Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University , Fort Lauderdale, FL, USA.
J Man Manip Ther. 2020 Sep;28(4):212-221. doi: 10.1080/10669817.2020.1719299. Epub 2020 Feb 12.
The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to MT and exercise in a patient population with AT.
Twenty-two subjects were randomly assigned to a control (MT+Ex) or experimental group (TDN+MT+Ex) and completed eight treatment sessions over 4 weeks with follow up at 3 months. TDN was performed to MTPs in the gastrocnemius, soleus or tibialis posterior each session. The same MT and exercise program was conducted in both groups.
Two of three criteria for feasibility were met. The attrition rate at 4-week and 3-month follow-up was 18.1% and 68%, respectively. Significant differences (p < .05) reported for within group analysis for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 3 months. The GROC was significant for MT + Ex at 3 months. No between group differences were found. The MCID for the FAAM, GROC was surpassed in both groups at 4 weeks and 3 months and NPRS for the MT + Ex group at 4 weeks.
A large RCT to investigate the effects of TDN on MTP in AT is not feasible without modifications due to low recruitment and high attrition rate. Modifications to study design should give consideration for closed or national health-care system for access to large patient populations and reduced financial burden to subjects.
ClinicalTrials.gov identifier: NCT03261504F.
触发点干针（TDN）对跟腱病（AT）中肌筋膜触发点（MTP）的影响尚不清楚。我们进行了一项研究，以测试一项大型随机对照试验（RCT）的可行性，该试验比较了 TDN 与 MT 和运动在 AT 患者人群中的效果。
22 名受试者随机分配到对照组（MT+Ex）或实验组（TDN+MT+Ex），并在 4 周内完成 8 次治疗，3 个月后进行随访。每次治疗均对腓肠肌、比目鱼肌或胫骨后肌的 MTP 进行 TDN。两组均进行相同的 MT 和运动方案。
有三个可行性标准中的两个得到了满足。4 周和 3 个月随访时的脱落率分别为 18.1%和 68%。两组在 4 周和 3 个月时的 FAAM、NPRS、疼痛压力阈值和力量的组内分析均有显著差异（p<.05）。MT+Ex 在 3 个月时的 GROC 有显著差异。两组间无差异。两组在 4 周和 3 个月时 FAAM、GROC 的 MCID 均超过，MT+Ex 组在 4 周时 NPRS 的 MCID 也超过。
由于招募率低和脱落率高，不进行修改，对 AT 中 TDN 对 MTP 的影响进行大型 RCT 是不可行的。研究设计的修改应考虑封闭或国家卫生保健系统，以获得大量患者人群，并减少受试者的经济负担。
ClinicalTrials.gov 标识符：NCT03261504F。
