Symposium 6 - Evidence-based Development in Integrated Chinese-Western Medicine

膝骨关节炎（Knee Osteoarthritis, KOA）是中老年人群中的常见慢性退行性疾病，其高发病率与致残率对患者生活质量及社会医疗资源造成重大影响。也是全球中老年健康问题。本报告回顾了AAOS指南三个版本的演变，结合《膝骨关节炎中西医结合诊疗指南（2023版）》，探讨中国KOA中西医结合指南的现状与战略发展方向。
近年来，中国在KOA指南制定方面取得显著进展。中医指南强调辨证论治与整体观念，治疗方法多样；西医指南以临床实用性为导向，强化循证医学基础。中西医结合指南融合传统与现代医学优势，构建多维度诊疗体系，规范中医特色疗法应用，并在科学性与文化性之间寻求平衡。
目前中西医结合诊疗指南构建了中西医协同框架；实现中西医技术的深度融合；将KOA纳入慢病管理、细化临床分期，更有利于中西医结合实践。
中国KOA中西医结合指南的战略发展，需着重关注以下几个关键方向：构建中西医结合的"标准化-个体化"双轨体系，促进技术创新：从"叠加"到"融合"从"光学工程"到"人工智能"，如研制智能可穿戴康复设备的研发，监测患者的功能恢复与治疗效果；政策与多学科协作的顶层设计，通过多维度努力，构建具有中医特色且符合国际诊疗规范的指南体系，为全球KOA防治贡献中国智慧与方案。
Knee Osteoarthritis (KOA) is a common chronic degenerative disease among middle-aged and elderly individuals, with high incidence and disability rates significantly impacting patients' quality of life and societal medical resources. It also represents a major health issue for the global middle-aged and elderly population. This report reviews the evolution of the three versions of the AAOS guidelines, combining them with the 'Chinese-Western Combined Diagnosis and Treatment Guidelines for Knee Osteoarthritis (2023 Edition)' to explore the current status and strategic development direction of combined traditional and Western medicine guidelines for KOA in China.
In recent years, China has made significant progress in the formulation of KOA guidelines. Traditional Chinese medicine guidelines emphasize pattern identification and holistic concepts, offering a variety of treatment methods. Western medicine guidelines focus on clinical practicality and strengthen the foundation of evidence-based medicine. Integrated guidelines combining both traditional and modern medicine leverage the strengths of each, establishing a multidimensional diagnostic and treatment system. They standardize the application of distinctive TCM therapies while seeking a balance between scientific rigor and cultural relevance.
The current integrated Traditional Chinese Medicine (TCM) and Western Medicine diagnostic and treatment guidelines have established a collaborative framework for TCM and Western Medicine; they achieve deep integration of TCM and Western medical techniques; incorporating KOA into chronic disease management and refining clinical staging better facilitates the practice of integrating TCM and Western Medicine.
The strategic development of the Chinese KOA Integrated Traditional and Western Medicine Guidelines should focus on the following key directions: Establishing a dual-track system of "standardization-individualization" for integrated traditional and Western medicine to promote technological innovation; Transitioning from "addition" to "integration", from "optical engineering" to "artificial intelligence," such as the development of intelligent wearable rehabilitation devices to monitor patients' functional recovery and treatment outcomes. Constructing clinical guidelines that embodies the unique characteristics of traditional Chinese medicine while aligning with international clinical standards through coordinated policy frameworks and multidisciplinary collaboration, with the goal of contributing valuable insights to the global challenge of KOA prevention and management.

In 2014, the Government engaged the Hospital Authority (HA) to implement the Integrated Chinese-Western Medicine (ICWM) Pilot Programme to provide ICWM treatment for HA in-patients

 In parallel with the establishment of the Clinical & Corporate Governance, collaboration model and evidence based approached, two designated hospital sites (Kwong Wah Hospital & Pamela Youde Nethersole Hospital) were founded for the pilot ICWM program of musculoskeletal (MSK) pain.


As at Oct 2024, total 16 hospital sites covered all Clusters for ICWM MSK Pain developed and in service under the same protocol. 


 With the concrete policy initiatives and expert support from Greater Bay Area (GBA) & local Chinese Medicine experts, the Chief Executive's Policy Address 2023 identified the disease areas of advantages of ICWM and proceeded to extend services to cover more degenerative disease areas.


 Degenerative knee osteoarthritis (OA knee) is a rapidly growing service load to Orthopaedics due to the ageing population. OA knee covers a wide spectrum of conditions which should be matched with the appropriate multi-pronged treatment strategies included both surgical or non-surgical care.


Conventional non-surgical care typically includes analgesics, physiotherapy and patients' empowerment programmes. Evidence based medicine has well confirmed the role of ICWM for symptom and functional improvement for selected groups of OA knee patients. The ICWM OA knee services commenced in Pok Oi Hospital in 2024, building on conventional care by incorporating Chinese medicine treatment for suitable patients upon agreement by the ICWM team. This was the first ICWM out-patient services which enhances the patients' access to an integrated approach of non-surgical care of OA knee.
 
 The ICWM team composed of Orthopaedic surgeons, Chinese Medicine practitioners and ICWM experts from GBA who evaluate, discuss and formulate the ICWM treatment plan together in the clinic. Chinese Medicine treatment modalities, mainly acupuncture, can be conducted in the clinic setting.
 
 After the successful implementation in Pok Oi Hospital, three more ICWM OA knee clinics have been established in other clusters and serving selected OA knee patients with well matched treatment plan.