The Effectiveness of Dry Needling in Patients with Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Abstract

Background: Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger points in the soft tissues. Dry needing (DN) is the most investigated technique for the treatment of myofascial trigger points. Thus, the aim of this study was to evaluate the effectiveness of DN in pain and physical function in patients with osteoarthritis in the short-, medium- and long-term.

Methods: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in September 2022. Randomized controlled trials involving DN compared to non-pharmacological interventions, sham techniques or no additional treatment were selected. Quality of the studies was assessed with PEDro scale and risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using fixed or random effects models according to the Cochrane handbook for systematic reviews of interventions.

Results: Seven studies were included in the meta-analysis involving 291 patients with osteoarthritis. The methodological quality of the included studies ranged from fair to high. DN showed significant improvements in pain intensity (SMD = -0.76; 95% CI: -1.24, -0.29; I²: 74%) and physical function (SMD = -0.98; 95% CI: -1.54, -0.42; I²: 75%) in the short-term. No differences were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence to very low.

Conclusions: Very low-quality evidence suggests a positive effect of DN for reducing pain intensity and improving physical function in the short term in patients with osteoarthritis. Further investigation is needed to determine a medium- and long-term effects.

Keywords: dry needling; meta-analysis; osteoarthritis; systematic review.

Figure A1

Funnel plot pain intensity in the short-term.

Figure A2

Funnel plot pain intensity in the medium-term.

Figure A3

Funnel plot pain intensity in the long-term.

Figure A4

Funnel plot physical function in the short-term.

Figure A5

Funnel plot physical function in the medium-term.

Figure A6

Funnel plot physical function in the long-term.

Figure 1

PRISMA flowchart of the study.

Figure 2

Risk of bias Cochrane tool [34,35,36,37,38,39,40].

Figure 3

(A) Forest plot of pain intensity for DN therapy versus sham, exercise or no intervention in the short-term. (B) Forest plot of pain intensity for DN therapy versus sham or exercise intervention in the medium-term. (C) Forest plot of pain intensity for DN therapy versus sham or exercise intervention in the long-term. (D) Forest plot of physical function for DN therapy versus sham, exercise, or no intervention in the short-term. (E) Forest plot of physical function for DN therapy versus sham or exercise intervention in the medium-term. (F) Forest plot of physical function for DN therapy versus sham or exercise intervention in the long-term [34,35,36,37,38,39,40].

Figure 3

(A) Forest plot of pain intensity for DN therapy versus sham, exercise or no intervention in the short-term. (B) Forest plot of pain intensity for DN therapy versus sham or exercise intervention in the medium-term. (C) Forest plot of pain intensity for DN therapy versus sham or exercise intervention in the long-term. (D) Forest plot of physical function for DN therapy versus sham, exercise, or no intervention in the short-term. (E) Forest plot of physical function for DN therapy versus sham or exercise intervention in the medium-term. (F) Forest plot of physical function for DN therapy versus sham or exercise intervention in the long-term [34,35,36,37,38,39,40].