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Li LW, Harris RE, Tsodikov A, et al. Self-Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2018 Feb;70(2):221-229. doi: 10.1002/acr.23262. Epub 2017 Dec 29.
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Psychologist 6 / 7
Physician 5 / 7
Abstract

OBJECTIVE: This double-blind randomized controlled trial aimed to test the efficacy of self-administered acupressure for pain and physical function improvement for older adults with knee osteoarthritis (OA).

METHODS: Participants were community-dwelling adults with symptomatic knee OA (n = 150, mean age 73 years), randomized to 1 of 3 groups: verum acupressure, sham acupressure, or usual care. Participants in the verum and sham groups, but not those in the usual care group, were taught to self-apply acupressure once daily, 5 days/week for 8 weeks. Assessments were collected during center visits at baseline, and at 4 and 8 weeks. In addition, pain level was assessed weekly by phone using a numeric rating scale (NRS). Outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary), and subjective and objective physical function measures and the NRS and physical function measures (secondary). Linear mixed regression analysis was conducted to test between-group differences in mean changes from baseline for the outcomes at 8 weeks.

RESULTS: Compared with usual care, both verum and sham acupressure participants experienced significant improvements in WOMAC pain (mean difference -1.27 units [95% confidence interval (95% CI) -1.95, -0.58] and -1.24 units [95% CI -1.92, -0.55], respectively), NRS pain (-0.74 units [95% CI -1.24, -0.24] and -0.51 units [95% CI -1.01, -0.01], respectively), and WOMAC function (-4.83 units [95% CI -6.99, -2.67] and -4.21 units [95% CI -6.37, -2.04], respectively) at 8 weeks. There were no significant differences between the verum and sham acupressure groups on any of the outcomes.

CONCLUSION: Self-administered acupressure is superior to usual care in pain and physical function improvement for older adults with knee OA. The reason for the benefits is unclear, and the placebo effect may play a role.

Comments from MORE raters

Physician rater

I'm surprised to find such an article in Arthritis Care & Research. The conclusion should be anything that seems more careful than usual is perceived as better than usual.

Physician rater

Acupressure and placebo acupressure were equivalent, so the premise of acupressure benefit for osteoarthritis is unsupported!

Physician rater

This study shows a clinically significant improvement both with acupressure and sham acupressure in OA knee pain in elderly. There was an improvement seen in all three groups that in my opinion can be explained by a regression to the mean phenomenon, as can be expected during 8 weeks. There was no clinically relevant improvement in the objective measures. It remains likely that a placebo effect is the major explanation for the pain improvement. In my opinion, this study does not prove that the acupressure itself would be better than any other good placebo treatment. The conclusion in the abstract is misleading.

Physician rater

This was a carefully developed and analysed double blind comparison of self-administered acupressure, self-administered sham acupressure, and usual care for older adults with symptomatic OA. More than 50% in all groups had meaningful reduction in pain and all groups had modest improvement in gait speed and comfortable walking speed. There was no difference between real acupressure and sham acupressure but the sites were not chosen specifically for knee OA, but rather had been successful in reducing pain in a group of breast cancer patients. The best conclusions appear to be that participation in a study is beneficial and specific intervention with potential to help appears better than no intervention.
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