Unravelling the mechanisms behind the short-term effects of dry needling: new insights from a mediation analysis with repeatedly measured mediators and outcomes.

Autor:	Murillo C; Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium. Electronic address: Ezcurra@cuanschutz.edu., Cerezo-Téllez E; Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain., Torres-Lacomba M; Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain; Physiotherapy in Women's Health Research Group, Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain., Pham TQ; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States., Lluch E; Department of Physical Therapy, University of Valencia, Valencia, Spain., Falla D; Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom., Vo TT; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2024 Aug 13. Date of Electronic Publication: 2024 Aug 13.
DOI:	10.1016/j.apmr.2024.07.016
Abstrakt:	Objective: to explore the causal pathways underlying the short-term effects of deep dry needling (DDN) in people with chronic neck pain. Design: explanatory longitudinal mediation analysis with repeatedly measured mediators and outcomes. Setting: primary care setting PARTICIPANTS: 128 patients with chronic neck pain. Interventions: Participants were randomized in 2 groups; DDN of the neck muscles combined with stretching (N = 64) and stretching alone (N=64). Outcome Measures(s): Two outcomes (pain intensity and neck pain-related disability) and 3 candidate mediators (local pain pressure thresholds (PPTs), cervical range of motion (ROM) and neck muscle strength) were included. Pain intensity was also included as a competing mediator in the mediation analysis for disability. Mediators and outcomes were measured at three timepoints; post-intervention and 2- and 4-week follow-up. Age, gender and the baseline values of the outcome and mediators were included as pre-treatment mediator-outcome confounders. Results: reductions in pain intensity strongly mediated the short-term effects of DDN on disability, from post-intervention to 4-week follow-up. In addition, the attenuation of local hypersensitivity (via increasing PPTs) moderately mediated reductions in pain intensity at each timepoint. On the other hand, gains in cervical ROM contributed to reducing neck pain-related disability. Changes in muscle strength did not lead to better outcomes. Conclusion: this novel study demonstrated that DDN effect on neck pain-related disability is strongly driven by the analgesic effects of this physical therapy modality. Increasing PPTs and cervical ROM seem to be also part of the mechanisms behind DDN's effect. Competing Interests: Declaration of competing interest The authors report no competing interests. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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