Knowledge, attitude, and practice regarding acupuncture among patients with knee osteoarthritis: a path analysis

This study aimed to investigate the knowledge, attitudes, and practices (KAP) of patients with knee osteoarthritis (KOA) regarding acupuncture. This multicenter cross-sectional study was conducted in multiple hospitals in Beijing between March and April 2025. Patients diagnosed with KOA completed a structured questionnaire. KAP scores were analyzed, and path analysis was used to examine their interrelationships. A total of 532 valid questionnaires were collected. Participants had a mean age of 49.24 ± 10.53 years, with 50.19% male. Most were married (96.62%), urban residents (82.52%), and had at least an associate degree (66.35%). The KAP scores were 6.21 ± 1.45 (possible range: 0-12), 29.05 ± 3.08 (possible range: 7-35), and 27.46 ± 3.06 (possible range: 7-35), respectively. Path analysis revealed that knowledge was directly associated with attitude (β = 0.315, P = 0.026) and practice (β = 0.125, P = 0.009), while attitude was directly associated with practice (β = 0.623, P = 0.009). Knowledge was also indirectly associated with practice through attitude (β = 0.196, P = 0.023), supporting the mediating role of attitude within the model. Patients with KOA exhibited moderate knowledge, generally positive attitudes, and relatively high engagement in acupuncture practices. Given that knowledge was associated with practice both directly and indirectly through attitude, integrating structured patient education and expectation management into routine KOA care may strengthen shared decision-making, enhance treatment adherence, and optimize real-world therapeutic outcomes.