Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study.

Anna Folli,Alessandro Schneebeli,Marco Barbero,Francesca Mena,Simone Ballerini,Emiliano Soldini,César Fernández-De-Las-Peñas

doi:10.3390/jcm9061958

Abstract

Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded and DN treatments of several trunk muscles can potentially result in pneumothorax. Ultrasound imaging (US) skin-to-rib measurement could ensure the safety of this treatment procedure. Therefore, the aim of this study was to determine the inter-rater reliability of depth measurement of different trunk muscles (i.e., rhomboid, lower trapezius, iliocostalis, and pectoralis major) between an expert and two novice physiotherapists. Skin-to-rib distance of 26 asymptomatic and normal weights subjects was consecutively, independently, and randomly measured for each muscle by the three examiners (1 expert and 2 novice physical therapists) with a handheld US wireless probe. Intraclass correlation coefficient (ICC3,k) and standard error of measurement (SEM) were used to assess inter-rater reliability. Inter-rater reliability of skin-to-rib measurements between the three examiners was good to excellent or excellent for every muscle, with an ICC3,k ranging from 0.92 and 0.98 (95% CI 0.86–0.99). The SEM never exceeded 10% of the skin-to-rib distance. In conclusion, skin-to-rib US measurements of the trunk muscles can be reliably performed by novice physical therapists using a handheld US device. These measures could be used as an innovative and reliable technique to improve the safety of some potential dangerous DN treatments.

Highlights

Trigger point dry needling (DN), as described in 1979 by Lewit [1] and popularized in the early 1990s by Hong [2], is a minimally invasive treatment technique that has become commonly used by physical therapists around the world, either alone or in combination with other treatments
Inter-rater reliability of skin-to-rib measurements between Expert and Novice 1, Expert and Novice 2, and Novice 1 and Novice 2 examiners was good to excellent for every muscle, with an ICC3,k ranging from 0.92 to 0.98
Despite the difference in the experience in DN and Ultrasound imaging (US) imaging of the three examiners, the results of our study revealed good to excellent inter-rater reliability skin-to-rib measurements on the rhomboid, lower trapezius, iliocostalis, and pectoralis major muscles

Summary

Introduction

Trigger point dry needling (DN), as described in 1979 by Lewit [1] and popularized in the early 1990s by Hong [2], is a minimally invasive treatment technique that has become commonly used by physical therapists around the world, either alone or in combination with other treatments. Despite the commonly declared safety of DN, Brady et al found that approximately 20% of the treatments (n = 7629) performed by physical therapists resulted in mild adverse events [7]. The most common adverse events were bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). A recent study described that most adverse events of DN application were bleeding (16%), bruising (7.7%), and pain (5.9%), which were all categorized as minor [8].

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