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Effects of Auricular Acupressure on Joint Pain, Range of Motion, and Sleep in the Elderly with Knee Osteoarthritis

Article information

Res Community Public Health Nurs. 2019;30(1):79-89
Publication date (electronic) : 2019 March 12
doi : https://doi.org/10.12799/jkachn.2019.30.1.79
Minjin Jang1, Yun-Mi Lim1, Hyojung Park,2
1Doctoral Student, Graduate School, College of Nursing, Ewha Womans University, Seoul, Korea
2Professor, College of Nursing, Ewha Womans University, Seoul, Korea
Corresponding author: Park, Hyojung College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemoon-gu, Seoul 03760, Korea. Tel: +82-2-3277-2824, Fax: +82-2-3277-2850, E-mail: hyojungp@ewha.ac.kr
Received 2018 November 20; Revised 2019 February 13; Accepted 2019 February 16.

Abstract

Abstract

Purpose

The purpose of this paper is to determine effects of auricular acupressure on knee pain, range of motion, and sleep in the elderly with knee osteoarthritis.

Methods

This is an experimental study designed with randomization and single-blind in a placebo-control approach. The subjects included the elderly with knee osteoarthritis who were using an elderly welfare facility. In each of the groups, 28 subjects were assigned. For the experimental group, auricular acupressure was applied to five pressure points related to the pain caused by osteoarthritis and sleep. In the case of the placebo-control group, auricular acupressure was applied to other five points than the former. The intervention lasted eight weeks. In order to examine intervention effects of auricular acupressure, joint pain, Pressure Pain Thresholds (PPTs), and extension and flexion range of motion (ROM) were measured weekly. As for the pre-and post-examinations, pain, sleep quality, and the time-by-sleep stage of the patients with knee osteoarthritis were measured.

Results

The VAS scores in the experimental group with auricular acupressure significantly decreased through time (p<.001) and WOMAC also significantly decreased (p<.01) compared with the placebo-control group. However, there were no significant differences in PPTs. The flexion (p<.01) and extension (p<.001) ROMs measured for eight weeks improved over time. Meanwhile, sleep quality improved significantly after the intervention termination (p<.01), but there was no significant difference found in the time-by-sleep stage.

Conclusion

Auricular acupressure applied for eight weeks was found to be effective in reducing joint pain, improving knee ROM, and improving sleep quality in patients with degenerative knee arthritis.

Keywords: Acupressure; Osteoarthritis; Knee; Pain; Range of motion; Sleep stages
Figure 1.

Auricular acupressure point for experimental group (1-A), and placebo control group (1-B).

Figure 2.

Changes in variables (2-A: Visual Analog Scale, 2-B: Pressure Pain Thresholds, 2-C: Knee Flexion, 2-D: Knee Extension) over time.

Homogeneity Test of General Characteristics and Variables between the Two Groups (N=56)

Difference of Joint Pain and Range of motions between the Two Groups for 8 Weeks (N=56)

Difference of the WOMAC, Sleep-Quality, Duration of Sleep between Two Groups (N=56)

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Article information Continued

Copyright © 2019 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1.

Figure 1.

Auricular acupressure point for experimental group (1-A), and placebo control group (1-B).

Figure 2.

Figure 2.

Changes in variables (2-A: Visual Analog Scale, 2-B: Pressure Pain Thresholds, 2-C: Knee Flexion, 2-D: Knee Extension) over time.

Table 1.

Homogeneity Test of General Characteristics and Variables between the Two Groups (N=56)

Characteristics Categories Exp. (n=28)
 Cont. (n=28)
 x2 or t p
n (%) or M±SD n (%) or M±SD
Age (year) 79.21±5.40 78.35±5.55 347.00 .459†
Gender Male 0 (0.0) 2 (7.1) .491‡
Female 28 (100.0) 28 (92.9)
Height (cm) 151.57±5.64 153.11±5.72 472.50 .183†
Body weight (kg) 55.21±7.87 56.29±8.86 -0.48 .634
Time since diagnosis (year) 5.39±5.76 5.58±5.33 405.00 .829†
Pain killer medication Yes 6 (21.4) 9 (32.1) 0.82 .356
No 22 (78.6) 19 (67.9)
Coffee intake No 6 (21.4) 6 (21.4) 5.76 .124
Once a day 13 (46.4) 8 (28.6)
Twice a day 8 (28.6) 7 (25.0)
≥Three times a day 1 (3.6) 7 (25.0)
VAS 6.14±2.01 5.71±2.35 0.73 .467
Pressure pain thresholds (kg/cm2) 4.80±1.50 4.95±1.20 -0.42 .676
WOMAC 43.39±15.84 49.39±11.96 -1.60 .116
Knee Flexion 125.78±12.00 124.93±11.35 0.27 .787
Knee Extension 12.81±7.23 14.69±5.98 -1.06 .295
PSQI 10.00±2.39 10.14±2.29 -0.23 .820
Duration of sleep Total 333.11±80.37 332.86±85.96 0.01 .991
Awake 62.96±24.59 57.29±15.65 1.03 .308
REM sleep 66.61±34.03 63.54±37.84 0.32 .751
Light sleep 221.82±56.11 222.36±69.47 -0.03 .975
Deep sleep 43.93±21.62 46.89±28.68 -0.44 .664
†

Fisher's exact;

‡

Mann-Whitney's U test; Exp=experimental group; Cont.=placebo Control group; VAS=Visual Analog Scale; WOMAC=Western Ontario and Master University Osteoarthritis; PSQI=Pittsburgh Sleep Quality Index; REM=Rapid Eye Movement.

