Effectiveness of Inclusion of Dry Needling Into a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial.

J Orthop Sports Phys Ther. 2017 May 13;:1-43

Authors: Espí-López GV, Serra-Añó P, Vicent-Ferrando J, Sánchez-Moreno-Giner M, Arias-Buría JL, Cleland J, Fernández-de-Las-Peñas C

Abstract
Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions including exercise therapy may be effective for patellofemoral pain (PFP), however no study has investigated the effects of trigger point dry needling (TrP-DN) in people with PFP. Objectives To compare the effects of adding TrP-DN into a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n=60) recruited from a public hospital in Valencia (Spain) were randomly allocated to manual therapy and exercises (n=30) or manual therapy and exercise plus TrP-DN (n=30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks). The manual therapy and exercise plus TrP-DN group also received TrP-DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS, 0-100 scale) was used as the primary outcome. Secondary outcomes included other subscales of KOOS, the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), and the numerical pain rate scale (NPRS). Patients were assessed at baseline, 15 days (post-treatment) and 3 months follow-up. Analysis was with mixed ANCOVAs adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-groups differences (all, P>0.391) were observed for any outcome: KOOS-P, mean difference -2.1 (95%CI -4.6, 0.4); IKDC, 2.3 (-0.1, 4.7); knee pain intensity, 0.3 (-0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (Standardized Mean Differences of 0.6 to 1.1), however only the KOOS-SP subscale surpassed the pre-specified minimum important change. Conclusions The current clinical trial suggests that the inclusion of 3 sessions of TrP-DN into a manual therapy and exercise program did not result in improved outcomes for pain and disability in individuals with PFP at 3-month follow-up. Level of Evidence Therapy, Level 1b. Prospectively registered July 27, 2015 on www.clinicaltrials.gov (NCT02514005). J Orthop Sports Phys Ther, Epub 13 May 2017. doi:10.2519/jospt.2017.7389.

PMID: 28504067 [PubMed – as supplied by publisher]