Environmental Scan of the United States Regulatory Practices of Physical Therapy Dry Needling

This study aimed to investigate the dry needling (DN) regulation of physical therapists across United States (US) regulatory jurisdictions and assess alignment of these regulations with identified DN regulatory recommendations.

Using Choo's modes of environmental scanning framework, we conducted a comprehensive review of DN regulations by collecting data from physical therapy jurisdictional regulatory authorities' websites and by contacting their representatives directly. Comparisons of DN regulation to documents offering DN regulation recommendations were made by collecting information on DN regulation, pre-requisites, approved courses, course criteria, instructional hours, method of registration, and continued competency.

Of 56 physiotherapy jurisdictions in the United States (50 states, 1 district and 5 territories), 43 jurisdictions permit physical therapists to practice DN. Of these, 22 legislate it, 2 regulate it using DN policy, 5 have both legislation and policy, and 14 have neither. Additionally, 5 prohibit the practice and 8 are silent on the topic. Comparisons of jurisdictional DN regulations to documents presenting regulation recommendations highlight gaps in regulation across jurisdictions. Jurisdictions have multiple and inconsistent requirements, including 24 jurisdictions having a course approval process, 22 requiring specific course content for DN courses, 21 requiring a minimum duration of DN instruction, 11 requiring clinical experience prior to practicing DN, 7 having an attestation form for DN, 4 reporting a registration or rostering system of physical therapists practicing DN and 1 mandating continued competency education for DN.

This environmental scan highlights the heterogeneity and gaps in DN regulations across US physical therapy regulatory jurisdictions. Our findings suggest that national regulatory guidelines may help reduce heterogeneity across jurisdictions by ensuring a minimal standard of competency, specifically from a safety perspective.