Table 4 An example of calculating level difference

Consider the following medical advice:

Dry needling may be used to improve pain and function in patients with knee osteoarthritis.

Rate the medical advice using the following criteria, and make a selection from integer 1,2,3,4:

Score 1 (Consensus): There is no supporting evidence, and the medical advice is possibly based on common practice or expert opinion.

Score 2 (Limited): Supported by evidence from one or more low-quality studies with consistent findings, or evidence from a single moderate-quality study.

Score 3 (Moderate): Supported by evidence from two or more moderate-quality studies with consistent findings, or evidence from a single high-quality study.

Score 4 (Strong): Supported by evidence from two or more high-quality studies with consistent findings.

As of my knowledge cut-off in September 2021, the use of dry needling for the improvement of pain and function in patients with knee osteoarthritis may be rated as 2 (Limited). The evidence for this practice comes from a few low to moderate-quality studies showing some potential benefits. However, more rigorous, high-quality studies are needed to confirm these findings and establish a solid consensus in the medical community.

Please consult with a healthcare professional for updated information or advice as the state of medical knowledge and research is constantly evolving.

Recommendation level of AAOS: 2

Level difference: 2-2 = 0