Patient case (clinical description): A 47-year-old woman comes to the office complaining of pain in the calf and knee when she bends down. The pain limits her activity. Her medical history is significant for osteoarthritis, for which she uses nonsteroidal anti-inflammatory drugs (NSAIDs) for the past two years. She is living with her husband and has 3 children. She doesn't smoke but drinks alcohol occasionally. Her vital signs are normal. On physical examination, there is a small effusion in the right knee. The effusion grew a little larger and she developed a tender swelling in the popliteal fossa and calf. Both the pain and swelling worsened as she bent and straightened her knee.

Patient's own account: I'm a 47-year-old woman, married with 3 kids. I don't smoke and I drink occasionally. I went to the doctor because of pain in my calf and knee when I was bending down. This has been limiting my daily activities. I have been diagnosed with osteoarthritis for which I have taken anti-inflammatory drugs for the past 2 years. The doctor saw a small fluid buildup in my right knee. This buildup became a bit bigger and I have a swollen calf. The pain is worse when I bend and straighten my knee.

Clinical trial: Self-administered Acupressure for Knee Osteoarthritis in Middle- and Older-Aged Adults

Eligibility criteria:
Inclusion Criteria:

          -  ethnic Chinese;

          -  aged 50 years or above;

          -  ability to comprehend Chinese;

          -  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 yielded 84% sensitivity and 89% specificity
             for OA knee diagnosis);

          -  having knee pain for at least 3 months;

          -  Knee pain ≥3 on a Likert pain scale from 1-10;

          -  having a smartphone (or a family member living together having a smartphone) that is
             compatible to WhatsApp (it is the investigator's experience in the pilot study that
             most of every subject had been used to using WhatsApp for social communication);

          -  willing to provide informed consent

        Exclusion Criteria:

          -  medical diagnoses or conditions that preclude individuals from active participation
             (e.g. bleeding disorders, alcohol or drug abuse);

          -  knee pain related to other conditions (cancer, fracture, rheumatoid arthritis,
             rheumatism) as screened according to the red flags for further investigation or
             referral in the NICE 2014 Guidelines for Osteoarthritis of the knee;

          -  score < 22 in Hong Kong Montreal Cognitive Assessment (HK-MoCA) indicating cognitive
             impairment that may prevent understanding of training instructions;

          -  body mass index over 30, the obese II criteria for Asians (it will be too difficult
             for the obese subjects to perform acupressure on the acupoints as physical pressure
             reaching the muscle is required);

          -  presence of skin lesions or infections at the treatment sites;

          -  ever had knee replacement surgery;

          -  pregnancy or contemplating pregnancy;

          -  ever received acupressure or steroid injection for knee pain over the past 6 months
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 50 Years old.
Subject must be at most 70 Years

Eligibility (NLI label): Contradiction