Effects of Auricular Acupressure on Sleep and Pain in Elderly People Who Have Osteoarthritis and Live in Nursing Homes: a randomized, single-blind, placebo-controlled trial

In Korea, 91.1% of elderly people have more than one chronic disease1. The prevalence of osteoarthritis caused by degenerative arthritis among those aged 65 years of age or older is 47.3%1. On the other hand, the prevalence of pain caused by osteoarthritis among elderly people who live in nursing homes is high, at 30.2%2. In addition, sleep disorders in the elderly with osteoarthritis are found to be higher than in the general elderly population3. There is a correlation between sleep disorders and osteoarthritis pain in the elderly, and osteoarthritis appears to be a risk factor for sleep disorders4. The worsening of the pain caused by osteoarthritis leads to a decrease in the total sleeping time and reduced sleep efficiency5. Moreover, elderly people who live in nursing homes may have severe sleep-wake dysfunction as they experience environmental and lifestyle changes, a decrease in physical activity, limited social interactions, and reduced exposure to daylight6, 7, 8. Drug therapy is provided to improve sleep, but its effect is not satisfactory in the case of the elderly9,10. Also, pain is not properly controlled, and drug compliance is significantly lowered even after the drug therapy, which was provided to reduce pain in elderly people with osteoarthritis11. Since drug therapy has a high risk of side effects and complications, its administration is intended to reduce pain and improve sleep by working in tandem with effective nonpharmacological intervention12, 13, 14.

In some studies on nonpharmacological intervention that intended to reduce pain in elderly people with osteoarthritis, it was discovered that exercise could increase the level of pain15, massage was difficult for self-care16, and tai chi required specialized training17; thus, these interventions cannot be practically applied by elderly people with osteoarthritis who live in nursing homes. Auricular acupressure (AA) is a type of complementary and alternative therapy that can be applied simply and quickly to the elderly, is noninvasive, can be applied by oneself, and has few side effects18. AA allows people to actively participate in their own health care by introducing pressure to auricular points. It is effective in maintaining health by alleviating various acute and chronic symptoms18. AA is backed by scientific evidence and is particularly effective in improving sleep19 and reducing pain20,21.

However, most of the previous studies related to sleep were randomized controlled trials using a subjective instrument to measure sleep and failed to verify the placebo effect by not providing any treatment to the control group19. Also, few studies measured sleep improvement through long-term intervention for more than eight weeks among the elderly with osteoarthritis who live in health-care facilities22. Previous studies on pain included only small samples23, used only a single group without a control group24, or failed to control the placebo effect20; thus, these studies had limitations in terms of research methodology. In addition, most studies measured outcome variables with a subjective tool that failed to provide an objective basis for determining the effects of AA25,26. Accordingly, it was difficult to generalize the results of the previous studies due to methodological limitations and measurement of variables with subjective tools, although AA was an effective intervention for sleep improvement and pain reduction.

Therefore, the main purpose of this study was to examine the effects of AA on sleep and pain in elderly people with osteoarthritis who live in nursing homes through objective measurement. In addition, it aimed to provide an accurate intervention method through scientific evidence by expanding previous studies using randomization, single blinding, and placebo control. The hypothesis of this study was that the application of AA would improve subjective and objective sleep quality. It was also hypothesized that the application of AA would reduce subjective and objective pain intensity.

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