OBJECTIVES: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA). MATERIALS AND METHODS: In total, 242 participants (n = 242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n = 121) or MT and exercise (n = 121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months. RESULTS: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC F 35.504; p < 0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR 1.6; 95% confidence interval 1.24 to 2.01; p = 0.001). On the basis of the cutoff score of >= 5 on the global rating of change, significantly (chi 14.887; p < 0.001) more patients (n = 91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n = 22, 18%) at 3 months. Effect sizes were large (standardized mean differences > 0.82) for all outcome measures in favor of the electrical dry needling group at 3 months. DISCUSSION: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA. LEVEL OF EVIDENCE: Level 1b-therapy. Prospectively registered February 10, 2015 on www.ClinicalTrials.gov (NCT02373631).

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