Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Emilio Puentedura

Date of original Performance / Presentation

January 2026

Publication Date / Copyright Date

1-1-2026

Abstract

Background: Intramuscular dry needling (IMDN) is increasingly used for low back pain (LBP), a leading cause of disability affecting nearly 10% of the global population. Evidence suggests IMDN may improve pain, disability, mobility, and functional outcomes; however, considerable variability exists in treatment application, including needle placement, frequency, duration, and retention time. Optimal dosage parameters remain unclear. This dissertation aimed to establish expert consensus on optimal IMDN dosage parameters for LBP and evaluate the resulting protocol's safety, feasibility, and preliminary effects. Methods: Two sequential studies were conducted. A modified Delphi methodology established expert consensus on optimal IMDN dosage parameters using a standardized patient vignette, with sample size determined a priori. The second phase was a prospective, quasi-experimental cohort study using a feasibility-based convenience sample of physical therapy students with and without self-reported LBP to assess the Delphi-derived protocol's safety, feasibility, and preliminary effectiveness. Outcomes included pain, disability, lumbar and hip mobility, functional performance, and fear-avoidance behaviors. Analysis: In the Delphi study, consensus was defined as ≥70% agreement. In the second study, repeated-measures ANOVA assessed outcome changes from baseline to post-treatment and follow-up, with Bonferroni-adjusted post hoc comparisons where appropriate. Statistical significance was set at p < .003. Results: Sixteen experts participated in Round 1, with 14 completing Round 2 and 12 completing Round 3, reflecting expected attrition. Consensus was achieved on most dosage and treatment parameters, yielding a standardized IMDN protocol. In the second study, 35 eligible participants received the protocol. Significant improvements in pain, lumbar and hip mobility, and functional performance were observed across time points (p < .003). Participants with self-reported LBP also demonstrated reductions in disability and fear-avoidance scores. Improvements were sustained or continued at follow-up. No serious adverse events were reported. Conclusions: Expert consensus established a standardized IMDN protocol for LBP. Preliminary testing demonstrated the protocol was safe, feasible, and associated with improvements in pain, mobility, functional performance, disability, and fear avoidance. These findings support a consensus-based protocol, offer guidance for clinician training and clinical reasoning, and provide a foundation for future research in clinical populations.

Disciplines

Physical Therapy

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