Knowledge and Using of Dry Needling by Physiotherapists in Central Africa in the Management of Trigger Points : The First Cross Sectional Survey in Cameroon

Background: Dry Needling (DN) emerged in the 1970s as a therapeutic breakthrough, proving effective in the treatment of Trigger Points (TP). Despite its worldwide application, there is few studies which explores knowledge, attitudes and practices (KAP) of physiotherapists towards this technique in Central Africa, particularly in Cameroon. This study aims to fill this gap by exploring the knowledge, attitudes and practices of Cameroonian physiotherapists concerning DN in relation to pressure point management. Understanding their current levels of KAP is essential to identify educational needs and developing strategies to improve TP diagnosis, caring and DN practice in the Nation.
Methods: A quantitative and analytical cross-sectional survey was carried out online in the 10 administrative ’regions of Cameroon over a six-month period in 2023, including practicing physiotherapists with at least one year's work experience and who had given their consent to participate to the survey. They were asked questions about general knowledge about TP as for example diagnosis, pathophysiology and management; moreover, some questions about general knowledge, specific attitudes and level of practice of DN in the management of TP were added in the online questionnaire which was previously tested on a small sample of physiotherapists to ensure good understanding and clarity of questions. Pearson correlations were performed between KAP domains together and with sociodemographic data, Using Epi Info software version 7.2.5.0.
Results: 123 physiotherapists (PTs) out of the 300 we contacted and who were listed as practicing in Cameroon on the official World Physiotherapy website in 2023 agreed to participate to the study, and all fulfilled inclusion criteria. The majority were male (56.1%), with an average age of 29 ± 5 years and average year of experience of 4 ±3 years. Furthermore, 37.4 % of PTs had insufficient knowledge, and 6.5 % had poor knowledge of TP and the various treatment methods, 14.63% had no knowledge of DN, 11.38% had very poor knowledge, 30.9% had poor knowledge, 26.83% had good knowledge and 16.23 % had very good knowledge. Concerning attitudes, we noticed that 1.63% had a neutral attitude towards DN, 21.96% strongly disagreed, 18.7% disagreed, 30.09% agreed and 27.62 % strongly agreed. With regard to respondents' DN practices, 75.61% of were not active, 7.32% were slightly active, 16.26% were active and 0.81% were very active.
Conclusions: This study highlights a significant need for educational initiatives in the field of Trigger Point and Dry Needling among physiotherapists in Cameroon. The results reveal a lack of knowledge and practice, despite a positive attitude towards the technique. Addressing this need for training is essential to improving the quality of patient care and the effectiveness of trigger zone management. The data collected provides a solid basis for the development of targeted training programmes and resources to equip physiotherapists with the necessary skills and knowledge. Such efforts will ultimately contribute to the advancement of physiotherapy practice in Cameroon and Africa as a whole.

Knowledge, attitudes, practices, Dry Needling, Cameroon, physiotherapists, and trigger point

1. Baily F, Foltz V, Rozenberg S, Bruno F, Gossec L. The impact of chronic low back pain is partly related to loss of social role: A quantitative study. Joint Bone Sine. 2015; 86(6): 437-441. [Google Scholar] [Crossref]

2. Bouziri H, Descatha A, Roquelaure Y, Jean K, Dab WO. Analyse sati-temporaelles des troubles musculo-squelettiques à partir du "Global Burden of Disease", 1990 à 2019. Revue de Santé Publique. 2022 Aoùt; 70(3): S226. [Google Scholar] [Crossref]

3. Diatta AE, Tougma WS, Diao ML, Ndiaye M. Etude des troubles musculo-squeletttiques par les manutentionnaires d'une industrie textile au Burkina Faso. Medecine d'Afrique Noire. 2021 Octobre; 6810: 589-596. [Google Scholar] [Crossref]

4. Bita FA, Assengue BR, Owona ML. Prevalence des troubles musculo-squelettiques dans un district de santé au Cameroun. Medecine d'Afrique Noire. 2022 Mars; 6903: 159-168. [Google Scholar] [Crossref]

5. Poiseau J, Laurent L. Les triggers points et l'hyothese integrée: revue de la litterature. 2020. [memoire]. Dijon: IFMK de Dijon; 2020. 87p. [Google Scholar] [Crossref]

6. Jan Dommerholt, Orlando MD, Christian G. Trigger Point Dry Needling. The Journal of Manual & Manipulative Therapy. 2006; 14(4): 70 - 87. [Google Scholar] [Crossref]

7. Casey U, Kathy B, Thomas J. DRY NEEDLING FOR MYOFASCIAL TRIGGER POINT. Int J Sports Phys Ther. 2015 Juin; 10(3): 402-418. [Google Scholar] [Crossref]

8. Gattie E, Cleland J, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of orthopaedic & sports physical therapy. 2017 March; 47(3): 133-49. [Google Scholar] [Crossref]

9. Lew J, Kim J, Nair P. Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. Journal of Manual & Manipulative Therapy. 2020 September; 22: 1-11. [Google Scholar] [Crossref]

10. Navarro-Santana M, Sanchez-Infante J, Gomez-Chiguano G, Cleland J, Lopez-de-Uralde-Villanueva I, Fernandez-de-las-Penas C, et al. effectys of triggerpoint dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clin Rehabil. 2020; 34(11): 1327-40. [Google Scholar] [Crossref]

11. Republique du Cameroun. [Online]. [cited 2023 Septembre 06. Available from: prc.cm/fr/le-Cameroun/presentation. [Google Scholar] [Crossref]

12. Cameroon tribune. [Online].; 2023 [cited 2023 Septembre 06. Available from: https://www.cameroon-tribune.cm/article.html/57645/fr.html/populatin-camerounaise. [Google Scholar] [Crossref]

13. Physiotherapy W. Annual Membership Census. 2022 30 June: p. 8. [Google Scholar] [Crossref]

14. JC S. L’harmonisation des pratiques kinesitherapiques à travers le monde basé sur l'Evidence-Based Practice: exemple du Dry Needling. 2017. [memoire].Pays de la Loire: IFM3R; 2017. 46p. [Google Scholar] [Crossref]

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