Dry Needling Research Articles

A COMPARATIVE STUDY BETWEEN DRY NEEDLING AND KINETIC CHAIN ACTIVATION TECHNIQUE WITH SPECIFIED EXERCISE PROGRAMME IN PAINFUL ARC SYNDROME

Objective: Many researcher have reported that painful arc syndrome arises from multiple lesion i. e. minor tear of supraspinatus tendon, supraspinatus tendinitis, calcified deposit in the supraspinatus tendon, subacromial bursitis, crack fracture of greater tuberosity of humerus and bicipital tenosynovitis. In this study, dry needling and KCAT technique with specific exercise programme has been done to reduce pain and improve functioning and their by prevent shoulder pathologies. The objective of the study is. 1) To evaluate the effectiveness of kinetic chain activation in painful arc syndrome. 2) To evaluate the effectiveness of dry needling therapy in painful arc syndrome. 3) To evaluate the effectiveness of a specific exercise program. Methods: 50 patient diagnosed with painful arc syndrome by the physiotherapy department orthopedic department OPD will be initially assessed for the inclusion or exclusion criteria. prior to the treatment procedure patients are oriented to the study and taken informed consent, patient is divided in to two groups(Group A and Group B) and both groups will be assessed for the pre-test parameter. Outcome measure – shoulder pain and disability scale and goniometry is used for measuring pre-test and post-test. Results: The study was significant in reducing pain level and improving function with the pretest. At the end of 6 w treatment program with, both group A (dry needling) and group B(KCAT) showed improvement in painful arc syndrome. Based on results, the study supports research hypothesis that there was a significant improvement in ROM and significant reduction in SPADI score associated with painful arc syndrome. Patient participated in group B shows more significant changes. Conclusion: The study showed that significant improvement in symptoms of group B as compared to group A from the initial level to week 6. At the end of 6 w training programme both group A and group B Shows improvements in symptoms but the result of study supports that group B (KCAT CONCEPT-finger fanning technique) B is more efficient compare to group A(dry needling).

Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21–60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged.

Investigating the Effect of Dry Needling on Myofascial Trigger Point in Soleus Muscle of Soccer Players with Medial Tibial Stress Syndrome

Introduction: This study investigates the impact of dry needling on myofascial trigger points in the soleus muscles among soccer players with medial tibial stress syndrome (MTSS). Materials and Methods: Soccer players diagnosed with MTSS were enlisted and randomly divided into two groups (11 participants in the experimental group [Group 1] and 11 participants in the control group [Group 2]). Pre-intervention measurements included repeated shuttle sprint ability, MTSS score, and pain pressure threshold (PPT) for both groups. In the experimental group, dry needling was performed on the soleus muscle, followed by active stretching and cryotherapy. The control group underwent active stretching of the soleus muscle and cryotherapy exclusively. Post-intervention measurements of repeated shuttle sprint ability, MTSS score, and PPT were taken for both groups after 2 days. Results: The experimental group exhibited a statistically significant improvement in PPT, MTSS score, and repeated shuttle sprint ability. Conversely, within the control group, statistically significant changes were observed only in PPT values through paired t-test assessment. Between-group analysis using an independent t-test revealed significant enhancement in PPT (P=0.000) and MTSS score (P=0.01) within the experimental group compared to the control group. Conclusion: Addressing myofascial trigger points in the soleus muscle through dry needling offers a more effective approach to treating MTSS than relying solely on muscle stretching.

