Hands-On Treatment May Help in Knee Osteoarthritis

Acupressure performed by patients on their own was at least somewhat effective for relieving symptoms of knee osteoarthritis (OA) in a randomized trial from Hong Kong, researchers said.

With 314 patients age 50 and up assigned either to twice-daily, self-administered acupressure or to an educational program, the intervention group showed reductions in pain scores, with a mean difference of -0.54 points after 12 weeks (95% CI -0.97 to -0.10 points, P=0.02), on a standard 10-point scale, than were reported by controls, according to Wing-Fai Yeung, PhD, of Hong Kong Polytechnic University, and colleagues.

Patients performing the acupressure also had significantly greater improvement in Short Form-6 Dimensions (SF-6D) utility scores than controls did (mean difference 0.03 points, 95% CI 0.003-0.01), the researchers reported in JAMA Network Open.

Other measures, however, such as Western Ontario-McMaster Universities Osteoarthritis Index (WOMAC) score and Timed Up and Go results, did not differ significantly between groups.

“[W]e found that a short [self-administered acupressure] training program, accompanied with a brief KHE [knee health education] session, could effectively alleviate knee pain and improve mobility in middle- and older-aged adults with probable knee OA,” Yeung and colleagues concluded.

“It was noteworthy that participants showed high acceptability and compliance with the … training program,” they added, observing that it also came with relatively low cost.

These results follow encouraging findings from another randomized trial examining self-performed acupressure. In that trial, the intervention was superior to usual care — but was no better than a sham procedure. As well, Yeung and colleagues noted, the specific acupressure protocol they tested wasn’t commonly used in knee OA, but rather had been geared toward improving sleep and fatigue in cancer survivors. Thus, they felt another trial of acupressure was warranted, this time with a procedure in actual clinical use.

The program used in the new trial was designed by experienced acupuncture practitioners, based on traditional Chinese acupuncture/acupressure theory. Yeung’s group explained that such treatment is now believed to work, in Western scientific terms, by “suppression of peripheral inflammation through the regulation of inflammatory signal transduction and pain signal transduction pathway modulation of ion channels and inhibition of glial cell activation.”

Participants assigned to the intervention received two 2-hour education sessions on how to perform the acupressure, which also included some brief instruction on knee health. Eight well-recognized acupressure points were targeted. Those assigned to the control group got more detailed KHE covering exercise, weight loss, drug treatments, and traditional Chinese therapeutic diets. Both groups were told to practice what they were instructed to do for 12 weeks, with periodic reminder phone calls.

Self-reported pain was the trial’s primary outcome measure. Secondary endpoints included those already mentioned along with fast gait speed and a cost-effectiveness analysis.

Patients’ mean age was about 63 and more than three-quarters were women. Most were in the normal-weight range. Knee pain duration averaged about 7 years. About half had tried Western-developed medications and some 40% had undergone some type of physical therapy. Only a minority had used traditional Chinese medications or external treatments.

At baseline, pain scores on the 10-point scale averaged just over 5. By week 12, these declined by roughly 2 points with acupressure versus about 1.5 points with education only.

Improvements from baseline were seen for most other measures in both groups, with the exception of fast gait speed, which barely changed at all. But with the exception of SF-6D score, the between-group differences fell short of statistical significance.

Costs to deliver the acupressure education were estimated to average about $89 (U.S. dollars), compared with $83 to deliver the control group’s KHE. This difference was statistically significant, but because the improvements in pain and SD-6D scores were greater with acupressure, the intervention was judged to be cost-effective with an incremental cost-effectiveness ratio of about $1,390.

Limitations to the study included its unblinded design plus its conduct in Hong Kong where participants might be particularly inclined to believe in acupressure’s effectiveness. Objective outcomes such as knee swelling or radiographic measures were not tracked. As well, it’s possible that both the acupressure treatment and the KHE content could be modified to improve their respective results.

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