Self-administered acupressure for knee osteoarthritis in older adults at Hong Kong community centers

An Implementation Science Approach to Evaluating Self-Administered Acupressure for Knee Osteoarthritis in Older-Aged Adults in the Community

This project tests whether a self-taught acupressure program can reduce knee pain and improve function for older adults with knee osteoarthritis who attend Hong Kong community centers.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 368 (estimated)
• Ages: 60 Years and up
• Sex: All
• Sponsor: The Hong Kong Polytechnic University (other)
• Locations: 1 site (Kowloon)
• Trial ID: NCT07329023 on ClinicalTrials.gov

What this trial studies

This pragmatic cluster randomized controlled trial delivers a self-administered acupressure (SAA) program through district elderly community centers in Hong Kong, training frontline workers and participants with two sessions plus ongoing support. The trial uses a mixed-methods approach, measuring clinical outcomes (pain, knee function, quality of life) over 24 weeks while applying the RE-AIM framework to capture reach, adoption, implementation, and maintenance. Qualitative interviews with staff and participants will explore facilitators and barriers to real-world adoption and sustainability. The control arm receives general health education to reflect usual community services.

Who should consider this trial

Good fit: Ideal participants are community-dwelling ethnic Chinese adults aged 60 or older with at least three months of knee pain consistent with knee osteoarthritis, who can read Chinese, understand Cantonese or Mandarin, and have access to a WhatsApp-compatible smartphone.

Not a fit: Those unlikely to benefit include people with non-osteoarthritis causes of knee pain, medical conditions that prevent active participation (for example bleeding disorders or severe uncontrolled illness), inability to learn or perform acupressure, or no access to a compatible smartphone or community center services.

Why it matters

Potential benefit: If successful, this could provide a low-cost, non-drug way for older adults to reduce knee pain and improve function that can be scaled within community centers.

How similar studies have performed: Previous randomized trials of acupressure for knee osteoarthritis have shown symptom benefit, but implementation and long-term sustainability in community settings remain less tested.

Eligibility criteria

Inclusion Criteria:

1. ethnic Chinese;
2. aged 60 years or above;
3. able to read Chinese and comprehend Mandarin or Cantonese;
4. fulfilling any 3 of the following criteria. i. morning stiffness 30 min; ii. crepitus on active joint motion; iii. bone tenderness; iv. bone enlargement; or v. no palpable joint warmth (this classification on those with age \>50 years yielded 84% sensitivity, and 89% specificity for OA knee diagnosis (25));
5. having knee pain for at least 3 months (26);
6. knee pain 23 on a Likert pain scale from 1-10;
7. having a smartphone (or a family member living together having a smartphone) that is compatible with WhatsApp (based on our previous studies, almost every eligible subject is used to using WhatsApp for social communication); and
8. willing to provide informed consent.

Exclusion Criteria:

1. medical diagnoses or conditions that preclude individuals from active participation (e.g., bleeding disorders, alcohol, or drug abuse);
2. knee pain related to other conditions (cancer, fracture, rheumatoid arthritis, and rheumatism) as screened according to the red flags for further investigation or referral in the NICE 2014 Guidelines for Osteoarthritis of the knee (27);
3. score \< 22 in Hong Kong Montreal Cognitive Assessment (HK-MoCA) indicating cognitive impairment that may prevent the understanding of training instructions (28);
4. body mass index over 30, the obese Il criteria for Asians (29) (obese subjects will find great difficulty in performing acupressure on acupoints because physical pressure reaching the muscle is required); and
5. ever had knee-replacement surgery

Further investigation or referral, either at the screening or during the study, will be made whenever necessary.

Where this trial is running

Kowloon

• The Hong Kong Polytechnic University — Kowloon, Hong Kong (RECRUITING)

Study contacts

• Principal investigator: WIng-Fai YEUNG, Phd — School of Nursing. the Hong Kong Polytechnic University, Hong Kong
• Study coordinator: Wing-Fai YEUNG, PhD

Conditions: Knee Osteoarthritis, knee OA, RCT, pain, osteoarthritis, implementation sciences