Background: Knee osteoarthritis is known as one of the common causes of disability worldwide. Despite the elderly tendency towards the use of traditional medicine, there is no clear consensus regarding acupressure efficacy to manage symptoms of knee osteoarthritis.
Objective: This study aimed to determine the effect of acupressure on knee osteoarthritis symptoms in the elderly.
Methods: This double-blind randomized clinical trial was performed from February 2017 to July 2018. Ninety-six patients were selected from comprehensive health care centers in Rafsanjan, Iran, according to inclusion criteria and then equally allocated into three groups (acupressure, sham and control) randomly, by the minimization method. The acupressure group received acupressure bilaterally at 6 points in 10 sessions for two minutes for each point in 10-seconds pressure and 2-seconds rest periods. Subjects In the sham group received only touches without any pressure with the same pattern as the acupressure group and the control group received no intervention. The osteoarthritis symptoms were measured before, immediately and one month after intervention on WOMAC scale. Data was analyzed by IBM-SPSS version 22 using Chi-square goodness of fit and repeated measure ANOVA at 0.05 level of significance.
Results: There were no significant differences between-groups regarding demographic characteristics. The mean of WOMAC score were significantly different between the three consecutive measurements (the time effect), (p=0.001, effect size = 0.082). But there was no significant difference between-groups (group effect) (p=0.852, effect size = 0.003). There was a significant difference in the interaction between time and group (p=0.001, effect size = 0.106). 
Conclusion: The study showed that acupressure was able to correct the WOMAC and pain scores in long and short term and improve physical function in short term in patients with knee osteoarthritis. Accordingly, acutherapy as an effective approach can be applied in self-care programs for knee osteoarthritis symptom management in the elderly, but in the sham groups, the selection of acupoint positions could be a crucial factor. 
Trial registration: This trial was registered at the Iranian Registry of Clinical Trials with clinical trial registration number: IRCT20180114038366N1. 
Funding: This study was financially sported by Deputy of Research and Technology of Rafsanjan University of Medical Sciences (Ref: 20.1056).
Keywords: Acupressure, Complementary therapy, Elderly, Osteoarthritis


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