Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.
Rehabilitación San Fernando, Madrid, Spain.
Phys Ther. 2021 Feb 4;101(2). doi: 10.1093/ptj/pzaa216.
The purpose of this study was to evaluate the effects of trigger point (TrP) dry needling alone or as an adjunct to other interventions on pain intensity and related disability in nontraumatic shoulder pain.
Ten databases were searched from inception to January 2020 for randomized clinical trials in which at least 1 group received TrP dry needling for shoulder pain of musculoskeletal origin with outcomes collected on pain intensity and related disability. Data extraction including participant and therapist details, interventions, blinding strategy, blinding assessment outcomes, and results were extracted by 2 reviewers. The risk of bias (Cochrane Risk of Bias, Cochrane Guidelines), methodological quality (Physiotherapy Evidence Database score), and evidence level (Grading of Recommendations Assessment, Development, and Evaluation approach) were assessed. The search identified 551 publications with 6 trials eligible for inclusion.
There was moderate-quality evidence that TrP dry needling reduces shoulder pain intensity with a small effect (mean difference = -0.49 points, 95% CI = -0.84 to -0.13; standardized mean difference = -0.25, 95% CI = -0.42 to -0.09) and low-quality evidence that TrP dry needling improves related disability with a large effect (mean difference = -9.99 points, 95% CI -15.97 to -4.01; standardized mean difference = -1.14, 95% CI -1.81 to -0.47) compared with a comparison group. The effects on pain were only found at short term. The Cochrane Risk of Bias was generally low, but the heterogenicity of the results downgraded the evidence level.
Moderate- to low-quality evidence suggests positive effects of TrP dry needling for pain intensity (small effect) and pain-related disability (large effect) in nontraumatic shoulder pain of musculoskeletal origin, mostly at short term. Future clinical trials investigating long-term effects are needed.
Dry needling is commonly used for the management of musculoskeletal pain. This is the first meta-analysis to examine the effects of dry needling on nontraumatic shoulder pain.
本研究旨在评估触发点（TrP）干针单独或作为其他干预措施的辅助治疗对非创伤性肩部疼痛的疼痛强度和相关残疾的影响。
从建库到 2020 年 1 月，10 个数据库被检索，纳入至少有 1 组接受 TrP 干针治疗肌骨源性肩部疼痛，且收集疼痛强度和相关残疾结局的随机临床试验。由 2 名评审员提取参与者和治疗师的详细信息、干预措施、盲法策略、盲法评估结果和结果。使用 Cochrane 偏倚风险（Cochrane 风险偏倚，Cochrane 指南）、方法学质量（物理治疗证据数据库评分）和证据水平（推荐评估、制定和评价方法）进行风险评估。该搜索确定了 551 篇文献，其中 6 项试验符合纳入标准。
有中等质量证据表明，TrP 干针治疗可降低肩部疼痛强度，效果较小（平均差异=-0.49 分，95%置信区间=-0.84 至-0.13；标准化平均差异=-0.25，95%置信区间=-0.42 至-0.09），且有低质量证据表明，TrP 干针治疗可改善相关残疾，效果较大（平均差异=-9.99 分，95%置信区间=-15.97 至-4.01；标准化平均差异=-1.14，95%置信区间=-1.81 至-0.47），与对照组相比。疼痛的效果仅在短期发现。Cochrane 风险偏倚通常较低，但结果的异质性降低了证据水平。
中等到低质量的证据表明，TrP 干针治疗对非创伤性肌骨源性肩部疼痛的疼痛强度（小效应）和与疼痛相关的残疾（大效应）具有积极作用，主要在短期。需要进一步的临床试验来研究长期效果。
干针治疗常用于治疗肌骨疼痛。这是第一项关于干针治疗非创伤性肩部疼痛的效果的荟萃分析。
