Expert consensus on the application of dry needling in stroke patients: A modified delphi method

Objective This study aimed to establish an expert consensus on the use of dry needling for treating spasticity in stroke patients via the Delphi method.Design A modified Delphi technique was conducted over four rounds.Setting The study was guided by the NEUMUSK Group Research, Department of Physiotherapy, Faculty of Health Sciences. & Aacute;vila Catholic University, following the Checklist for Reporting of Survey Studies (CROSS).Participants A total of 102 international experts in stroke rehabilitation and dry needling collaborated on this consensus study.Intervention Panellists rated 35 key questions across rounds via a 6-point Likert scale. Questions that failed to reach 70% consensus were eliminated.Main measurements Validated Likert scale responses to carry out the expert consensus.Results There was a high level of consensus regarding the use of dry needling in the early spasticity and hypertonia phases of stroke rehabilitation (early spasticity defined as the first few weeks after stroke when increased muscle tone begins to appear), with 87% and 91% agreement, respectively. However, less consensus has been reached for its application in hypotonia. Local twitch responses have been identified as critical indicators of treatment success, and ultrasound-guided dry needling has been widely endorsed for its precision. The effects of dry needling were reported to last between 48 and 72 h.Conclusion This study provides clear recommendations for the use of dry needling in stroke patients, particularly during the early stages of spasticity. While the short-term benefits are evident, further research is needed to optimize the treatment frequency and explore its role in different stages of recovery, such as hypotonia. This consensus will aid healthcare professionals in integrating dry needling into comprehensive stroke rehabilitation programmes.