EFFECT OF DRY NEEDLING ON PAIN AND CERVICAL RANGE OF MOTION IN PATIENTS WITH UPPER TRAPEZIUS TRIGGER POINTS: A SYSTEMATIC REVIEW

Objectives: This systematic review seeks to provide high-quality evidence on the effect of dry needling on cervical range of motion and pain in patients. The objective of this systematic review was to determine the evidence base for the effect of dry needling on cervical range of motion and pain in patients with upper trapezius trigger points. Material and methods: A systematic electronic literature search was undertaken utilizing keywords and medical subject heading search phrases in the PubMed/Medline, Cochrane Central, Scopus, and EBSCO databases, as well as Google Scholar. In addition, the reference lists of the systematic reviews included in the study were manually searched. Patient satisfaction and complications were collected from a range of motion prospective and experimental studies that provided the greatest degree of evidence. Articles were evaluated critically, and the methodological index for non-randomized studies scale was used to determine the risk of bias. Results: This systematic review suggested the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals. To the interventions, dry needling combined with physical therapy was shown to be effective in decreasing pain, whereas isolated dry needling did not demonstrate significant improvements in the analyzed studies. Conclusion: Finally, as for pain, dry needling combined with physical therapy was the therapy that showed the most benefits in function in the analyzed studies

Testing the Safety of Piriformis Dry Needling Interventions: An Observational Study Evaluating the Predictive Value of Anthropometric and Demographic Factors

Testing the Safety of Piriformis Dry Needling Interventions: An Observational Study Evaluating the Predictive Value of Anthropometric and Demographic Factors

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain

Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants.Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks.Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p>0.001) in the comparions of the groups.Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.

Development and Testing of a Device to Detect Trigger Points, and Local Twitch Responses in Dry Needling Intervention

Trigger point dry needling (TrpDN) has emerged as a promising intervention for the treatment of myofascial pain. This involves insertion of a sterile filament needle directly into the trigger point (Trp), with the aim of eliciting a local twitch response (LTR). This sudden, involuntary contraction of the muscle fibers confirms the breakdown and success of TrpDN intervention. Not all LTRs are perceptible through visual observation or tactile sensation during the intervention. In search of noticeable LTR, clinicians perform Hong's technique (back-and-forth movements of needle in muscle). This results in muscle damage and causes pain and discomfort thereby limiting functional movements of patients. One important factor in the diagnosis and post intervention follow-up of TrpDN is the pain pressure threshold (PPT). Currently most of the clinicians use thumb pressure and subjective scales for confirming trigger points. These methods can introduce biasness due to its reliance on subjective factors.•In this present study, an effort has been made to assemble a device to overcome the challenges faced during assessment and treatment of trigger points.•This device can provide audiovisual feedback for LTR and can measure PPT.

The effectiveness of intramuscular dry needling stimulation in treating trigger points: A case series

Myofascial trigger points are a common presentation in clients with chronic spinal pain. Various techniques are used to manage trigger points and are considered a vital part of chronic spinal pain management. Reducing pain caused by trigger points may be effective in improving function. Case series can provide preliminary evidence and assist in feasibility assessment. The objective of this case series is to document the feasibility of intramuscular dry needling stimulation in managing trigger-point-induced chronic pain. Three individuals aged 35, 33, and 28 years presented to a private clinic with chief complaints of scapular region muscular pain, and their management is reported in this case series. Initial physical examination revealed tenderness over D6 and D8. There was a palpable para spinal muscle hypertonicity and reduced thoracic spine mobility to both sides in all the three clients. The presence of multiple trigger points bilateral to the spine indicated postural dysfunction, which altered pain on changing thoracic posture. Clients were treated with dry needling with intramuscular stimulation over trigger points, paraspinal muscle and inferior to scapula by a therapist trained in the technique. The frequency was kept at 1.5 Hz and intensity was as tolerated by the patient. Outcome measures were taken using VAS, RMDQ and digital inclinometer for thoracic spine rotation. Subject one reported a change of 22 mm in VAS after the first week and 40 mm in the fourth week. It also reported an improvement in mobility to both side rotations by 20 degrees in the first week and full towards the fourth week. Subject two and three improved VAS by 10 mm in week one and 35 mm towards the fourth week. Full mobility was achieved in the fourth week in both cases. RMDQ scores improved significantly in the three cases. The three cases demonstrate significant improvement in both symptoms and function based on outcome measures. This indicates the efficacy of treating thoracic spine myofascial trigger points with dry needling and intramuscular stimulation, but a large-scale study is recommended.

