Physiother Theory Pract. 2025 Oct 17:1-14. doi: 10.1080/09593985.2025.2575837. Online ahead of print.

ABSTRACT

BACKGROUND: Periosteal and intraarticular electrical dry needling (PIEDN) has been found to reduce pain, stiffness, and disability in individuals with knee osteoarthritis (OA) in the short-term. Optimum dosing interval of PIEDN to maintain these improvements in the longer-term has yet to be determined.

OBJECTIVE: Compare the longer-term effects (30 weeks) of three different dosing intervals of PIEDN boosters on pain, stiffness, and disability in individuals with knee OA, and to quantify the effect size of PIEDN as a stand-alone treatment.

METHODS: Patients with knee OA (n = 586) received PIEDN (1-2 times per week) over 6 weeks. Patients were then randomized to receive a PIEDN booster session once every 4 weeks (n = 195), once every 8 weeks (n = 197), or no further treatment (n = 194) for the next 6 months. The primary outcome was the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index.

RESULTS: Patients receiving PIEDN every 4 weeks experienced significantly greater improvements in disability (WOMAC: F = 33.060; p < .001) than those receiving PIEDN every 8 weeks, or those receiving no further treatment. Patients receiving PIEDN boosters every 4 weeks experienced significantly greater improvements in pain (NPRS: F = 25.678, p < .001; WOMAC-Pain: F = 22.816, p < .001), stiffness (WOMAC-Stiffness: F = 27.416, p < .001) and function (WOMAC-Physical Function: F = 32.856; p < .001). The between-group effect size was large (WOMAC: SMD = 1.32; 95% CI: 1.10, 1.54) at 30 weeks in favor of the group that received PIEDN every 4 weeks. The between-group effect size was large for the NPRS (SMD = 1.14; 95% CI: 0.93, 1.36) at 30 weeks for the PIEDN-4 group. At 30 weeks, significantly more patients in the PIEDN-4 group (n = 123, 63.1%) had completely stopped taking medication compared to the control group (X² = 70.158; p < .001; n = 41, 21.1%).

CONCLUSION: PIEDN boosters every 4 weeks were a more effective dosage regimen for maintaining improvements in pain, stiffness, function, and disability than once every 8 weeks or no further treatment sessions.Trial Registration: www.clinicaltrials.gov XXXXXXX May 4, 2022.

PMID:41104706 | DOI:10.1080/09593985.2025.2575837