A Clinical Study on the Effects of Acupressure Combined with Herbal Poultice in the Treatment of Knee Osteoarthritis: Clinical Outcomes and Patient Satisfaction

Abstract

Introduction and Objectives: Osteoarthritis is a physiological and anatomical disorder of the articular cartilage, leading to structural changes and inflammatory processes within the knee joint. The severity of the disease correlates with pain levels and joint functionality, which limits joint mobility and affects daily activities. According to traditional Thai medicine theory, knee osteoarthritis is believed to result from a blockage of wind energy in the knee joint, causing stiffness and pain, and eventually leading to dysfunction of the earth element. Therefore, traditional Thai medicine treatments focus on relieving the blockage of wind energy in the knee area to reduce pain and improve joint function. This study aims to evaluate the clinical outcomes and patient satisfaction of a treatment combining knee acupressure and knee herbal poultice for patients with knee osteoarthritis.

Methods: This quasi-experimental clinical study was conducted with 36 knee osteoarthritis patients diagnosed by physician at Thepha Hospital, Thepa district, Songkhla province. All patients received knee acupressure combined with knee herbal poultice; knee acupressure at seven points (2 minutes per point for a total of 14 minutes) including signal points 1, 2, 3 of knee, signal point 4 of outer knee, 2 inches above the inner knee joint, signal point 4 of inner knee, and 2 inches below the knee joint. Knee herbal poultice for 30 minutes; the herbal formula, developed by the Traditional Thai Medicine Hospital, Prince of Songkla University, contained Plai (Zingiber cassumunar Roxb.), Dong-dueng (Gloriosa superba L.), Ya-dam (dried resin of Aloe vera (L.) Burm.f.), and camphor. The treatment was administered once daily for three consecutive days. The clinical outcomes were measured pre- and post-treatment. Pain levels were measured using a numerical pain rating scale, and clinical outcomes were assessed with the Thai version of the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which includes 3 questions on pain, stiffness, and functional ability. Patient satisfaction was also evaluated. Data were analyzed using frequency and percentage for pain changes and satisfaction, while paired t-tests were used for clinical outcome comparisons pre- and post-treatment, with a statistical significance level set at 0.05.

Result: After 3 consecutive days of treatment, 55.56% of patients experienced a reduction in pain from moderate to mild levels. Statistical analysis of the modified WOMAC results showed significant improvements in pain, stiffness, and functional ability (p < 0.001). Additionally, patients reported an average satisfaction score of 4.47 ± 0.65, with 55.55% expressing the highest level of satisfaction with the treatment outcomes.

Discussion: Knee acupressure combined with knee herbal poultice effectively reduced pain and improved patient’s clinical outcomes. The 7 knee acupressure points used in this study, based on Thai massage principles and anatomical locations, stimulated blood, and wind circulation around the knee, leading to muscle relaxation and improved joint functionality. The knee herbal poultice formula, containing active ingredients such as terpinene-4-ol, a compound with anti-inflammatory effects, and camphor, which enhance the skin’s absorption of active ingredients. These properties may support the deeper penetration of therapeutic compounds in the knee herbal poultice, contributing to the observed clinical improvements. The effects may also be linked to the gate control theory of pain, which inhibits pain signals from the spinal cord to the brain and stimulates the release of β-endorphins, promoting vasodilation and pain relief.

Conclusion and recommendations: Knee acupressure combined with knee herbal poultice, administered once daily for three consecutive days, significantly reduces pain, stiffness, and improves knee joint function in osteoarthritis patients. This approach can be effectively applied in managing osteoarthritis care.