The Effect of Dry needling and Muscle energy technique on Pain in Myofascial Trigger Point Syndrome (MTRPS) M.Upper Trapezius

Background: Myofascial Pain Syndrome is a common health problem where the main cause is repetitive injury. Various interventions can be performed to reduce pain and symptoms from MTrPs, one of which is dry needling (DN) and muscle energy technique (MET). Purpose: of this study is to determine the effect of DN, MET, and combination of DN+MET on pain at MTrPs m.upper trapezius. Research method quantitative three groups pre and post test design. Sample was taken using total sampling technique and total of 48 people with MTrPs m.upper trapezius obtained. Numeric Rating Scale (NRS) used to measure pain intensity. The statistical tests used are Wilcoxon signed ranked test and the Mann-Whitney U. Results and discussion: effect of DN intervention with P-Value= 0.000 (P<0.05), MET P-Value= 0.000 (P<0.05), Combination of DN+MET P-Value= 0.000 (P<0.05). Comparison of DN with MET P-Value= 0.001 (P<0.05), DN with combination of DN+MET P-Value= 0.030 (P<0.05), MET with a combination of DN+MET P-Value= 0.000 (P<0.05). Conclusion: based on statistical result DN, MET, and the combination of DN+MET had the same effect on reducing pain at MTrPs m.upper trapezius, where the DN+MET combination proved to be more effective and more recommended in the treatment of MTrPs m.upper trapezius. Keywords: Myofascial Trigger Point Syndrome; Dry Needling; Muscle Energy Technique.

Trends in Clinical Research on Ultrasound-Guided Acupuncture: A Scoping Review

Acupuncture is widely used to reduce pain and improve function in various conditions. Despite ongoing research in ultrasound-guided acupuncture, evidence supporting efficacy remains inconclusive. This study aimed to examine Korean and international research trends, clinical efficacy, and safety of ultrasound-guided acupuncture by performing a scoping review of clinical research on ultrasound-guided acupuncture. Literature searches were conducted across 11 databases, including all clinical studies published before April 2024, without restrictions on condition/disease or type of study. Of the 2,644 identified articles, 25 studies were selected for review, mostly involving patients with musculoskeletal pain, and post-stroke sequelae. Interventions included ultrasound-guided acupuncture, warming acupuncture, dry needling, and electroacupuncture. The effectiveness of ultrasound-guided acupuncture was evaluated using pain, functional disability, and effective rate as outcome measures, and most studies reported significant improvements. This study is the first scoping review to report on trends, clinical efficacy, and safety of ultrasound-guided acupuncture. While it demonstrates potential for treating musculoskeletal disorders, post-stroke sequelae, spinal injuries, and other conditions/diseases, research on its application remains limited to specific conditions/diseases. Furthermore, substantial variations were observed in types of acupuncture, application areas, and treatment frequencies. Future research should focus on high-quality randomized controlled trials with standardized ultrasound frequencies for specific conditions/diseases.

Myofascial pain syndrome in small animal practice.

This capsule review is a discussion of myofascial pain syndrome in small animals. The history of myofascial pain syndrome is discussed as well as facts and theories behind the aetiology and treatment of this syndrome. Diagnostic techniques are both discussed and illustrated. Accepted treatments including dry needling, photobiomodulation, manual therapy and thermal therapy are outlined.

