Acupressure plus education program improves mobility, eases knee osteoarthritis pain
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Key takeaways:
- Self-administered acupressure plus knee health education was cost-effective for knee OA pain relief.
- Future studies should incorporate acupressure rods to prevent finger overexertion.
Self-administered acupressure, combined with a short education program, was a cost-effective method of pain relief that boosted mobility in adults with probable knee osteoarthritis, according to data published in JAMA Network Open.
“Acupressure stimulates the same acupoints as acupuncture with the use of fingers, hands or elbows, based on traditional Chinese medicine meridian theory,” Wing-Fai Yeung, PhD, associate professor at the Hong Kong Polytechnic University, and colleagues wrote. “The effectiveness of the traditionally used acupoints now being used in clinical practice for knee OA remains uncertain.”
To assess the effectiveness of self-administered acupressure, demonstrated in a brief training course, in improving knee OA pain, Yeung and colleagues conducted an assessor-blinded, two-group randomized clinical trial. Participants included 314 adults with a mean age of 62.7 years, recruited through public posters and social media from September 2019 to May 2022.
To be eligible, participants had to be aged 50 years or older and fulfill three of five criteria associated with probable diagnosis of knee OA, such as morning stiffness. Half were randomly assigned to receive self-administered acupressure training and knee health education, while half were randomly assigned to knee health education only.
The intervention consisted of two 2-hour training sessions on self-administered acupressure conducted in small groups. The course included a “brief version” of a knee health education protocol from the Hong Kong Department of Health, the researchers wrote. Meanwhile, the control group was given education on maintaining knee health on the same schedule and for the same duration.
The primary outcome was numerical rating scale (NRS) pain score at 12 weeks, with other outcomes including Short Form 6 Dimensions (SF-6D) score. An incremental cost-effectiveness ratio was also calculated, while a cost-effectiveness acceptability curve was plotted to show “the probability that the intervention was cost-effective for a range of willingness-to-pay threshold values,” the researchers wrote.
Compared with the control group, those who received the intervention demonstrated significantly reduced NRS pain score (mean difference –0.54 points; 95% CI, –0.97 to –0.1) at 12 weeks, as well as greater improvement in SF-6D utility score (mean difference 0.03 points; 95% CI, 0.003-0.01). The cost-effectiveness acceptability curve, meanwhile, showed a greater than 90% chance that the intervention is “cost-effective at a willingness to pay threshold of 1 GDP per capita,” according to the researchers.
Adverse events were reported by 13.4% of participants. According to the researchers, all were “mild and self-resolved,” except for one participant who dropped out of the program due to finger joint pain.
“This study, to our knowledge, was the largest RCT that examined the effectiveness of [a self-administered acupressure] program for probable knee OA along with health economic analyses,” Yeung and colleagues wrote. “Our study found a small effect size for the [self-administered acupressure] training program in relieving knee pain by NRS compared with [knee health education] alone. To enhance the safety of [self-administered acupressure], future studies should promote the use of acupressure rods to prevent finger overuse and overexerting pressure on acupoints.”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
A group of 314 patients in Hong Kong with probable knee osteoarthritis were randomized to receive acupressure that consisted of two training sessions and knee treatment education, with improvements in their symptoms and signs. This is promising, but the study is very weak.
First, patients were diagnosed with probable and not definite osteoarthritis, which confounds the data. Cost effectiveness, which is claimed, is not necessarily valid in the United States, which has a different health care system. In the United States, health providers are culturally less familiar with a Chinese system of implementation.
There are also many different presentations of knee osteoarthritis, and the patients were examined by different practitioners, which makes the findings less consistent.
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