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Hou C, Zhang L, Wang L, Zhao S, Nie J, Lv M, Zhang W, Su X, Tian S, Li Y. A meta-analysis and systematic review of photodynamic therapy for diabetic foot ulcers. Photodiagnosis Photodyn Ther 2024; 48:104228. [PMID: 38866070 DOI: 10.1016/j.pdpdt.2024.104228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is a chronic and challenging condition, addressed through various treatments including photodynamic therapy (PDT) and standard of care (SOC), yet lacking consensus on the optimal approach. This study presents a comprehensive meta-analysis of randomized controlled trials to evaluate the efficacy and safety of PDT versus SOC in managing DFU. METHODS An extensive literature search was conducted across PubMed, Embase, and the Cochrane Library databases to identify RCTs that compared the effectiveness of PDT with SOC in treating DFU. The primary metrics evaluated included changes in ulcer area, wound healing indices, and pain levels experienced by the patients. RESULTS This meta-analysis incorporated data from 6 RCTs, encompassing 458 patients with 467 DFUs. The analysis indicated that while PDT led to a faster reduction in ulcer size compared to SOC, the difference was not statistically significant [mean difference (MD): 2.73cm², 95 % Confidence Interval (CI) -2.98 to 8.44; p > 0.05]. However, a notable improvement was observed in the wound healing rate in the PDT group [MD: 29.26 %, 95 % CI 7.24 to 51.28; p = 0.01]. Based on the Visual Analog Scale (VAS), pain assessment revealed no significant difference between the two treatment groups [MD: 2.35, 95 % CI -2.36 to 7.06; p = 0.33]. CONCLUSION The study suggests that PDT might offer an enhanced healing rate for DFUs compared to SOC alone, potentially leading to improved patient outcomes. Importantly, our findings highlight the superiority of photodynamic therapy in accelerating ulcer healing without an associated increase in complications. PROSPERO 2023 CRD42023493930.
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Affiliation(s)
- Chunliu Hou
- Shanxi Medical University, No. 56, Xinjian south Road, Yingze District, Shanxi 030000, PR China
| | - Lei Zhang
- Novo Nordisk (Shanghai) Pharma Trading Co. Ltd, Beijing, PR China
| | - Lifeng Wang
- Tianjin Jizhou District People's Hospital, No. 18, Nanhuan road, Jizhou District, Tianjin 301900, PR China
| | - Sai Zhao
- Systematic Review Solutions. Ltd, Shanghai, PR China
| | - Jing Nie
- Tianjin Jizhou District People's Hospital, No. 18, Nanhuan road, Jizhou District, Tianjin 301900, PR China
| | - Mo Lv
- Tianjin Jizhou District People's Hospital, No. 18, Nanhuan road, Jizhou District, Tianjin 301900, PR China
| | - Wenjie Zhang
- Shanxi Medical University, No. 56, Xinjian south Road, Yingze District, Shanxi 030000, PR China
| | - Xuesen Su
- Shanxi Medical University, No. 56, Xinjian south Road, Yingze District, Shanxi 030000, PR China
| | - Shouyuan Tian
- Shanxi Medical University, No. 56, Xinjian south Road, Yingze District, Shanxi 030000, PR China
| | - Yan Li
- Tianjin Jizhou District People's Hospital, No. 18, Nanhuan road, Jizhou District, Tianjin 301900, PR China; Shanxi Medical University, No. 56, Xinjian south Road, Yingze District, Shanxi 030000, PR China.
