.0 (95% CI 21.4;42.6)] resulting in a significant difference between groups (p<0.001) and a clinically relevant effect size [Cohen’s d 0.68 (95% CI 0.35;1.01)]. Similar tendencies were observed for all secondary outcomes at week 12. Effects were sustainable at follow-ups after 6 and 12 months. Conclusions: The results suggest that a complex Ayurvedic treatment might be clinically superior to complex conventional care in the treatment of knee osteoarthritis.
Registration: The trial was registered at clinicaltrials.gov under NCT01225133.
Funding Source: Ministry of AYUSH, Government of India.