Sánchez-Infante Jorge, Navarro-Santana Marcos J, Bravo-Sánchez Alfredo, Jiménez-Diaz Fernando, Abián-Vicén Javier
Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
Department of Radiology, Rehabilitation and Physiotherapy, University of Complutense de Madrid, Madrid, Spain.
Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzab070.
The main objective of this systematic review and meta-analysis was to determine the short-, medium-, and long-term effectiveness of dry needling (DN) applied by physical therapists to myofascial trigger points for the treatment of pain.
PubMed, Scopus, SportDiscus, and Web of Science databases were searched from their inception to February 2020. Randomized controlled trials that compared DN with other treatments or placebo and measured pain with a visual analog Scale or another numerical pain rating scale were included. Two authors used a personalized form to collect the following data relevant to the objectives of the review from each article independently: study design, purpose, sample size, diagnosis, characteristics of DN intervention, characteristics of placebo intervention, outcome measures, period of assessment, body region, DN technique, and number of sessions. The initial search identified 1771 articles. After the selection, 102 articles were assessed for eligibility; 42 of these articles measuring pain were used for the meta-analysis. Four meta-analyses were performed according to the follow-up period from the last reported treatment.
This meta-analysis found a large effect to decrease pain within 72 hours (standardized mean difference [SMD] = -0.81; 95% CI = -1.21 to -0.40), a moderate effect in 1 to 3 weeks (SMD = -0.69; 95% CI = -1.02 to -0.35), a large effect in 4 to 12 weeks (SMD = -0.85; 95% CI = -1.30 to -0.40), and a large effect in 13 to 24 weeks (SMD = -0.81; 95% CI = -1.64 to -0.03). The risk of bias was generally low; however, the heterogeneity of the results downgraded the level of evidence.
Low-quality evidence that the immediate to 72-hour (large) effect, 4- to 12-week (large) effect, 13- to 24-week (large) effect, and moderate-quality 1- to 3-week (moderate) effect suggested that DN performed by physical therapists was more effective than no treatment, sham DN, and other therapies for reducing pain.
DN is commonly used by physical therapists to treat musculoskeletal pain, and it is very important for physical therapists to know the clinical conditions and time periods for which DN is effective in reducing pain in their patients.
本系统评价和荟萃分析的主要目的是确定物理治疗师对肌筋膜触发点进行干针治疗（DN）在短期、中期和长期缓解疼痛方面的有效性。
检索了PubMed、Scopus、SportDiscus和Web of Science数据库自建库至2020年2月的文献。纳入比较DN与其他治疗或安慰剂，并使用视觉模拟量表或其他数字疼痛评分量表测量疼痛的随机对照试验。两位作者使用个性化表格，从每篇文章中独立收集与本评价目的相关的以下数据：研究设计、目的、样本量、诊断、DN干预特征、安慰剂干预特征、结局指标、评估期、身体部位、DN技术和治疗次数。初步检索共识别出1771篇文章。筛选后，对102篇文章进行了资格评估；其中42篇测量疼痛的文章用于荟萃分析。根据最后一次报告治疗后的随访期进行了四项荟萃分析。
本荟萃分析发现，在72小时内减轻疼痛有显著效果（标准化均数差[SMD]=-0.81；95%置信区间[CI]=-1.21至-0.40），在1至3周有中等效果（SMD=-0.69；95%CI=-1.02至-0.35），在4至12周有显著效果（SMD=-0.85；95%CI=-1.30至-0.40），在13至24周有显著效果（SMD=-0.81；95%CI=-1.64至-0.03）。偏倚风险总体较低；然而，结果的异质性降低了证据水平。
低质量证据表明，即刻至72小时（显著）效果、4至12周（显著）效果、13至24周（显著）效果以及中等质量的1至3周（中等）效果表明，物理治疗师实施的DN在减轻疼痛方面比不治疗、假DN和其他疗法更有效。
DN被物理治疗师广泛用于治疗肌肉骨骼疼痛，了解DN在减轻患者疼痛方面有效的临床情况和时间段对物理治疗师非常重要。
