Clinical Pearl: The Value of Test/Re-Test

Keri_Maywhort_092010_175by Keri Maywhort, PT, DPT

One concept promoted passionately by our KinetaCore instructors is the use of test/re-test measures with Functional Dry Needling®.  The use of test/re-test is not novel and is an integral part of best practice in physical therapy.  It does, however, take on additional relevance with dry needling.

Following a thorough subjective and objective evaluation the therapist should be able to identify one or more objective markers that can be performed immediately after an intervention and then again at subsequent visits to assess the efficacy of intervention within a single visit and between visits.  This provides guidance for the progression of care as it helps the therapist determine if the working diagnosis is on target, if the intervention chosen is effective, and if modifications need to be made.   It also establishes whether or not the problem is being managed wholly.  Clinicians are charged with managing the presenting problem and, more importantly, the reason behind it.  More simply stated, clinicians must identify and manage both the “What” and the “Why”.  If a clinician can make a change within a session that does not carry over between visits it indicates that they have missed the What or the Why or both, or that a contributing or precipitating factor has not been identified or addressed. It may also help determine that after-care or exercise instructions were not clear, not followed, or were ineffective.

Physiotherapist giving knee therapy to a woman in clinicWhen Functional Dry Needling is incorporated into clinical practice there are reasons in addition to the above-mentioned to utilize a test/re-test methodology.  One of these is the goal to apply dry needling with a “less is more” approach.   If a clinician can make a powerful change with few versus many needles, fewer is preferable!   Assessing before and after needling different areas can help identify where the impact is optimal. Furthermore, treating in this manner renders dry needling a diagnostic tool as much as it is a therapeutic tool.  Another purpose for use of test/re-test with dry needling surrounds the occasion that a patient may experience some degree of muscle soreness following a treatment session.  This soreness needs to be coupled with positive change for the therapist to be able to qualify it as normal and acceptable! What’s more, if a patient is sore but also appreciates a meaningful change with a re-test, the re-test becomes an incredibly powerful tool as an external reward stimulus, likely leaving the patient motivated to follow up with prescribed exercises and after-care instructions.

So, what is an acceptable test/re-test measure?  This will certainly vary among clinicians.  It could be anything from palpation findings, joint mobility, AROM or PROM, to orthopedic tests, neurodynamic assessments, sensation or motor changes. At the end of the day, functional and meaningful movement on the part of the patient is the un-matched test/re-test.  All other measures chosen are part of this bigger picture.

The use of test/re-test affords the reflective practitioner what is necessary to become skilled and effective in integrating Functional Dry Needling into their practice, and fosters a collaborative effort between practitioner and patient for optimal outcomes.