Blinding Strategies in Dry Needling Trials: Systematic Review and Meta-Analysis

Abstract

Background Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling. Purpose The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials. Data Sources Twelve databases were searched from inception to February 2016. Study Selection Trials that compared active dry needling with a sham that simulated dry needling were included. Data Extraction The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index). Data Synthesis The search identified 4894 individual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding. Limitations Trials were clinically and methodologically diverse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial. Conclusions Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.

Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis

“…Based on the current evidence, it seems that the application alone of dry needling targeting active TrP may be effective for the treatment of neck pain (low-to-moderate evidence); however, the effects were mostly observed at the short-term (2–12 weeks after treatment) and vs. sham/placebo/waiting list/other forms of dry needling but not against manual therapy or physical therapy interventions. In fact, the topic of a proper sham needling approach is questioned, since sham needling interventions used in the current literature are highly diverse, limiting the comparability of blinding effectiveness across current studies [ 52 ]. It has been supported that sham needling could also have a potential therapeutic effect, probably related to cognitive factors, such as expectative or placebo [ 52 ].…”

“…In fact, the topic of a proper sham needling approach is questioned, since sham needling interventions used in the current literature are highly diverse, limiting the comparability of blinding effectiveness across current studies [ 52 ]. It has been supported that sham needling could also have a potential therapeutic effect, probably related to cognitive factors, such as expectative or placebo [ 52 ].…”

Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

“…The topic of a proper sham needling intervention should also be considered, since it is not possible to determine that real dry needling is superior to sham dry needling. In fact, Braithwaite et al concluded that sham needling interventions used in clinical trials are diverse, limiting the comparability of blinding effectiveness across current studies [ 60 ].…”

Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis

“…Braithwaite et al concluded that sham needling approaches used in most studies investigating the effects of dry needling are highly heterogeneous limiting comparability of blinding effectiveness across published trials. 40 Development of proper sham needling interventions and proper blinding of patients during dry needling interventions are needed to further elucidate the true effects of dry needling. In fact, the potential role of patient expectations or previous beliefs in the effects of dry needling has been recently discussed in the literature.…”