# Identifying Early Responders to Dry Needling for Lower-Limb Spasticity in Multiple Sclerosis: A Secondary Responder Analysis of a Pilot Randomized Controlled Trial

## TL;DR

A third of multiple sclerosis patients showed improvement after dry needling for spasticity, with early responders more likely to have relapsing-remitting MS and lower disability.

## Contribution

Identified early responders to dry needling in MS and linked response to disease type and baseline disability.

## Key findings

- Approximately one-third of MS patients showed clinically meaningful improvement after dry needling.
- Early responders were more likely to have relapsing–remitting MS and lower baseline disability.
- Dry needling may benefit a specific subgroup of MS patients rather than being a universal treatment.

## Abstract

What are the main findings?
Approximately one-third of ambulatory people with multiple sclerosis showed clinically meaningful improvement after a single session of dry needling for lower-limb spasticity.Early responders were more likely to have a relapsing–remitting disease course and lower baseline disability.

Approximately one-third of ambulatory people with multiple sclerosis showed clinically meaningful improvement after a single session of dry needling for lower-limb spasticity.

Early responders were more likely to have a relapsing–remitting disease course and lower baseline disability.

What are the implications of the main findings?
Dry needling may be a beneficial adjunctive intervention for a specific subgroup of patients with multiple sclerosis rather than a universal treatment.Responder-based analyses can support personalized rehabilitation strategies and inform patient selection in future clinical trials.

Dry needling may be a beneficial adjunctive intervention for a specific subgroup of patients with multiple sclerosis rather than a universal treatment.

Responder-based analyses can support personalized rehabilitation strategies and inform patient selection in future clinical trials.

Background/Objectives: Response heterogeneity limits the implementation of dry needling for spasticity in multiple sclerosis (MS). This secondary analysis aimed to identify early responders and explore predictors of response. Methods: We conducted a responder analysis of a pilot randomized, double-blind, sham-controlled trial (NCT05956119) including 18 ambulatory MS patients with spasticity, randomized to a single session of dry needling (n = 9) or sham (n = 9). Sensitive responder criteria were defined as improvement ≥ 2.0 s in Timed Up-and-Go, ≥5 points in MSQOL-54 physical component, or ≥10% in 25-Foot Walk Test at 4 weeks. Results: Using these criteria, 33.3% (3/9) of dry needling recipients were classified as responders versus 0% (0/9) in the sham group (p = 0.214). Responders were more frequently observed among participants with relapsing–remitting MS (100% vs. 40%, p = 0.090) and lower baseline disability (Expanded Disability Status Scale 3.4 vs. 4.4). A positive association was observed between baseline pyramidal subscore and physical quality-of-life change, although this did not reach statistical significance (r = 0.52, p = 0.150) in the active group. Conclusions: Approximately one-third of participants met predefined responder criteria following dry needling; however, these findings should be interpreted as preliminary signals derived from an exploratory, underpowered pilot analysis. These results are hypothesis-generating and require confirmation in adequately powered trials.