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Perrier Q, Moro C, Lablanche S. Diabetes in spotlight: current knowledge and perspectives of photobiomodulation utilization. Front Endocrinol (Lausanne) 2024; 15:1303638. [PMID: 38567306 PMCID: PMC10985212 DOI: 10.3389/fendo.2024.1303638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Diabetes is a global health concern characterized by chronic hyperglycemia resulting from insulinopenia and/or insulin resistance. The rising prevalence of diabetes and its associated complications (ulcers, periodontitis, healing of bone defect, neuropathy, retinopathy, cardiopathy and nephropathy) necessitate innovative therapeutic approaches. Photobiomodulation (PBM), involves exposing tissues and cells to low-energy light radiation, leading to biological effects, largely via mitochondrial activation. Methods This review evaluates preclinical and clinical studies exploring the potential of PBM in diabetes and its complications, as well all clinical trials, both planned and completed, available on ClinicalTrials database. Results This review highlights the variability in PBM parameters across studies, hindering consensus on optimal protocols. Standardization of treatment parameters and rigorous clinical trials are needed to unlock PBM's full therapeutic potential. 87 clinical trials were identified that investigated PBM in diabetes mellitus (with 5,837 patients planned to be treated with PBM). Clinical trials assessing PBM effects on diabetic neuropathy revealed pain reduction and potential quality of life improvement. Studies focusing on wound healing indicated encouraging results, with PBM enhancing angiogenesis, fibroblast proliferation, and collagen density. PBM's impact on diabetic retinopathy remains inconclusive however, requiring further investigation. In glycemic control, PBM exhibits positive effects on metabolic parameters, including glucose tolerance and insulin resistance. Conclusion Clinical studies have reported PBM-induced reductions in fasting and postprandial glycemia without an increased hypoglycemic risk. This impact of PBM may be related to its effects on the beta cells and islets in the pancreas. Notwithstanding challenges, PBM emerges as a promising adjunctive therapy for managing diabetic neuropathy, wound healing, and glycemic control. Further investigation into its impact on diabetic retinopathy and muscle recovery is warranted.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, INSERM U1055, Pharmacy Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | - Cécile Moro
- Univ. Grenoble Alpes, CEA-Leti, Clinatec, Grenoble, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, INSERM U1055, Diabetology and Endocrinology Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
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3
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Mineroff J, Maghfour J, Ozog DM, Lim HW, Kohli I, Jagdeo J. Photobiomodulation CME part II: Clinical applications in dermatology. J Am Acad Dermatol 2024:S0190-9622(24)00187-7. [PMID: 38307144 DOI: 10.1016/j.jaad.2023.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 02/04/2024]
Abstract
Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.
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Affiliation(s)
- Jessica Mineroff
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York
| | - Jalal Maghfour
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | - David M Ozog
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Henry W Lim
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Indermeet Kohli
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York.
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Rathnayake A, Saboo A, Vangaveti V, Malabu U. Electromechanical therapy in diabetic foot ulcers patients: A systematic review and meta-analysis. J Diabetes Metab Disord 2023; 22:967-984. [PMID: 37969923 PMCID: PMC10638302 DOI: 10.1007/s40200-023-01240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/22/2023] [Indexed: 11/17/2023]
Abstract
Purpose Diabetic foot ulcer (DFU) is one of the most devastating and troublesome consequences of diabetes. The current therapies are not always effective because of the complicated aetiology and interactions of local and systemic components in DFU. However, adjunctive therapy (electromechanical therapy) has become the latest modality in recent years, although there is a lack of significant research to support its utilization as a treatment standard. The purpose of this systematic research was to review the literature on the application of electromechanical therapies in the healing of DFUs. Methods For this systematic review, we searched PubMed, Medline, EmBase, the Cochrane library, and Google Scholar for the most current research (1990-2022) on electromechanical therapies for DFUs. We used the PICO method (where P is population, I is intervention, C is comparator/control, and O is outcome for our study) to establish research question with the terms [Electromechanical therapy OR Laser therapy OR photo therapy OR Ultrasound therapy OR Shockwave therapy] AND [diabetic foot ulcers OR diabetes] were used as search criteria. Searches were restricted to English language articles only. Whereas, Cochrane handbook of "Systematic Reviews of Interventions" with critical appraisal for medical and health sciences checklist for systematic review was used for risk of bias assessment. There were 39 publications in this study that were deemed to be acceptable. All the suitably selected studies include 1779 patients. Results The meta-analysis of 15 included research articles showed the overall effect was significant (P = 0.0002) thus supporting experimental groups have improvement in the DFUs healing in comparison to the control group. Conclusion This systematic review and meta-analysis revealed electromechanical treatments are significantly viable options for patients with DFUs. Electromechanical therapy can considerably reduce treatment ineffectiveness, accelerate healing, and minimize the time it takes for complete ulcer healing. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01240-2.
