# Acupressure for Managing Osteoarthritis: A Systematic Review and Meta-Analysis
###### Abstract  
This review aims to evaluate the effectiveness of acupressure as a treatment method for osteoarthritis. Fourteen electronic databases were searched from the date of inception until 16 March 2021, for eligible studies. Studies comparing acupressure with sham acupuncture, no intervention or conventional intervention were eligible for inclusion. The risk of bias of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Assessment tool Version 2.0. A total of eight trials were included in this review, focusing on the seven trials investigating knee osteoarthritis. The risk of bias is judged as low in only two trials and concerning in the remaining six trials. The meta-analysis showed that acupressure has equivalent effects in reducing pain (\(p\) = 0.12), relieving stiffness (\(p\) = 0.38), and improving physical function (\(p\) = 0.12), as compared to sham acupressure. Pooled results also showed similar results where acupressure has an equivalent effect in reducing pain (\(p\) = 0.09), and relieving stiffness (\(p\) = 0.68), but showed a favorable effect in improving physical function of joints (MD -6.30, CI 95%: \(-\)11.69 to \(-\)0.92, \(p\) = 0.02), as compared to no intervention. For acupressure complementing conventional intervention, pooled results showed superior effects for easing pain compared to conventional intervention alone (MD -3.72, 95% CI: \(-\)4.84 to \(-\)2.61, \(p\) < 0.00001). Overall, the studies included in this review have concerning quality and suffer from small sample sizes, and the findings of this review should be interpreted with caution. More clinical trials with proper methodology are needed to confirm the effectiveness of acupressure for osteoarthritis.  
acupoint massage; adjunctive therapy; complementary therapy; degenerative arthritis; musculoskeletal diseases +
Footnote †: journal: Medical  
including acupuncture, yoga, manual therapy, and electrotherapy, are recommended for the OA treatment by the National Clinical Guideline Centre in United Kingdom and the American Academy of Orthopedic Surgeons (AAOS) [8]. Among the complementary and alternative options for the treatment of OA, the clinical evidence of dry seedling [3], moxibustion [2], and yoga [9] have been systematically evaluated, but the clinical evidence of acupuncture for OA treatment has not been systematically examined yet.  
Acupressure is a non-invasive and cost-efficient medical approach and involves applying pressure to the acupoints or meridian points as practiced in Chinese Medicine [10]. Acupressure has been used for various purposes. Previous systematic reviews have investigated the efficacy or the impact of acupuncture as a sole intervention on pain [11], low back pain [10; 12], labor or labor pain [13; 14; 15], neck pain syndrome [16], sleep quality, or sleep disorders [17; 18; 19], promoting the health of older adults [20], respiratory allergic diseases [21], postoperative gastrointestinal symptoms [22], chemotherapy-induced nausea and vomiting [23], primary dysmenorrhea [24; 25; 26], anxiety [27], neurological disorders [28], and symptom management [29; 30; 31]; and other reviews considered acupressure as a complementary intervention with acupuncture on cancer pain [32], cancer-related fatigue [33], weight reduction [34], uremic pruritus [35], premenstrual syndrome [36], and labor pain [37].  
This review aims to add to the existing literature on acupressure as a treatment method for osteoarthritis by systematically reviewing clinical trials for its clinical efficacy.