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

Minjin Jang; Yun-Mi Lim; Hyojung Park

doi:10.12799/jkachn.2019.30.1.79

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

Original Article

J Korean Acad Community Health Nurs 2019;30(1):79-89.

Published online: 12 March 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.1.79

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

Minjin Jang¹, Yun-Mi Lim¹, Hyojung Park²

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 20 November 2018 Revised 13 February 2019 Accepted 16 February 2019

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.

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

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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.

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
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age (year)		79.21±5.40	78.35±5.55	347.00	.459^†
Gender	Male	0 (0.0)	2 (7.1)		.491^‡
Gender	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	t	p	M±SD	M±SD	t	p	M±SD	M±SD	t	p	M±SD	M±SD	t	p
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
Variable	Group	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
WOMAC	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
PSQI	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
Duration of sleep (total)	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
Awake	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
REM sleep	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
Light sleep	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
Deep sleep	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.

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