Clinical Pearl: Changing the Message

Last month I published a blog on turf issues. Much of the inspiration for that blog came from my past work in advocacy and, more importantly, the information attained from surveys done to evaluate dry needling in physical therapy collected recently by a state that is dealing with the “turf” issue.

I wanted to share the results with those following the dry needling issue:

Total Survey Responses   Sessions documented as part of the survey results
  • 431 licensed physical therapists
  • 2167 patients
 
  • Patient: 20,000 sessions
  • PT: 1,000,000+ reported sessions (as part of practice frequency utilizing DN as part of the session

Adverse Events:

(We should be defining this by the FDA standards and not just the minor occurrences that are more inconvenient rather than serious.)
https://www.fda.gov/safety/medwatch/howtoreport/ucm053087.htm

Quickly defined: An adverse event is any undesirable experience associated with the use of a medical product in a patient. The event is serious and should be reported to FDA when the patient outcome is: death, life-threatening, hospitalization, disability or permanent damage, or patient required other medical intervention to prevent long-term disability or damage.

Evaluate the reported adverse events associated with DN in this light.

Interesting that the perception of the patient is so different from that of the PT.  Likely due to the PT having a more objective view of the results?

Rate of adverse events

Based upon over one million aggregate treatment sessions utilizing 5-6 filaments per session with 16% of insertions in the thoracic region, it was found that patients reported the following “adverse” events:

  • Muscle soreness per session
    • <24 hours – 51%
    • >24 hours – 20%
  • Light-headedness – 1%
  • Hematoma – 7%
  • Infection – 0/0003% (PT reported) < 0.0004% (patient)
  • Pneumothorax – 0.0006% (PT) which equates to 1 in 140,000 thorax region insertions
    From McCutcheon & Yelland 2011:
    Rates of pneumothorax:

    • 1/ o UK/Japan 0 in 66,000
    • Germany 1 in 70,000
    • Overall approximately 100 pneumothorax reported in trials combined in the McCutcheon review

Impact on Medication?

As you know, the media reports a crisis in opioid use, dependency, and addiction bordering on an epidemic. Recent numbers from the CDC indicate that 91 people die of an opioid overdose every day. How is this considered ok?
The DN survey showed important data regarding a possible alternative to pain medications and to assist patients in reducing or terminating use all together.

Questions asked to patients regarding medication use and DN:
Did DN change your medication use?
• 1 in 4 reported completely discontinuing use of pain medications altogether.

How many sessions to achieve the biggest response?

How can you argue with this picture?

 

 

Let’s change the conversation from “turf” and even, “there isn’t enough research to support DN in physical therapy,” to putting the patient first and evaluating why the high-level research isn’t supporting the clinical results being reported every day

 

 


Edo Zylstra PT, DPT, OCS

is CEO, Founder and Lead Instructor for KinetaCore–an Evidence In Motion partner company. Learn more about Edo, and KinetaCore’s dry needling continuing education offerings at KinetaCore.com.