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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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Souza-Barros L, Dhaidan G, Maunula M, Solomon V, Gabison S, Lilge L, Nussbaum EL. Skin color and tissue thickness effects on transmittance, reflectance, and skin temperature when using 635 and 808 nm lasers in low intensity therapeutics. Lasers Surg Med 2017; 50:291-301. [PMID: 29178437 DOI: 10.1002/lsm.22760] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the role of skin color and tissue thickness on transmittance, reflectance, and skin heating using red and infrared laser light. METHODS Forty volunteers were measured for skin color and skin-fold thickness at a standardized site near the elbow. Transmittance, reflectance and skin temperature were recorded for energy doses of 2, 6, 9, and 12 Joules using 635 nm (36 mW) and 808 nm (40 mW) wavelength laser diodes with irradiances within American National Standards Institute safety guidelines (4.88 mm diameter, 0.192 W/cm2 and 4.88 mm diameter, 0.214 W/cm2 , respectively). RESULTS The key factors affecting reflectance to an important degree were skin color and wavelength. However, the skin color effects were different for the two wavelengths: reflectance decreased for darker skin with a greater decrease for red light than near infrared light. Transmittance was greater using 808 nm compared with 635 nm. However, the effect was partly lost when the skin was dark rather than light, and was increasingly lost as tissue thickness increased. Dose had an increasing effect on temperature (0.7-1.6°C across the 6, 9, and 12 J doses); any effects of wavelength, skin color, and tissue thickness were insignificant compared to dose effects. Subjects themselves were not aware of the increased skin temperature. Transmittance and reflectance changes as a function of energy were very small and likely of no clinical significance. Absorption did not change with higher energy doses and increasing temperature. CONCLUSION Skin color and skin thickness affect transmittance and reflectance of laser light and must be accounted for when selecting energy dose to ensure therapeutic effectiveness at the target tissue. Skin heating appears not to be a concern when using 635 and 808 nm lasers at energy doses of up to 12 J and irradiance within American National Standards Institute standards. Photobiomodulation therapy should never exceed the American National Standards Institute recommendation for the maximum permissible exposure to the skin. Lasers Surg. Med. 50:291-301, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Leanna Souza-Barros
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
| | - Ghaith Dhaidan
- Kent Chiro-Med Wellness Clinic, 563 Gladstone Ave., Ottawa, Ontario, K1R 5P2, Canada
| | - Mikko Maunula
- Firefly Community Service, 1 Meno Ya Win Way, Sioux Lookout, Ontario, P8T 1B4, Canada
| | - Vaeda Solomon
- Department of Physiotherapy, Haliburton Highlands Health Services, 7199 Gelert Rd, Haliburton, Ontario, K0M 1S0, Canada
| | - Sharon Gabison
- Department of Physical Therapy, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Lothar Lilge
- Princess Margaret Cancer Centre, Toronto Medical Discovery Tower, 101 College Street, Room 15-310, Toronto, Ontario, M5G 1L7, Canada
| | - Ethne L Nussbaum
- Department of Physical Therapy, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada
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Xu Y, Lin Y, Gao S, Shen J. Study on mechanism of release oxygen by photo-excited hemoglobin in low-level laser therapy. Lasers Med Sci 2017; 33:135-139. [DOI: 10.1007/s10103-017-2363-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/15/2017] [Indexed: 12/20/2022]
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Chaves MEDA, Araújo ARD, Piancastelli ACC, Pinotti M. Effects of low-power light therapy on wound healing: LASER x LED. An Bras Dermatol 2014; 89:616-23. [PMID: 25054749 PMCID: PMC4148276 DOI: 10.1590/abd1806-4841.20142519] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/29/2013] [Indexed: 12/28/2022] Open
Abstract
Several studies demonstrate the benefits of low-power light therapy on wound
healing. However, the use of LED as a therapeutic resource remains
controversial. There are questions regarding the equality or not of biological
effects promoted by LED and LASER. One objective of this review was to determine
the biological effects that support the use of LED on wound healing. Another
objective was to identify LED´s parameters for the treatment of wounds. The
biological effects and parameters of LED will be compared to those of LASER.
Literature was obtained from online databases such as Medline, PubMed, Science
Direct and Scielo. The search was restricted to studies published in English and
Portuguese from 1992 to 2012. Sixty-eight studies in vitro and in animals were
analyzed. LED and LASER promote similar biological effects, such as decrease of
inflammatory cells, increased fibroblast proliferation, stimulation of
angiogenesis, granulation tissue formation and increased synthesis of collagen.
The irradiation parameters are also similar between LED and LASER. The
biological effects are dependent on irradiation parameters, mainly wavelength
and dose. This review elucidates the importance of defining parameters for the
use of light devices.
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Affiliation(s)
| | | | | | - Marcos Pinotti
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Al-Shenqiti AM, Oldham JA. The use of phototherapy in peripheral nerve regeneration: an updated critical review. Expert Rev Neurother 2014; 14:397-409. [PMID: 24552573 DOI: 10.1586/14737175.2014.892419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the effects of phototherapy on peripheral nerve regeneration. Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified. A search of the literature was conducted. In vitro and in vivo experimental studies and clinical trials were included. Twenty five studies were critically reviewed and showed considerable variability in irradiation parameters, techniques, approaches, length of irradiation courses, experimental injury tools and procedures. Many studies that have investigated the use of phototherapy in nerve regeneration produce positive results. However, the majority of these studies suffered from a number of shortcomings: no evidence of blinding and/or randomizing procedures, lack of specification of irradiation parameters, unspecified and/or inadequate tests in their experimental injury procedures, inappropriate irradiation parameters and/or poor experimental conditions.
