OBJECTIVE: This meta-analysis evaluated the effect of dry needling alone or combined with other treatment interventions on pain, related-disability, pressure pain sensitivity, and strength in people with lateral epicondylalgia of musculoskeletal origin.
DATA SOURCES: MEDLINE, CINAHL, PubMed, PEDro, Cochrane Library, SCOPUS and Web of Science databases from their inception to 5 April 2020.
REVIEW METHODS: Randomized controlled trials collecting outcomes on pain, related-disability, pressure pain thresholds, or strength where one group received dry needling for lateral epicondylalgia of musculoskeletal origin. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the PEDro score, and the quality of evidence by using the GRADE approach.
RESULTS: Seven studies including 320 patients with lateral epicondylalgia were included. The meta-analysis found that dry needling reduced pain intensity (SMD ?1.13, 95%CI ?1.64 to ?0.62) and related-disability (SMD ?2.17, 95%CI ?3.34 to ?1.01) with large effect sizes compared to a comparative group. Dry needling also increased pressure pain thresholds with a large effect size (SMD 0.98, 95%CI 0.30 to 1.67) and grip strength with a small size effect (SMD 0.48, 95%CI 0.16 to 0.81) when compared to a comparative group. The most significant effect was at short-term. The risk of bias was generally low, but the heterogenicity of the results downgraded the evidence level.
CONCLUSION: Low to moderate evidence suggests a positive effect of dry needling for pain, pain-related disability, pressure pain sensitivity and strength at short-term in patients with lateral epicondylalgia of musculoskeletal origin.
LEVEL OF EVIDENCE: Therapy, level 1a.
REGISTRATION NUMBER: OSF Registry - https://doi.org/10.17605/OSF.IO/ZY3E8.
|Rehab Clinician (OT/PT)|
This meta-analysis found low to moderate evidence suggesting a positive effect of dry needling for pain, related-disability, pressure pain sensitivity and strength in lateral epicondylalgia of musculoskeletal origin, mostly at short-term. Seven studies including 320 patients with lateral epicondylalgia were included.
The absence of a de novo finding and the heterogeneity of underlying cause associated with non-specific lateral epicondylar pain ensures the contribution of this meta-analysis is uncertain to those already relatively familiar with the literature. To those, it may not be conceivably of value.