European Delphi Consensus on Minimum Training Standards for Dry Needling (EDNES): a protocol for a modified Delphi study
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Abstract
Background: Dry needling is increasingly used in physiotherapy, yet substantial variation exists in training duration, curriculum content, competency expectations, and regulatory approaches across countries. No unified European framework currently defines minimum educational and competency standards for dry needling practice.
Methods: This protocol describes a modified Delphi study aiming to establish European consensus on minimum training standards and clinician-level competencies for dry needling in physiotherapy. An international expert panel of clinicians, educators, and researchers (approximately 25–35 experts) will participate in 2–4 online rounds. An evidence-informed initial item set will be rated using a 5-point Likert scale, with controlled feedback between rounds. Consensus will be defined as ≥70% agreement in Round 1 and ≥75% in subsequent rounds. The study will be conducted in accordance with CREDES recommendations and was preregistered on the Open Science Framework (OSF Registries, DOI: 10.17605/OSF.IO/32TAZ).
Ethics and dissemination: Ethical approval has been obtained from the CEIC Aragón (CEICA; Ethics: PI26/237). The study will be conducted in accordance with the Declaration of Helsinki, and findings will be disseminated through peer-reviewed publication and relevant professional channels.
Discussion: This study is expected to provide a structured consensus-based framework to support greater consistency, safety, and harmonisation in dry needling education and practice across Europe.
Keywords
- dry needling
- Delphi study
- education standards
- physiotherapy
- competency
- consensus
- Europe
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Copyright (c) 2026 Giorgos Tzigkounakis, Konstantinos Georgiadis, Katerina Simati
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