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Affiliation(s)
- Ayeshmanthe Rathnayake
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
| | - Apoorva Saboo
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
| | - Venkat Vangaveti
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
| | - Usman Malabu
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
- Department of Diabetes and Endocrinology, Townsville University Hospital, Douglas, Australia
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5
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Baracho VDS, Silva NCD, Peixoto MFD, Sampaio KH, Cordeiro CAF, Lucas TC. LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review. Rev Gaucha Enferm 2023; 44:e20220274. [PMID: 37585961 DOI: 10.1590/1983-1447.2023.20220274.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To identify scientific evidence of LED photobiomodulation in the treatment and tissue repair of chronic wounds in people with Diabetes Mellitus, types I and II. METHOD Systematic review conducted from September/2021 to April/2022 in PubMed, LILACS, SCIELO, COHRANE, EMBASE and Web of Science. Randomized and observational clinical trials using LED in wound healing in diabetics, published between 2015 and 2022 were included. Data were descriptively analyzed with title/abstract screening, full text articles reading and definitive selection after meeting the predefined inclusion and exclusion criteria. RESULTS Fromthe total of 840 references, eight articles were selected, that evaluated the effectiveness of LED phototherapy in wounds of diabetic patients. CONCLUSION LED light proved to be beneficial in tissue repair, with increased production in collagen and fibroblasts, angiogenesis, reduction of inflammation and, consequently, a decrease in lesion size.
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Affiliation(s)
- Valéria da Silva Baracho
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Natália Cristina da Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Marco Fabrício Dias Peixoto
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Educação Física. Diamantina, Minas Gerais, Brasil
| | - Kinulpe Honorato Sampaio
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Medicina. Diamantina, Minas Gerais, Brasil
| | - Cláudia Aparecida Fernandes Cordeiro
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Thabata Coaglio Lucas
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem. Diamantina, Minas Gerais , Brasil
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Dhlamini T, Houreld NN. Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered? J Diabetes Res 2022; 2022:3312840. [PMID: 36573132 PMCID: PMC9789897 DOI: 10.1155/2022/3312840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.
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Affiliation(s)
- Thabo Dhlamini
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, South Africa 2028
| | - Nicolette Nadene Houreld
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, South Africa 2028
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Mármora BC, Brochado FT, Schmidt TR, Santos LG, Araújo AAD, Medeiros CACXD, Ribeiro SB, Martins MAT, Pilar EFS, Wagner VP, Martins MD. Defocused high-power diode laser accelerates skin repair in a murine model through REDOX state modulation and reepithelization and collagen deposition stimulation. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 225:112332. [PMID: 34653929 DOI: 10.1016/j.jphotobiol.2021.112332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022]
Abstract
Skin wounds represent a burden in healthcare. Our aim was to investigate for the first time the effects of defocused high-power diode laser (DHPL) on skin healing in an animal experimental model and compare it with gold standard low-level laser therapy. Male Wistar rats were divided into 5 groups: Negative control; Sham; 0.1 W laser (L0.1 W); DHPL Dual 1 W (DHPLD1 W); and DHPL Dual 2 W (DHPLD2 W). Rats were euthanized on days 3, 5, 10, 14 and 21. Clinical, morphological, PicroSirus, oxidative stress (MDA, SOD and GSH) and cytokines (IL-1β, IL-10 and TNF-α) analyses were performed. A faster clinical repair was observed in all laser groups at D10 and D14. DHPLD1 W exhibited lower inflammation and better reepithelization compared to other groups at D10. DHPL protocols modulated oxidative stress by decreasing MDA and increasing SOD and GSH. Collagen maturation was triggered by all protocols tested and L0.1 W modulated cytokines release (IL-1β and TNF-α) at D3. In conclusion, DHPL, especially DHPL1 W protocol, accelerated skin healing by triggering reepithelization and collagen maturation and modulating inflammation and oxidative stress.
