International Consensus Initiative in Invasive Physiotherapy (ICI-IP): Protocol for an Evidence-Informed Delphi Study on Percutaneous Neuromodulation and Percutaneous Electrolysis
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Abstract
Background: Percutaneous neuromodulation and percutaneous electrolysis are increasingly used in physiotherapy for the management of musculoskeletal conditions. However, substantial variability exists in their clinical application, including differences in indications, technical parameters, safety procedures, and integration within multimodal care. Currently, no unified, evidence-informed framework defines best practice for these interventions.
Methods: This protocol describes an evidence-informed modified Delphi study, registered on the Open Science Framework (OSF; registration number: osf.io/tkrn4), aiming to establish international consensus on the clinical application of percutaneous neuromodulation and percutaneous electrolysis. The study will be conducted in accordance with CREDES recommendations. Two parallel Delphi processes will be undertaken, with international experts in each field participating in 3–4 online rounds. An initial item set will be developed through a targeted literature review and internal expert input, and rated using a Likert-type scale with controlled feedback between rounds. Consensus for inclusion will be predefined using percentage agreement and median thresholds.
Ethics and dissemination: Ethical approval has been granted by the CEIC Aragón (CEICA), Zaragoza, Spain (reference: PI26/238, 20 May 2026). 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 structured, consensus-based recommendations to support consistency, safety, and evidence-informed clinical practice in invasive physiotherapy, and to guide future research and educational initiatives.
Keywords
- percutaneous neuromodulation
- percutaneous electrolysis
- Delphi study
- invasive physiotherapy
- consensus
- clinical application
- physiotherapy
References
- Plaza-Manzano G, Gómez-Chiguano GF, Cleland JA, Arías-Buría JL, Fernández-de-las-Peñas C, Navarro-Santana MJ. Effectiveness of percutaneous electrical nerve stimulation for musculoskeletal pain: A systematic review and meta-analysis. European Journal of Pain. 2020;24(6):1023–44. doi: 10.1002/ejp.1559 DOI: https://doi.org/10.1002/ejp.1559
- Rodríguez-Sanz J, Rodríguez-Rodríguez S, López-de-Celis C, Malo-Urriés M, Pérez-Amodio S, Pérez-Antoñanzas R, et al. Biological and Cellular Effects of Percutaneous Electrolysis: A Systematic Review. Biomedicines. 2024;12(12):2818. doi: 10.3390/biomedicines12122818 DOI: https://doi.org/10.3390/biomedicines12122818
- Asensio-Olea L, Leirós-Rodríguez R, Marqués-Sánchez MP, de Carvalho FO, Maciel LYS. Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clin Rehabil. 2023;37(6):747–59. doi: 10.1177/02692155221144272 DOI: https://doi.org/10.1177/02692155221144272
- Badia M, Figueroa J, Penagos P, Carcasona-Otal A. Effect of Percutaneous Electrical Stimulation on Active Muscle Functionality. A Systematic Review. Invasive Physiotherapy and Musculoskeletal Medicine. 2025;1. doi: 10.63360/ipmm.v1.e11 DOI: https://doi.org/10.63360/ipmm.v1.e11
- Guerrero Troyano J. Aplicación de la Estimulación Eléctrica Nerviosa Percutánea (PENS) en trastornos musculoesqueléticos: una revisión narrativa. Invasive Physiotherapy and Musculoskeletal Medicine. 2025;1. doi: 10.63360/ipmm.v1.e8 DOI: https://doi.org/10.63360/ipmm.v1.e8
- Gattie E, Cleland JA, Snodgrass S. A survey of American physical therapists’ current practice of dry needling: Practice patterns and adverse events. Musculoskelet Sci Pract. 2020;50:102255. doi: 10.1016/j.msksp.2020.102255 DOI: https://doi.org/10.1016/j.msksp.2020.102255
- Barrett TL, Kearns GA, Puentedura EJ, Brismée JM. Curricular Variability in Dry Needling Education Across Entry-Level DPT Programs in the US. Med Sci Educ. 2025;35(6):3013–24. doi: 10.1007/s40670-025-02511-8 DOI: https://doi.org/10.1007/s40670-025-02511-8
- McPherson S, Reese C, Wendler MC. Methodology Update. Nurs Res. 2018;67(5):404–10. doi: 10.1097/nnr.0000000000000297 DOI: https://doi.org/10.1097/NNR.0000000000000297
- Gianola S, Bargeri S, Pellicciari L, Gambazza S, Rossettini G, Fulvio A, et al. Evidence-informed and consensus-based statements about SAFEty of Physical Agent Modalities Practice in physiotherapy and rehabilitation medicine (SAFE PAMP): a national Delphi of healthcare scientific societies. BMJ Open. 2024;14(3):e075348. doi: 10.1136/bmjopen-2023-075348 DOI: https://doi.org/10.1136/bmjopen-2023-075348
- Naqvi WM, Mishra G V, Shaikh SZ, Pashine AA, Sánchez Romero EA, Swaminathan N, et al. PhyCARE reporting guidelines for physiotherapy case reports: a consensus-based development . BMJ Open. 2026;16(1):e110765. doi: 10.1136/bmjopen-2025-110765 DOI: https://doi.org/10.1136/bmjopen-2025-110765
- Tzigkounakis G, Simati K, Georgiadis K, Kostaridou V, Battersby P, Calvo S, et al. CARE-DN: An Extension of the CARE Guidelines for Dry Needling Case Reports. Cureus. 2026; doi: 10.7759/cureus.101789 DOI: https://doi.org/10.7759/cureus.101789
- Rhim HC, Singh M, Maffulli N, Saxena A, Leal C, Gerdesmeyer L, et al. Recommendations for use of extracorporeal shockwave therapy in sports medicine: an international modified Delphi study. Br J Sports Med. 2025;59(18):1287–301. doi: 10.1136/bjsports-2024-109082 DOI: https://doi.org/10.1136/bjsports-2024-109082
- Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684–706. doi: 10.1177/0269216317690685 DOI: https://doi.org/10.1177/0269216317690685
- Lang JK, Haines KJ, Hodgson CL. Development of a performance standard for physiotherapists delivering exercise and mobilisation to the critically ill: A modified Delphi consensus study. Australian Critical Care. 2023;36(4):470–6. 10.1016/j.aucc.2022.07.003 DOI: https://doi.org/10.1016/j.aucc.2022.07.003
- Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review. PLoS One. 2011;6(6):e20476. doi: 10.1371/journal.pone.0020476 DOI: https://doi.org/10.1371/journal.pone.0020476
- Hohmann E, Beaufils P, Beiderbeck D, Chahla J, Geeslin A, Hasan S, et al. Guidelines for Designing and Conducting Delphi Consensus Studies: An Expert Consensus Delphi Study. Arthroscopy. 2025;41(10):4208. doi: 10.1016/j.arthro.2025.03.038 DOI: https://doi.org/10.1016/j.arthro.2025.03.038
- Deng C, Sidebotham D. Using the Delphi process to determine the minimum clinically important effect size for the Balanced-2 randomised controlled trial. Clinical Trials. 2023;20(5):473–8. doi: 10.1177/17407745231173058 DOI: https://doi.org/10.1177/17407745231173058
- Twose P, Jones U, Cornell G. Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique. J Intensive Care Soc. 2019;20(2):118–31. doi: 10.1177/1751143718807019 DOI: https://doi.org/10.1177/1751143718807019
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