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Dry-needling and exercise for chronic whiplash-associated disorders: a randomized single-blind placebo-controlled
Michele Sterling1, Bill Vicenzino, Tina Souvlis
1Griffith Health Institute, Centre of National Research on Disability and Rehabilitation Medicine (CONROD) and Centre for Musculoskeletal Research and School of Allied Health, Griffith University, Parklands, Australia University of Queensland, School of Health and Rehabilitation Sciences, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Brisbane, Australia Healthindustry.com.au Pty Ltd, New Farm, Australia Griffith University, Gold Coast, Australia Centre of National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Brisbane, Australia Australian Centre for Economic Research on Health, The University of Queensland, Edith Cavell Building, Royal Brisbane and Women's Hospital, Brisbane, Australia School of Economics, The University of Queensland, Brisbane, Australia University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract:
This randomized controlled trial investigated the effectiveness and cost-effectiveness of dry-needling and exercise compared with sham dry-needling and exercise for chronic whiplash-associated disorders (WAD). The setting was a single university centre and 4 physiotherapy practices in Queensland, Australia. Eighty patients with chronic WAD (>3 months) were enrolled between June 2009 and August 2012 with 1-year follow-up completed in August 2013. The interventions were 6 weeks of dry-needling to posterior neck muscles (n = 40) and exercise or sham dry-needling and exercise (n = 40). The primary outcomes of the Neck Disability Index (NDI) and self-rated recovery were measured at baseline, 6 and 12 weeks, 6 and 12 months by a blinded assessor. Analysis was intention to treat. An economic evaluation was planned but missing data deemed further analysis unwarranted. Seventy-nine patients (99%) were followed up at 6 weeks, 78 (98%) at 12 weeks, 74 (93%) at 6 months, and 73 (91%) at 12 months. The dry-needling and exercise intervention was more effective than sham dry-needling and exercise in reducing disability at 6 and 12 months but not at 6 and 12 weeks. The treatment effects were small and not clinically worthwhile. At 6 weeks, the treatment effect on the 0-100 NDI was -0.3 (95% confidence interval -5.4 to 4.7), 12 weeks -0.3 (-5.2 to 4.9), 6 months -4.4 (-9.6 to -0.74), and 12 months -3.8 (-9.1 to -0.5). There was no effect for self-rated recovery. In patients with chronic WAD, dry-needling and exercise has no clinically worthwhile effects over sham dry-needling and exercise.
