Delaware

15.4 Dry Needling

15.4.1 Dry needling is “an intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying muscular tissue, connective tissues and myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments; is based upon Western medical concepts; and requires a physical therapy examination and diagnosis.” 24 Del.C. §2602(6). Dry needling is within the scope of practice for a Physical Therapist. 24 Del.C. §2602(10)(a). It is not in the scope of practice for Athletic Trainers, Physical Therapy Assistants or Physical Therapy Aides.

15.4.2 Requirements for Physical Therapists to perform dry needling:

15.4.2.1 Dry needling may be performed by a licensed Physical Therapist who meets the requirements of subsection 15.4.

15.4.2.2 The Physical Therapist shall have no less than 2 years of active clinical experience in the treatment of patients as a licensed Physical Therapist and shall hold a current license in good standing.

15.4.2.3 The Physical Therapist shall have current CPR certification by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation’s website.

15.4.2.4 Dry needling shall be performed directly by the Physical Therapist and shall not be delegated.

15.4.2.5 Dry needling shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques and the bloodborne pathogen standards of the Occupational Safety and Health Administration (“OSHA”).

15.4.2.6 Dry needling is an advanced procedure that requires specialized training. A Physical Therapist shall not perform dry needling in Delaware unless he or she has and maintains documented proof of completing a Board-approved training program on dry needling.

15.4.2.6.1 The program shall be a minimum of 54 hours, which shall be completed within no more than 2 years;

15.4.2.6.2 The Physical Therapist shall successfully complete the minimum passing criteria for the dry needling program; and

15.4.2.6.3 The Physical Therapist shall only utilize the specific techniques for which he or she has demonstrated competency.

15.4.3 Physical Therapists who are performing dry needling at the time of enactment of this regulation, and who have completed 25 hours of dry needling education, may continue to practice dry needling, upon submission of proof of experience and education to the Board. Such Physical Therapists shall complete the required 54 hours of education within 2 years after enactment of this regulation.

15.4.4 Board approved dry needling training program: A dry needling training program shall include the following to be eligible for Board approval:

15.4.4.1 A dry needling training program shall require each trainee to demonstrate successful psychomotor and cognitive performance through practical and written examination.

15.4.4.2 A dry needling program shall be attended in person by the Physical Therapist, shall not be attended online or through any other means of distance learning and shall not be a self-study program.

15.4.4.3 The program curriculum shall include the following:

15.4.4.3.1 History and current literature review of dry needling and evidence based practice;

15.4.4.3.2 Pertinent anatomy and physiology;

15.4.4.3.3 Choice and operation of supplies and equipment;

15.4.4.3.4 Knowledge of technique including indications/contraindications and precautions for use;

15.4.4.3.5 Proper technique of tissue penetration;

15.4.4.3.6 Knowledge of hazards and complications;

15.4.4.3.7 Safe practice guidelines and generally accepted standards of practice including clean needle techniques and OSHA’s bloodborne pathogen standards;

15.4.4.3.8 Post intervention care, including an adverse response or emergency;

15.4.4.3.9 Documentation of successful completion of psychomotor and cognitive performance through practical and written examination; and

15.4.4.3.10 Supervised training.

15.4.4.3.11 The dry needling program, including the required supervised training, shall be taught by a Physical Therapist who meets the qualifications of subsection 15.4.

15.4.5 Scope of Practice

15.4.5.1 A Physical Therapist may not perform dry needling on a patient until completion of at least 25 hours of education in a Board approved dry needling program.

15.4.5.2 A Physical Therapist may not perform dry needling on high risk areas until completion of at least 54 hours of education in a Board approved dry needling program. As used in this regulation, high risk areas are the anterior cervical region, abdominal region, and the region directly over the ribs, unless the pincher technique is performed.

15.4.6 Examination and Informed Consent

15.4.6.1 Examination: A Physical Therapist shall only perform dry needling following an examination and diagnosis for the purpose of treating specific anatomic entities selected according to physical signs.

15.4.6.2 Informed consent: At the first visit, a Physical Therapist performing dry needling shall obtain written informed consent from the patient before the Physical Therapist performs dry needling on the patient. The patient shall receive a copy of the informed consent, and the Physical Therapist shall retain a copy in the patient’s record. The informed consent shall include, at a minimum, the following:

15.4.6.2.1 The patient’s signature;

15.4.6.2.2 The risks and benefits of dry needling;

15.4.6.2.3 The Physical Therapist’s level of education regarding supervised hours of training in dry needling; and

15.4.6.2.4 A clearly and conspicuously written statement that the patient is not receiving acupuncture, including the following language: “Dry needling is a technique used in physical therapy practice to treat myofascial, muscular, and connective tissues for the management of neuromuscular pain and movement dysfunction. Dry needling technique should not be confused with an acupuncture treatment performed by a licensed acupuncturist.”

15.4.7 Referral required: A physician referral specific for dry needling is required. If the initial referral is received orally, it must be followed up with a written referral.

15.4.8 Procedure notes: A Physical Therapist who performs dry needling shall maintain documentation in the patient’s chart or record for each dry needling session. The note shall include the treatment received, the response to treatment and any adverse response.

15.4.9 Documentation of training: The Physical Therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention. If requested by the Board or a member of the public, the Physical Therapist practicing dry needling shall provide documentation of completion of the training required by this regulation. Failure to provide written documentation to the Board of meeting the training requirements shall be deemed prima facie evidence that the Physical Therapist is not competent and shall not be permitted to perform dry needling.