Comparative effectiveness of Tuina therapy versus manual physical therapy for knee osteoarthritis: a randomized controlled trial
Peihong Ma#, 1, 2, Luping Liu#, 3, Sina Li4, Meiling Cai5, Siyu Han3, Zhiwen Weng3, Qianji Chen6, Yixuan Gao3, Lingyun Zhang3, Guiyun Wu7, Xiaoming Yang3, Yang Zhang3, Duoduo Li3, Changxin Liu3, Ya'nan Sun8, Shiyan Yan9, Xiyou Wang10, Changhe Yu11
Affiliations:
1Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China.
2School of Medical Technology, Tianjin University of Traditional Chinese Medicine, Beijing, China.
3Tuina and Pain Management Department, Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China.
4Pediatrics Department, Inner Mongolia Xing'an Meng People's Hospital, Wulanhaote, China.
5Acupuncture and Moxibustion Department, Langfang TCM Hospital, Langfang, China.
6Acupuncture and Moxibustion Department, Luohu District Chinese Hospital, Shenzhen, China.
7Medical Insurance Payment Department, Beijing Municipal Bureau of Medical Insurance, Beijing, China.
8Traditional Chinese Medicine Department, Xuanwu Hospital Capital Medical University, Beijing, China.
9Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China. yanshiyan@bucm.edu.cn.
10Tuina and Pain Management Department, Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China. dzmyywxy@163.com.
11Tuina and Pain Management Department, Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China. yakno2@163.com.
#Contributed equally.
Abstract
Background: Tuina therapy (Tuina) is commonly utilized for managing knee osteoarthritis (KOA), yet the available evidence is limited. This study aimed to evaluate the effectiveness of Tuina compared to widely accepted manual physical therapy (mPT) for patients with KOA.
Methods: Between Oct 2019 and Oct 2021, patients with KOA (Kellgren-Lawrence score II or III) were randomly assigned in a 1:1 ratio to receive Tuina or mPT, with eight 20-min sessions over 3 weeks. Assessments were performed at baseline, week 4, 8, and 16. The primary outcome was the change of total Western Ontario and McMaster University Osteoarthritis Index (WOMAC) from baseline to week 4. Secondary outcomes included WOMAC subscales, knee pain measures, performance-based tests, quality-of-life measures, and safety assessments. Patients, evaluators, and statisticians were blinded to treatment group assignment. All main analyses were by intention-to-treat.
Results: Of the 140 patients allocated to Tuina or mPT, 127 completed the treatment. There was significant intervention × time interaction observed in the WOMAC-total (F(2, 266) = 3.87, P = 0.02), there was no statistically significant between groups at week 4 (between-group difference: -1.00, 95%CI: -5.33 to 3.33, P = 0.79, Bonferroni correction). By week 8, Tuina showed significantly consistent improvement compared to mPT (between-group difference: -4.33, 95%CI: -8.34 to -0.31, P = 0.03, Bonferroni correction), whereas there were no statistically significant differences between groups at week 16 (between-group difference: 0.74, 95%CI: -3.67 to 5.15, P = 0.37, Bonferroni correction). Most secondary outcomes showed no significant between-group differences, except for the Timed Up and Go Test Time favoring mPT (0.94, 95%CI: 0.03 to 1.85, P = 0.04). No serious adverse events occurred. One patient in the mPT group took the medication and no patients received other therapies for KOA.
Conclusions: Tuina produced beneficial effectiveness similar to mPT in treating KOA.
Trial registration: NCT03966248, Registered on 29/05/2019, ClinicalTrials.gov.
https://doi.org/10.1186/s12906-025-04850-w