Baseline Examination Factors Associated With Clinical Improvement After Dry Needling in Individuals With Low Back Pain.

J Orthop Sports Phys Ther. 2015 Jun 25;:1-31

Authors: Koppenhaver SL, Walker MJ, Smith RW, Booker JM, Walkup ID, Su J, Hebert JJ, Flynn T

Abstract
Study Design Quasi-experimental. Objectives To explore for associations between demographic, patient history, and physical examination variables and short-term improvement in self-reported disability following dry needling therapy performed on individuals with low back pain (LBP). Background Dry needling is an intervention used with increasing frequency in patients with LBP, however, the characteristics of patients who are most likely to respond are not known. Methods Seventy-two volunteers with mechanical LBP participated in the study. Potential prognostic factors were collected from baseline questionnaires, patient history, and physical examination tests. Treatment consisted of dry needling to the lumbar multifidus muscles bilaterally which was administered during a single treatment session. Improvement was based on percent change in the Oswestry Disability Index (ODI) at 1 week. The univariate and multivariate associations between 33 potential prognostic factors and improved disability were assessed with correlation coefficients and multivariate linear regression. Results Increased LBP with the multifidus lift test (MLT) (rpb = 0.31, P = .01) or during passive hip flexion performed with the patient supine (rpb = 0.23, P = .06), as well as positive beliefs about acupuncture/dry needling (ρ = 0.22, P = .07) demonstrated univariate associations with ODI improvement. Aggravation of LBP with standing (rpb = -0.27, P = .03), presence of leg pain (rpb = -0.29, P = .02), and any perception of hypermobility in the lumbar spine (rpb = -0.21, P=.09) were associated with less improvement. The multivariate model identified 2 predictors of improved disability with dry needling: pain with MLT and no aggravation with standing (R(2) = 0.16, P = .01). Conclusion Increased LBP with the MLT was the strongest predictor of improved disability after dry needling suggesting that the finding of pain during muscle contraction should be studied in future dry needling studies. J Orthop Sports Phys Ther, Epub 25 Jun 2015. doi:10.2519/jospt.2015.5801.

PMID: 26110549 [PubMed – as supplied by publisher]