Table 2.

Difference of Joint Pain and Range of motions between the Two Groups for 8 Weeks (N=56)

Day VAS
 Pressure pain thresholds (kg/cm2)
 Knee Flexion
 Knee Extension
Exp. (n=28)
 Cont. (n=28)
 t p Exp. (n=28)
 Cont. (n=28)
 t p Exp. (n=28)
 Cont. (n=28)
 t p Exp. (n=28)
 Cont. (n=28)
 t p
M±SD M±SD M±SD M±SD M±SD M±SD M±SD M±SD
Pre 6.14±2.01 5.71±2.35 0.73 .467 4.80±1.51 4.95±1.20 -0.42 .676 125.78±12.01 124.93±11.35 0.27 .787 12.81±7.23 14.69±5.98 -1.06 .295
1 5.25±1.60 6.54±2.20 -2.50 .016 4.71±1.22 5.09±1.23 -1.16 .252 131.41±14.05 124.07±11.76 2.12 .038 10.58±6.45 15.12±6.62 -2.60 .012
2 5.21±1.85 6.07±2.04 -1.65 .105 4.76±1.05 4.73±1.26 0.08 .936 130.17±13.96 127.78±10.27 0.73 .469 10.09±5.93 15.64±18.76 -1.49 .141
3 5.21±1.47 5.60±1.75 -0.90 .373 4.65±1.02 4.43±1.18 0.75 .457 132.44±12.44 126.98±7.50 1.99 .053 8.70±4.78 15.24±7.20 -4.01 ＜.001
4 4.96±1.26 6.11±1.57 -3.00 .004 4.68±1.01 4.69±1.08 -0.05 .960 133.11±12.15 125.60±10.02 2.52 .015 8.29±3.91 13.61±5.92 -3.96 ＜.001
5 4.57±1.42 5.64±2.06 -2.26 .028 4.70±0.96 4.74±1.30 -0.13 .898 134.18±13.23 126.28±9.44 2.57 .013 7.79±4.32 13.95±7.16 -3.90 ＜.001
6 4.57±1.67 6.00±1.76 -3.12 .003 4.56±1.06 4.24±1.24 1.07 .291 135.84±13.31 127.81±8.17 2.72 .009 5.73±5.31 14.00±7.91 -4.59 ＜.001
7 4.50±1.50 5.82±1.98 -2.81 .007 4.73±1.07 4.31±1.33 1.30 .201 138.20±12.12 128.35±7.50 3.66 .001 5.72±4.09 12.63±7.35 -4.35 ＜.001
8 3.71±1.58 5.11±2.04 -2.85 .006 4.59±1.00 4.99±1.35 -1.27 .208 139.95±10.72 127.97±6.97 4.95 ＜.001 4.18±3.41 11.36±6.73 -5.04 ＜.001
F p F p F p F p
Group 9.72 .003 0.00 .999 8.71 .005 23.46 ＜.001
Time 4.44 ＜ ＜.001 1.67 .103 3.76 .002 7.41 ＜.001
Group*Time 1.91 .080 1.24 .275 2.04 .062 1.52 .175

Exp.=experimental group, Con.=placebo control group; VAS=Visual Analog Scale.

Table 3.

Difference of the WOMAC, Sleep-Quality, Duration of Sleep between Two Groups (N=56)

Variable Group Pretest
 Posttest
 Within group
 Mean difference
 Between groups
M±SD M±SD t p M±SD t p
WOMAC Exp. (n=28) 43.39±15.84 30.36±17.06 -4.34 ＜.001 -13.04±15.90 -2.81 .007
Cont. (n=28) 49.39±11.96 46.68±12.16 -1.28 .212 -2.71±11.24
PSQI Exp. (n=28) 10.00±2.39 8.14±3.39 -2.81 .009 -1.86±3.49 -2.51 .015
Cont. (n=28) 10.14±2.29 10.50±3.05 0.61 .548 0.36±3.11
Duration of sleep (total) Exp. (n=28) 333.11±80.37 334.00±120.69 0.03 .973 0.89±140.19 -0.38 .705
Cont. (n=28) 332.86±85.96 346.96±86.21 0.63 .536 14.11±119.20
  Awake Exp. (n=28) 62.96±24.59 56.46±22.30 -1.09 .287 -6.50±31.67 -1.56 .124
Cont. (n=28) 57.29±15.65 62.61±22.51 1.15 .262 5.32±24.57
  REM sleep Exp. (n=28) 66.61±34.03 62.00±27.98 -0.68 .503 -4.61±35.90 -0.45 .654
Cont. (n=28) 63.54±37.84 63.96±23.90 0.05 .962 0.43±46.93
  Light sleep Exp. (n=28) 221.82±56.11 223.71±76.19 0.12 .903 1.89±81.81 -0.74 .461
Cont. (n=28) 222.36±69.47 240.64±66.64 1.16 .257 18.29±83.52
  Deep sleep Exp. (n=28) 43.93±56.11 41.64±24.04 -0.39 .702 -2.29±31.26 0.24 .808
Cont. (n=28) 46.89±28.68 42.36±20.71 -0.64 .527 -4.54±37.45

Exp.=experimental group, Cont.=placebo control group; WOMAC=Western Ontario and Master University Osteoarthritis; PSQI=Pittsburgh Sleep Quality Index; REM=rapid eye movement.