OBJECTIVE: Considering the chronicity of osteoarthritis-associated pain, we aimed to evaluate long-term outcome differences between patients who received immediate or delayed acupuncture in addition to usual care, and to identify predictors for further acupuncture usage and a better long-term outcome. MATERIALS AND METHODS: The Acupuncture in Routine Care study was an open-label randomized pragmatic trial. As adjunct to usual care patients (> 40 y, clinical and radiologic diagnosis of primary osteoarthritis of the knee or hip, pain duration > 6 mo) received either immediate acupuncture in the first 3 months or delayed acupuncture in the subsequent 3 months. After 36 months 613 of 632 patients were available and asked to complete follow-up questionnaires. Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: A total of 500 (82%) of the contacted patients completed questionnaires. After 36 months the WOMAC Index did not differ significantly between groups (immediate acupuncture 36.53 +/- 26.19 versus delayed acupuncture 38.24 +/- 25.54; p = 0.420). Further acupuncture treatment during the follow-up period was reported by 202 patients and predicted by previous successful acupuncture treatment at baseline (odds ratio 2.5; 95% confidence interval 1.6 to 3.9). Less osteoarthritis symptoms (WOMAC Index) after 36 months were predicted by being an acupuncture responder at 6 months (p < 0.001), having higher school education (p = 0.005), not wanting to use medications (p = 0.016), and using additional therapies (p < 0.001 to p = 0.025). DISCUSSION: No long-term outcome differences were found between patients who received immediate versus those who received delayed acupuncture treatment. Education level and additional therapies were identified as predictors for a better long-term outcome.

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