Dry Needling: A Possible Detrimental Treatment After Total Hip Arthroplasty

Dry Needling: A Possible Detrimental Treatment After Total Hip Arthroplasty

LIBERAÇÃO MIOFASCIAL COMO RECURSO NO TRATAMENTO DAS ALGIAS NA COLUNA VERTEBRAL - UMA REVISÃO DE LITERATURA

Myofascial release is a manual technique widely used in the treatment of musculoskeletal pain, including sciatica, back pain and low back pain. This study aims to review the existing literature on the effectiveness of myofascial release in the management of spinal pain, highlighting its applications, benefits and limitations. Scientific articles were analyzed that discuss the use of the technique alone or in conjunction with other therapeutic approaches, such as stabilization exercises, dry needling and joint manipulation. The results indicate that myofascial release can significantly reduce pain and improve patients' mobility, although effectiveness varies depending on the protocol used and the patient's profile. The combination of the technique with other therapies proved to be particularly effective in cases of chronic pain. However, little data was found on its application in the treatment of back pain, suggesting the need for more research focused on this condition. Furthermore, the lack of standardization in application methods and the limitation in the number of studies reviewed are critical points that must be considered. It is concluded that myofascial release is a promising approach, but requires greater methodological rigor in future research to consolidate its use in the management of spinal pain.

Electrophysiological evidence of dry needling efficacy on spasticity in poststroke patients: A randomized control trial

Abstract: CONTEXT: Therapists use dry needling (DN) to treat myofascial trigger points and various pain conditions. Need for study: A gap analysis showed that more information about how DN works on spastic muscles through alpha motor neurofiring and what role it plays in clinical and functional outcomes. Currently, the objective evidence for the usefulness of DN in neurological diseases is required. AIMS: The purpose of this research was to examine how DN affects spasticity in stroke patients using the H reflex and a Modified Tardieu Scale (MTS). SETTINGS AND DESIGN: We conducted a randomized controlled trial. We randomly assigned 81 stroke survivors to one of two groups: one group underwent six sessions of DN over the muscles with conventional treatment, whereas the other group received conventional care. We assessed spasticity using the H reflex and the MTS. We analyzed all outcome measures before, after, and 2 weeks later names as H1, H2, H3 and T1, T2, and T2 receptivity. RESULTS: After the intervention, people who received DN had improvement in spasticity. H3-H1 is statistically significant (P = 0.42) in the experimental group against the control group. T3-T1 and T2-T3 are statistically significant (P = 0.00) in the experimental group compared to the control group. CONCLUSIONS: The DN is effective for lowering spastic muscle tone and local muscle stiffness. This could be because DN diminishes the nodular zone of spastic muscle and reduces the firing of alpha motor neurons. These findings are very promising in terms of lowering spasticity.

Estimation of the muscle force by perineural intramuscular electrical stimulation in healthy volunteers.

The present study aimed to evaluate the elbow flexor force induced by perineural intramuscular stimulation compared with surface electrical stimulation (ES) and maximal voluntary contraction. Thirty nondominant arms of healthy volunteers were evaluated. Isometric elbow flexion force was evaluated using a surface electrode stimulation at the biceps brachii muscle, a perineural intramuscular stimulation around the musculocutaneous nerve, and maximum voluntary contraction. The elbow flexion force was measured at the wrist volar area in a 90° elbow flexion posture, fixed with a rigid elbow orthosis. Pain and discomfort associated with ES were evaluated using a numeric rating scale. The mean maximum elbow flexion force was 16.6 ± 4.1 kgf via voluntary contraction. The mean elbow flexion force by ES was 2.9 ± 2.0 kgf, stimulation intensity was 24.8 ± 5.5 mA, and the numeric rating scale was 5.0 ± 2.5 via surface electrode stimulation and 3.1 ± 2.0 kgf, 5.0 mA, and 3.8 ± 1.9 via perineural stimulation, respectively. ES provides 16% to 18% of the maximal voluntary contraction force in elbow flexion, which corresponds to a fair grade of muscle force. Perineural intramuscular stimulation can generate an equivocal contraction force with less discomfort in elbow flexion than surface electrode stimulation.

Global trends and performance of dry needling from 2004 to 2024: a bibliometric analysis.

