CARE-DN: An Extension of the CARE Guidelines for Dry Needling Case Reports

Background Dry needling (DN) is widely used in musculoskeletal and pain management, yet published DN case reports vary substantially in structure, terminology, and completeness, limiting reproducibility and interpretation. The objective of this study was to develop a consensus-based reporting guideline extension for DN case reports, as an extension of the CARE (CAse REport) guidelines. Methods A protocol was registered a priori on the Open Science Framework (OSF). A two-round modified electronic Delphi process was conducted with an international multidisciplinary panel of clinicians, researchers, and educators experienced in DN and acupuncture. Proposed DN-specific reporting items were generated through structured mapping of the CARE checklist and relevant literature. In Round 1, panellists rated item relevance and provided qualitative feedback. In Round 2, revised items were re-evaluated using a predefined consensus threshold of ≥80% agreement for ratings of 4 or 5 on a five-point relevance scale. An online implementation of the final checklist was subsequently developed and subjected to usability evaluation. Reporting of the Delphi study was guided by the Conducting and REporting of DElphi Studies (CREDES) guideline. Results In total, 13 voting panellists from seven countries participated, with 12 completing Round 2. Overall, 16 DN-specific items achieved the predefined consensus threshold and were integrated into the final CARE-DN checklist. The items address treatment specificity, anatomical targeting, procedural characteristics, needle specifications, imaging use, and clinician expertise. Usability evaluation of the online CARE-DN tool indicated favourable ratings for clarity, navigation, and checklist export, supporting feasibility for routine academic and clinical use. Conclusion CARE-DN provides the first consensus-based reporting guideline extension specifically for DN case reports. By supplementing the original CARE framework with DN-specific items, CARE-DN promotes transparent, accurate, and reproducible reporting. The checklist and accompanying online tool are intended to support authors, reviewers, and editors in improving the quality and interpretability of DN case literature.