Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial

Abstract

Objectives: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA).

Materials and methods: In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months.

Results: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. 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 MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months.

Discussion: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA.

Level of evidence: Level 1b-therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).

FIGURE 1

Standardized 9-point protocol of periosteal electrical dry needling for knee osteoarthritis.

FIGURE 2

Flow diagram of patient recruitment and retention. FU indicates follow-up; OA, osteoarthritis.

FIGURE 3

Evolution of the WOMAC Osteoarthritis Index throughout the course of the study stratified by randomized treatment assignment. Data are means (SE). DN indicates dry needling; WOMAC, Western Ontario and McMaster Universities.

FIGURE 4

Evolution of knee pain intensity (NPRS, 0 to 10) throughout the course of the study stratified by randomized treatment assignment. Data are means (SE). NPRS indicates Numeric Pain Rating Scale.