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Affiliation(s)
- Abdullah M Al-Shenqiti
- Faculty of Medical Rehabilitation Sciences, Taibah University, Madinah Al-Munawarah, Saudi Arabia
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Naghdi S, Ansari NN, Fathali M, Bartley J, Varedi M, Honarpishe R. A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis. Physiother Theory Pract 2013; 29:596-603. [PMID: 23521568 DOI: 10.3109/09593985.2013.775204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp(2) ηp(2) = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.
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Affiliation(s)
- Soofia Naghdi
- Assistant Professor, Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
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Al-Shenqiti AM, Oldham JA. The use of low intensity laser therapy in the treatment of myofascial trigger points: an updated critical review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Saayman L, Hay C, Abrahamse H. Chiropractic Manipulative Therapy and Low-Level Laser Therapy in the Management of Cervical Facet Dysfunction: A Randomized Controlled Study. J Manipulative Physiol Ther 2011; 34:153-63. [DOI: 10.1016/j.jmpt.2011.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 01/31/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
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Peplow PV, Chung TY, Baxter GD. Laser Photobiomodulation of Wound Healing: A Review of Experimental Studies in Mouse and Rat Animal Models. Photomed Laser Surg 2010; 28:291-325. [DOI: 10.1089/pho.2008.2446] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Philip V. Peplow
- Department of Anatomy & Structural Biology, University of Otago, Dunedin, New Zealand
| | - Tzu-Yun Chung
- Department of Anatomy & Structural Biology, University of Otago, Dunedin, New Zealand
| | - G. David Baxter
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Lin YS, Huang MH, Chai CY. Effects of helium-neon laser on the mucopolysaccharide induction in experimental osteoarthritic cartilage. Osteoarthritis Cartilage 2006; 14:377-83. [PMID: 16359876 DOI: 10.1016/j.joca.2005.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 10/27/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of mucopolysaccharide induction after treatment by low power laser for experimental osteoarthritis (OA). METHODS Seventy-two rats with three different degrees of papain induced OA over right knee joints were collected for helium-neon (He-Ne) laser treatment. The severity of induced arthritis was measured by 99mTc bone scan and classified into three groups (I-III) by their radioactivity ratios (right to left knee joints). The rats in each group were further divided into study subgroups (Is, IIs, and IIIs) and control subgroups (Ic, IIc, and IIIc) randomly. The arthritic knees in study subgroups received He-Ne laser treatment, and those in controls received sham laser treatment. The changes of arthritic severity after treatment and follow-up 2 months later were measured. The histopathological changes were evaluated through light microscope after disarticulation of sections (H.E. stain), and the changes of mucopolysaccharide density in cartilage matrix were measured by Optimas scanner analyzer after Alcian blue (AB) stain. The densities of mucopolysaccharide induced after treatment in arthritic cartilage were compared and correlated with their histopathological changes. RESULTS The density of mucopolysaccharide rose at the initial stage of induced arthritis, and decreased progressively in later stages. The densities of mucopolysaccharide in treated rats increased upon complete laser treatment more than those of the controls, which is closely related with the improvement in histopathological findings, but conversely with the changes in arthritic severity. CONCLUSION He-Ne laser treatment will enhance the biosynthesis of arthritic cartilage, and results in the improvement of arthritic histopathological changes.
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Affiliation(s)
- Y-S Lin
- Kun Shan University, Tainan, Taiwan, ROC
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Lin YS, Huang MH, Chai CY, Yang RC. Effects of Helium-Neon Laser on Levels of Stress Protein and Arthritic Histopathology in Experimental Osteoarthritis. Am J Phys Med Rehabil 2004; 83:758-65. [PMID: 15385784 DOI: 10.1097/01.phm.0000137310.15943.19] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of low-power laser therapy on levels of stress proteins (SPs) in experimental arthritis and their relation to the bioeffects on arthritic cartilage repair. DESIGN A total of 42 rats with similar degrees of induced arthritis evaluated by means of bone scan were divided randomly into two groups. In the treated group, 21 rats received helium-neon laser treatment; in the control group, 21 rats received sham laser treatment. The changes in chondrocytes of SPs were measured by electrophoresis of proteins extracted from chondrocytes of arthritic cartilage at various time periods. The histopathologic changes and the presence of SP of arthritic cartilage were identified by hematoxylin and eosin stain and by immunostains of SP72 antibody individually from frozen sections of arthritic cartilage. RESULTS SP density increased markedly in rats after laser treatment and was closely related to the repair of arthritic cartilage. Furthermore, the pathohistology of arthritic cartilage improved significantly with the decline of SP levels in the follow-up period. CONCLUSION Helium-neon (632 nm) low-power laser can enhance SP production in arthritic chondrocytes. The extragenic production of SP is well correlated with the therapeutic effect of low-power laser in preserving chondrocytes and the repair of arthritic cartilage in rats.
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