Table 6.
Level of Evidence (Grading of Recommendations Assessment, Development, and Evaluation (GRADE)) for dry needling on pain intensity, pressure pain sensitivity, and cervical range of motion in patients with neck pain.
| Number of Studies | Risk of Bias | Inconsistency | Indirectness of Evidence | Imprecision | Publication Bias | Quality of Evidence | MD or SMD (95% CI) |
|---|---|---|---|---|---|---|---|
| Dry Needling vs. Sham/Control vs. Physical Therapy Modalities on Neck Pain Intensity | |||||||
| Immediate Follow-Up (less than 1 week after single session) | |||||||
| Overall effect (n = 11) | No | Serious (I2 = 77%) | No | No | No | Moderate | MD −0.75 (−1.43 to −0.06) * |
| Sham/Placebo/Waiting list/Other form of Dry Needling (n = 6) | No | Serious (I2 = 58%) | No | Serious | No | Low | MD −1.53 (−2.29 to −0.76) * |
| Manual Therapy (n = 3) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD 0.19 (−0.61 to 1.00) |
| Other Physical Therapy Intervention (n = 2) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD −0.07 (−0.51 to 0.37) |
| Short-term Follow-Up (1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 24) | No | Very Serious (I2 = 87%) | No | No | No | Low | MD −0.65 (−1.09 to −0.22) * |
| Sham/Placebo/waiting list/Other form of Dry Needling (n = 6) | No | Very Serious (I2 = 87%) | No | No | No | Low | MD −2.31 (−3.64 to −0.99) * |
| Manual Therapy (n = 7) | No | Serious (I2 = 46%) | No | No | No | Moderate | MD −0.53 (−0.97 to −0.09) * |
| Other Physical Therapy Intervention (n = 13) | No | Serious (I2 = 44%) | No | No | No | Moderate | MD 0.10 (−0.21 to 0.41) |
| Mid-term Follow-Up (more than 12 weeks after intervention) | |||||||
| Overall effect (n = 5) | No | No (I2 = 28%) | No | Very Serious | No | Low | MD −0.27 (−0.73 to 0.18) |
| Manual Therapy (v = 2) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD −0.75 (−1.70 to 0.20) |
| Other Physical Therapy Intervention (n = 3) | No | Serious (I2 = 47%) | No | Very Serious | No | Very Low | MD −0.19 (−0.75 to 0.38) |
| Dry Needling vs. Sham/Control vs. Physical Therapy Modalities on Pain-Related Disability | |||||||
| Short-term Follow-Up (1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 20) | No | Serious (I2 = 58%) | No | No | Yes | Low | SMD −0.26 (−0.48 to −0.05) * |
| Sham/Placebo/Waiting list/Other form of Dry Needling (n = 5) | No | Serious (I2 = 79%) | No | No | No | Moderate | SMD −0.87 (−1.60 to −0.14) * |
| Manual Therapy (n = 7) | No | No (I2 = 23%) | No | No | No | High | SMD −0.20 (−0.49 to 0.10) |
| Other Physical Therapy Intervention (n = 9) | No | No (I2 = 12%) | No | No | No | High | SMD −0.07 (−0.27 to 0.13) |
| Mid-term Follow-Up (more than 12 weeks after intervention) | |||||||
| Overall effect (n = 5) | No | Serious (I2 = 48%) | No | Very Serious | No | Very Low | SMD −0.33 (−0.70 to 0.05) |
| Manual Therapy (n = 2) | No | No (I2 = 0%) | No | Very Serious | No | Low | SMD −0.40 (−0.88 to 0.08) |
| Other Physical Therapy Intervention (n = 3) | No | Serious (I2 = 71%) | No | Very Serious | No | Very Low | SMD −0.29 (−0.88 to 0.31) |
| Dry Needling vs. Sham/Control vs. Physical Therapy Modalities on Pressure Pain Thresholds | |||||||
| Immediate Follow-Up (less than 1 week after single session) | |||||||
| Overall effect (n = 9) | No | Very Serious (I2 = 92%) | No | No | No | Low | MD 4.93 (−42.18 to 52.04) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 4) | No | No (I2 = 28%) | No | Serious | No | Moderate | MD 55.48 (27.03 to 83.93) * |
| Manual Therapy (n = 3) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD −11.77 (−37.02 to 13.47) |
| Other Physical Therapy Intervention (n = 2) | No | Very Serious (I2 = 97%) | No | Very Serious | No | Very Low | MD −58.34 (−159.05 to 42.38) |
| Short-term Follow-Up (1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 17) | No | Very Serious (I2 = 95%) | No | No | No | Low | MD 6.84 (−33.41 to 47.12) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Very Serious (I2 = 90%) | No | Very Serious | No | Very Low | MD 75.53 (−9.82 to 160.88) |
| Manual Therapy (n = 6) | No | Serious (I2 = 75%) | No | No | No | Moderate | MD 32.25 (−1.02 to 65.52) |
| Other Physical Therapy Intervention (n = 8) | No | Very Serious (I2 = 93%) | No | No | No | Low | MD −33.89 (−89.44 to 21.66) |
| Number of studies | Risk of bias | Inconsistency | Indirectness of evidence | Imprecision | Publication bias | Quality of evidence | MD or SMD (95% CI) |
| Dry Needling vs. Sham/Control vs. Physical Therapy Modalities on Cervical Range of Motion | |||||||
| Cervical Flexion (Immediate Follow-Up, less than 1 week after single session) | |||||||
| Overall effect (n = 5) | No | Very Serious (I2 = 83%) | No | Very Serious | No | Very Low | MD 1.93 (−5.90, 9.77) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Very Serious (I2 = 83%) | No | Very Serious | No | Very Low | MD 7.51 (−3.23, 18.25) |