Many doctors are incorporating dry needling into their clinical practice. Despite this growing trend, there has not been a comprehensive bibliometric analysis conducted in this field. Thus, this study aims to investigate the current research landscape, key research contributors, and popular research topics in dry needling, and to analyze the developmental trends within this area of study. The study utilized the Web of Science Core Collection (WoSCC) as the main data source. Scientific literature was gathered through title (TI) searches for original clinical research papers on dry needling published between 2004 and 2024, using 'dry needling' or 'dry needle' as the search term. Statistical analyses and visualizations of the literature information, such as keywords, countries, research institutions, and authors, were conducted using the bibliometric.com online platform and VOSviewer. This approach aimed to statistically analyze and visualize the key research entities, hotspots, and frontiers in dry needling research. Additionally, the study delved into collaborative networks, research outputs, hot topics, and trends within the field of dry needling. This investigation encompassed 468 publications, with the year 2021 topping the charts for the highest publication output, amassing a total of 271 articles. The journal "Acupuncture in Medicine" emerged as the most frequently cited publication. The most impactful article was titled "Acupuncture and dry-needling for low back pain: An updated systematic review within the framework of the Cochrane Collaboration." Spain took the lead as the most productive country in this domain, with the United States closely following. Cesar Fernández-de-las-Peñas emerged as the most prolific author in the field. The Universidad Rey Juan Carlos in Spain was recognized as the most productive institution for research in dry needling. As for journal keywords, "dry needling," "trigger point," and "myofascial pain syn-drome" were the triumvirate of terms most recurrently encountered. The field of dry needling research has witnessed significant growth in recent years, characterized by the emergence of novel trends such as comparative studies with acupuncture, exploration into the mechanisms of action, and a transition toward interdisciplinary approaches. As medical models evolve, the focus is expanding from the exclusive treatment of muscle pain to broader applications. Despite this progress, the domain is underscored by a paucity of large-scale, multicenter clinical trials and animal studies. There exists an imperative for enhanced collaboration among academic and research institutions. A more profound exploration and comprehensive research endeavors are essential to enhance our understanding and broaden the clinical application of dry needling techniques.

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background & Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P < 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P > 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

Inferior-Medial Dry Needling at the Thoracolumbar Junction: A Cadaveric Study.

Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas. The purpose of this study was to reproduce the methods employed by Williams et al.but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction. Descriptive Cadaveric study. The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal. A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior. The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented. Level IV.

Optimizing dry needling for chronic low back pain: A novel approach to treatment site selection: A randomized controlled trial

Optimizing dry needling for chronic low back pain: A novel approach to treatment site selection: A randomized controlled trial

Patient-Determined Important Change for the Neck Disability Index With Application of Credibility Analysis: An Exploratory Study

ObjectiveThe purposes of this study were to preliminarily report patient-identified change for the neck disability index (NDI) as either important or not important with time between follow-up of approximately 7 to 10 days and assess the credibility of the preliminary results with the use of a recently established credibility instrument. MethodsThis study was a secondary analysis from a primary randomized clinical trial assessing short-term physical therapist care for individuals with mechanical neck pain. Neck disability index scores and participant-reported importance of global rating of change scores from 42 participants were analyzed from a randomized clinical trial assessing short-term responses to thoracic manipulation and dry needling for neck pain. Patient-important change was computed using receiver operating characteristic curves, and statistical error of the measurement was calculated using (SD × [1 − r]1/2) × 1.96 to assess measurement error at the 95% CI. ResultsThirty-six participants rated global rating of change as important, and 6 rated it as not important. Patient-important change was calculated at 3.5 NDI points on a 0 to 50 NDI scoring scale. This value exceeded the statistical error, which was calculated at 2.16 NDI points. The credibility analysis revealed that 4 of 5 criteria showed strong credibility for the patient-important change estimate. ConclusionUsing patient-determined importance to dichotomize improvement may yield a lower threshold than current researcher-defined methods. Clinically, these results may be more responsive to patient-centric change than using previously reported minimal clinically important difference data.