Dry Needling Plus Manual Therapy and Exercise for Subacromial Pain Syndrome: A Sham-Controlled Randomized Clinical Trial

OBJECTIVE: To determine the effect on Shoulder Pain and Disability Index (SPADI) scores of adding dry needling to a program of exercise and manual therapy in individuals with subacromial pain syndrome (SAPS). U DESIGN: Three-arm randomized trial involving 121 participants with SAPS. U METHODS: Participants were randomized to physical therapy (PT) treatment (PT Only), PT and sham dry needling (PT+SDN), or PT and dry needling (PT+DN) groups. The primary outcome was the SPADI at 1 year. Secondary measures included the Physical Function and Pain Interference subscales from the PROMIS-57, the Patient Acceptable Symptom State (PASS), and self-reported shoulder-related health care use. Linear marginal models and generalized estimating equations were used to identify differences between groups at each follow-up. Logistic regression was used to determine differences in health care use between groups at 1 year. U RESULTS: Differences (95% confidence interval) in SPADI scores at 1 year between the PT+DN and PT Only (−7.51 [−16.57, 1.54]) and the PT+DN and PT+SDN (−9.85 [−18.98, 0.73]) groups did not reach statistical significance. Differences in the percentage of “yes” responses to the PASS were significant at 6 months between the PT+DN and PT Only groups (34% [14%–55%]) and the PT+DN and PT+SDN groups (24% [4%–45%]) and at 1 year between the PT+DN and PT+SDN groups (28% [7%–49%]). Participants in the PT+DN group were less likely to receive additional care for their shoulder in the year following enrollment (OR=0.35 [0.13, 0.95]). U CONCLUSION: Adding dry needling to a standard PT program did not result in greater improvements in SPADI scores at 1 year. Improvements in secondary outcomes and patientperceived symptom acceptability may suggest potential clinical value.