| Manual Therapy (n = 1) | No | No | No | Very Serious | No | Low | MD −6.43 (−17.96, 5.10) |
| Other Physical Therapy Intervention (n = 1) | No | No | No | Very Serious | No | Low | MD −6.37 (−11.09, −1.65) |
| Cervical Flexion (Short-term Follow-Up, 1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 10) | No | Very Serious (I2 = 85%) | No | No | No | Low | MD 1.26 (−3.06, 5.58) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Very Serious (I2 = 87%) | No | Very Serious | No | Very Low | MD 6.76 (−4.53, 18.06) |
| Manual Therapy (n = 3) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD 0.26 (−2.07, 2.60) |
| Other Physical Therapy Intervention (n = 4) | No | Very Serious (I2 = 92%) | No | Very Serious | No | Very Low | MD −1.74 (−10.51, 7.03) |
| Cervical Extension (Immediate Follow-Up, less than 1 week after single session) | |||||||
| Overall effect (n = 5) | No | Serious (I2 = 63%) | No | Very Serious | No | Very Low | MD 5.23 (−1.05, 11.51) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Serious (I2 = 77%) | No | Very Serious | No | Very Low | MD 8.70 (−1.94, 19.35) |
| Manual Therapy (n = 1) | No | No | No | Very Serious | No | Low | MD 1.95 (−11.47, 15.37) |
| Other Physical Therapy Intervention (n = 1) | No | No | No | Very Serious | No | Low | MD 0.68 (−5.01, 6.37) |
| Cervical Extension (Short-term Follow-Up, 1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 10) | No | Serious (I2 = 72%) | No | No | Yes | Low | MD 0.34 (−3.02, 3.70) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Serious (I2 = 66%) | No | Very Serious | No | Very Low | MD 8.26 (−1.36, 17.88) |
| Manual Therapy (n = 3) | No | No (I2 = 0%) | No | Very Serious | No | Low | MD −0.21 (−2.70, 2.28) |
| Other Physical Therapy Intervention (n = 4) | No | Very Serious (I2 = 85%) | No | Very Serious | No | Very Low | MD −3.04 (−9.94, 3.87) |
| Cervical Lateral-Flexion (Immediate Follow-Up, less than 1 week after single session) | |||||||
| Overall effect (n = 4) | No | Serious (I2 = 67%) | No | Very Serious | No | Very Low | MD 2.65 (−2.07, 7.37) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Serious (I2 = 57%) | No | Very Serious | No | Very Low | MD 4.54 (−1.41, 10.48) |
| Other Physical Therapy Intervention (n = 1) | No | No | No | Very Serious | No | Low | MD −0.95 (−2.07, 7.37) |
| Cervical Lateral-Flexion (Short-term Follow-Up, 1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 10) | No | Very Serious (I2 = 86%) | No | No | No | Low | MD 0.30 (−1.00, 1.61) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Serious (I2 = 66%) | No | Very Serious | No | Very Low | MD 3.21 (−2.28, 8.70) |
| Manual Therapy (n = 3) | No | Serious (I2 = 77%) | No | Very Serious | No | Very Low | MD 1.09 (−1.11, 3.28) |
| Other Physical Therapy Intervention (n = 6) | No | No (I2 = 25%) | No | No | No | High | MD −0.58 (−1.59, 0.42) |
| Cervical Rotation (Immediate Follow-Up, less than 1 week after single session) | |||||||
| Overall effect (n = 4) | No | Serious (I2 = 60%) | No | Very Serious | No | Very Low | MD 2.04 (−4.08, 8.15) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | No (I2 = 22%) | No | Very Serious | No | Low | MD 4.51 (−0.96, 9.98) |
| Other Physical Therapy Intervention (n = 1) | No | No | No | Very Serious | No | Low | MD −3.77 (−9.58, 2.04) |
| Cervical Rotation (Short-term Follow-Up, 1 to 12 weeks after intervention) | |||||||
| Overall effect (n = 9) | No | Serious (I2 = 74%) | No | No | Yes | Low | MD −0.23 (−1.40, 1.09) |
| Sham/Placebo/Waiting list/Other form of dry needling (n = 3) | No | Serious (I2 = 71%) | No | Very Serious | No | Very Low | MD 6.20 (−1.08, 13.48) |
| Manual Therapy (n = 3) | No | Serious (I2 = 70%) | No | Very Serious | No | Very Low | MD −0.52 (−1.91, 0.87) |
| Other Physical Therapy Intervention (n = 5) | No | Serious (I2 = 47%) | No | Very Serious | No | Very Low | MD −0.82 (−2.73, 1.09) |
* Statistically significant (p < 0.05). Risk of bias: No: Most information is from results at a low risk of bias. Serious: Crucial limitation for one criterion, or some limitations for multiple criteria, sufficient to lower confidence in the estimate of the effect. and Very Serious: Crucial limitation for one or more criteria sufficient to substantially lower the confidence in the estimate of the effect. Inconsistency: Serious: I2 > 40% and Very Serious: I2 > 80%. Indirectness of Evidence: No indirectness of evidence was found in any study. Imprecision (based on the sample size): Serious: n < 250 subjects and Very Serious: n < 250 and the estimated effect is little or absent. Publication bias (based on funnel plots): Funnel plots are shown as Supplementary Files in those analyses with more than 10 trials. MD: mean differences and SMD: standardized mean differences.