Effectiveness of dry needling combined with exercise therapy versus exercise alone for pain and functional outcomes in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials
File(s)
Submitted version
Author(s)
Al Sinani, Moahammed
Type
Journal Article
Abstract
Background: Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability worldwide. Although exercise therapy is the recommended first-line treatment, many patients continue to experience pain and functional limitations. Dry needling (DN) has emerged as potential adjunct therapy targeting myofascial and neuropathic pain mechanisms.
Objectives: To evaluate the effectiveness of dry needling combined with exercise therapy compared with exercise therapy alone for pain reduction and functional improvement in patients with KOA.
Design: Systematic review and meta-analysis of randomized controlled trials. Data Sources and Methods: A systematic search of PubMed, ClinicalTrials.gov, and the Cochrane Library was conducted from inception
to 23 October 2025 following PRISMA 2020 guidelines. Studies involving adults with knee osteoarthritis comparing dry needling (DN) plus exercise
with exercise alone or sham DN plus exercise were included. The primary outcome was pain intensity (VAS/NPRS), while secondary outcomes
included WOMAC scores, neuropathic pain, functional performance, and psychosocial measures. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Heterogeneity was assessed with the I² statistic, and risk of bias was evaluated using the Cochrane RoB-2 tool.
Results: Six RCTs involving 453 participants were included. Compared with exercise alone, dry needling plus exercise significantly reduced pain at 3 months (MD −1.91; 95% CI −2.60 to −1.21; I² = 66%). Significant
improvements were also observed in WOMAC pain, stiffness, and physical function at short- and mid-term follow-up. Long-term outcomes (6–12
months) showed favorable trends, although confidence intervals were wider.
Conclusion: Dry needling combined with exercise therapy may offer short- to mid-term improvements in pain and function in patients with knee osteoarthritis compared with exercise alone. However, the evidence
is limited by a small number of studies, moderate certainty, and substantial heterogeneity, warranting cautious interpretation. The long-term benefits remain uncertain.
Registration: PROSPERO (Registration ID: [CRD420261285294]).
Objectives: To evaluate the effectiveness of dry needling combined with exercise therapy compared with exercise therapy alone for pain reduction and functional improvement in patients with KOA.
Design: Systematic review and meta-analysis of randomized controlled trials. Data Sources and Methods: A systematic search of PubMed, ClinicalTrials.gov, and the Cochrane Library was conducted from inception
to 23 October 2025 following PRISMA 2020 guidelines. Studies involving adults with knee osteoarthritis comparing dry needling (DN) plus exercise
with exercise alone or sham DN plus exercise were included. The primary outcome was pain intensity (VAS/NPRS), while secondary outcomes
included WOMAC scores, neuropathic pain, functional performance, and psychosocial measures. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Heterogeneity was assessed with the I² statistic, and risk of bias was evaluated using the Cochrane RoB-2 tool.
Results: Six RCTs involving 453 participants were included. Compared with exercise alone, dry needling plus exercise significantly reduced pain at 3 months (MD −1.91; 95% CI −2.60 to −1.21; I² = 66%). Significant
improvements were also observed in WOMAC pain, stiffness, and physical function at short- and mid-term follow-up. Long-term outcomes (6–12
months) showed favorable trends, although confidence intervals were wider.
Conclusion: Dry needling combined with exercise therapy may offer short- to mid-term improvements in pain and function in patients with knee osteoarthritis compared with exercise alone. However, the evidence
is limited by a small number of studies, moderate certainty, and substantial heterogeneity, warranting cautious interpretation. The long-term benefits remain uncertain.
Registration: PROSPERO (Registration ID: [CRD420261285294]).
Date Acceptance
2026-06-11
Citation
Therapeutic Advances in Musculoskeletal Disease
ISSN
1759-720X
Publisher
SAGE Publishing
Journal / Book Title
Therapeutic Advances in Musculoskeletal Disease
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted