OBJECTIVE: To determine the effect on Shoulder Pain and Disability Index (SPADI) scores of adding dry needling to a program of exercise and manual therapy in individuals with subacromial pain syndrome (SAPS). DESIGN: Three-arm randomized trial involving 121 participants with SAPS. METHODS: Participants were randomized to physical therapy (PT) treatment (PT Only), PT and sham dry needling (PT+SDN), or PT and dry needling (PT+DN) groups. The primary outcome was the SPADI at 1 year. Secondary measures included the Physical Function and Pain Interference subscales from the PROMIS-57, the Patient Acceptable Symptom State (PASS), and self-reported shoulder-related health care use. Linear marginal models and generalized estimating equations were used to identify differences between groups at each follow-up. Logistic regression was used to determine differences in health care use between groups at 1 year. RESULTS: Differences (95% confidence interval) in SPADI scores at 1 year between the PT+DN and PT Only (-7.51 [-16.57, 1.54]) and the PT+DN and PT+SDN (-9.85 [-18.98, 0.73]) groups did not reach statistical significance. Differences in the percentage of "yes" responses to the PASS were significant at 6 months between the PT+DN and PT Only groups (34% [14%-55%]) and the PT+DN and PT+SDN groups (24% [4%-45%]) and at 1 year between the PT+DN and PT+SDN groups (28% [7%-49%]). Participants in the PT+DN group were less likely to receive additional care for their shoulder in the year following enrollment (OR = 0.35 [0.13, 0.95]). CONCLUSION: Adding dry needling to a standard PT program did not result in greater improvements in SPADI scores at 1 year. Improvements in secondary outcomes and patient-perceived symptom acceptability may suggest potential clinical value. J Orthop Sports Phys Ther 2026;56(1):50-63. Epub 19 November 2025. doi:10.2519/jospt.2025.13460.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Rehab Clinician (OT/PT) rater
The authors reported that the outcomes were analyzed according to the intention-to-treat (ITT) principle, using linear marginal models for the continuous outcomes. However, this was only a modified intention-to-treat principle with all available data being analyzed; however, the number of participants analyzed at 1 year was not the same as at baseline. The principle of “analysis by assignment or randomization” with missing data imputation would be more consistent with the principle of ITT.
Rehab Clinician (OT/PT) rater
The results suggested that dry needling did not contribute to additional improvements in SPADI scores for people who were already receiving manual therapy and exercise.
, McMaster University