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Affiliation(s)
- Belkiss Câmara Mármora
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Thomé Brochado
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tuany Rafaelli Schmidt
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Gonçalves Santos
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aurigena Antunes de Araújo
- Post-Graduation Program Oral Science, Post-Graduation Program in Pharmaceutical Science, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Caroline Addison Carvalho Xavier de Medeiros
- Department of Biophysics and Pharmacology, Postgraduate Program in Biological Science and Rede Nordeste de Biotecnologia, Renorbio, Federal University of Rio Grande Norte, Natal, Brazil
| | - Susana Barbosa Ribeiro
- Postgraduate Program in Biological Science and Rede Nordeste de Biotecnologia, Renorbio, Federal University of Rio Grande Norte, Natal, Brazil
| | - Marco Antonio Trevizani Martins
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Ferreira Salles Pilar
- Experimental Pathology Unit, Clinics Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vivian Petersen Wagner
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Manoela Domingues Martins
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
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Sutton E, Ganie S, Chan C, Kaur A, Nussbaum E. Photobiomodulation and diabetic foot and lower leg ulcer healing: A narrative synthesis. Foot (Edinb) 2021; 48:101847. [PMID: 34390946 DOI: 10.1016/j.foot.2021.101847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To provide a comprehensive narrative review and critical appraisal of research investigating photobiomodulation (PBM), formerly known as low level laser therapy which includes lasers and light emitting diodes (LEDs), as a treatment to promote diabetic foot and lower leg ulcer (DFU) healing for humans. MATERIALS AND METHODS Pubmed, CINAHL, Scopus, and OVID Medline databases were used to find relevant studies published between January 2000 and January 2020. Reference lists of identified articles were scanned for additional studies that might have been missed in the database searches. RESULTS A total of 13 studies, with a total of 417 participants, were included in this review. DISCUSSION The studies were critically appraised using the PEDro scale, which revealed weaknesses in study designs such as small sample sizes and problems with reproducibility with respect to the laser protocols. Characteristics of PBM that improved wound healing were wavelengths of 630 nm-660 nm and infrared wavelengths of 850 or 890 nm, and radiant exposure levels of 3 J/cm2-7 J/cm2. PBM was beneficial for superficial and deep DFUs. Controlled blood glucose levels and adherence to best practices (pressure off-loading, optimized wound dressing changes, appropriate debridement, etc.) could have been a factor in the beneficial outcomes. CONCLUSION Regardless of the laser characteristics chosen, in the majority of studies PBM as a treatment for DFUs improved healing rate when compared with standard wound care alone. However, weaknesses across the studies indicate that further research is required.
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Affiliation(s)
- Eliana Sutton
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Sharifah Ganie
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Charlene Chan
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Anureet Kaur
- Faculty of Health Sciences, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada
| | - Ethne Nussbaum
- Department of Physical Therapy, MClSc Program in Wound Healing, Western University, Elborn College, Room 1588, London, ON, N6G 1H1, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; KITE, Toronto Rehab Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada.
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Dos Santos Mendes-Costa L, de Lima VG, Barbosa MPR, Dos Santos LE, de Siqueira Rodrigues Fleury Rosa S, Tatmatsu-Rocha JC. Photobiomodulation: systematic review and meta-analysis of the most used parameters in the resolution diabetic foot ulcers. Lasers Med Sci 2020; 36:1129-1138. [PMID: 33190161 DOI: 10.1007/s10103-020-03192-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
The most common photobiomodulation parameters used to aid in the treatment of diabetic foot ulcers were investigated in this paper. The databases MEDLINE, LILACS, MEDCARIB, PAHO-IRIS, and WHOLIS were searched with the following descriptors: diabetic foot ulcers AND low-level laser therapy OR low-level therapy AND wound healing; this search was conducted from January of 2014 to December of 2019. Inclusion criteria were randomized clinical trials on humans. Exclusion criteria were systematic reviews, literature reviews, studies with animals, studies lacking photobiomodulation parameters, and studies with non-diabetic individuals. The Jadad scale was used in order to analyze the methodological quality of the matching papers. There were seventeen studies found on PubMed and four on LILACS. Among these, seven were selected, according to the inclusion and exclusion criteria. Two out of the seven matching studies obtained a high score, and five obtained a low score, on the Jadad scale. The studies settled on the use of 600-nm and 800-nm wavelength spectrum. Most of the analyzed papers on photobiomodulation on diabetic foot ulcers did not describe the detailed parameters in their methodology. None of the studies featured the maximum score with regard to the Jadad scale for methodological quality. The relations of energy versus wavelength and power versus wavelength were divergent among the parameters on the papers. Therefore, it is necessary to analyze the parameters for an optimized power value in order to improve the results of the treatment.
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Affiliation(s)
- Luan Dos Santos Mendes-Costa
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil
| | - Vanessa Garcia de Lima
- Center for Health Sciences, Physiotherapy Department, University of Fortaleza, Fortaleza, Brazil
| | - Maria Paula Ribeiro Barbosa
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil
| | | | | | - José Carlos Tatmatsu-Rocha
- Faculty of Medicine, Physiotherapy Department, Center for Research and Technological Innovation on Human Rehabilitation, Federal University of Ceará, Rua Rodolfo Teófilo, Fortaleza, Ceará, 60430-540, Brazil. .,Post-Graduate Program of Biomedical Engineering, University of Brasília, Brasília, Brazil.
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