Author Names

Reviewer Name

Katharina Harding, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

James Dunning, DPT, MSc, FAAOMPT, Raymond Butts, DPT, MSc, PhD, Ian Young, DSc, PT, Dip Osteopractic,Firas Mourad, PT, OMT, Dip Osteopractic, Victoria Galante, DPT, FAAOMPT, Paul Bliton, DPT, FAAOMPT, Michelle Tanner, DPT, FAAOMPT, and César Fernández-de-las-Peñas, DMSc, PT, PhD

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Yes
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

Patients receiving electrical dry needling experienced greater improvements in related disability than those receiving manual therapy and exercise alone.

Key Finding #2

Individuals receiving electrical dry needling experienced significantly greater decrease in knee pain than those receiving manual therapy and exercise alone.

Key Finding #3

Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving manual therapy and exercise alone.

 

Please provide your summary of the paper

This article compares two different treatment groups in those with knee osteoarthritis (OA) via a randomized clinical trial. One group received manual therapy and an exercise program, while the other received electrical dry needling, manual therapy, and an exercise program. The main objective of this study was to compare the effects of using electrical dry needling as an adjunct treatment to manual therapy and an exercise program on pain, stiffness, function, and disability in individuals with knee OA over 3 months. This study uses Western Ontario and McMaster Universities (WOMAC total score) Osteoarthritis Index to measure related disability. Other outcomes included knee pain intensity via the Numeric Pain Rating Scale (NPRS), and all of the WOMAC subscales. These outcome measures in addition to the tools utilized for data analysis are validated for RCTs to determine that the electrical dry needling, manual therapy, and exercise program group had statistically significant improvements in pain and related disability when compared to the manual therapy and exercise program group.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

This article provides significant data that highlights the short-term benefits when including the use of electrical dry needling with manual therapy and an exercise program when treating individuals with painful knee OA. This study indicates that electrical dry needling should be utilized as an adjunctive therapy for those with knee OA to aid in pain reduction and decreasing related disability. However, these specific results were attained with performing dry needling with a 9-point protocol which physical therapists will need to consider if performing dry needling when treating these individuals. Furthermore, it has not been determined that these results can be generalized with different doses, protocols, and techniques of dry needling. This study also defines manual therapy as passive joint mobilizations and muscle stretching, which can be performed with great variability, thus, also making these results difficult to generalize. Additionally, these results are only applicable within a 3-month time frame, indicating that there should be continued research on the long-term effects of this treatment method. Overall, this study presents a new category of research and practice that physical therapists should continue to consider and investigate when treating individuals with painful knee OA.