To explore whether the deqi effect affects the effectiveness of manual acupuncture for treating knee osteoarthritis by a network meta-analysis (NMA).

Eight databases were searched for relevant published studies since inception through January 2021. Randomized control trials that compared manual acupuncture with deqi, manual acupuncture without deqi, and conventional treatment of western medicine were included. Languages were limited to English and Chinese. Two authors independently selected eligible studies, assessed methodological quality and the effects of deqi, and extracted outcome data. The mean difference (MD) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated by Stata 15.0 to conduct an NMA based on a frequentist framework.

Fourteen trials with a total of 1868 subjects were included. The direct and indirect comparisons were authentic, according to inconsistency tests. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pooled results indicated that there was no significant effect of deqi (SMD = −0.23, 95% CI [−0.81, 0.35]). The pooled results of visual analogue scale (VAS) were similar to those of WOMAC (MD = −0.53, 95% CI [−1.03, 0.02]).

As a summary of the currently available research, the NMA results indicated that deqi effect might not be the crucial factor for the effectiveness of manual acupuncture.