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de la Barra Ortiz HA, Arias M, Liebano RE. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain. Lasers Med Sci 2024; 39:124. [PMID: 38709332 DOI: 10.1007/s10103-024-04069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).
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Affiliation(s)
- Hernán Andrés de la Barra Ortiz
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, 7591538, Las Condes, Santiago de Chile, Chile.
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.
| | - Mariana Arias
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
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Liu C, Wang Y, Yu W, Xiang J, Ding G, Liu W. Comparative effectiveness of noninvasive therapeutic interventions for myofascial pain syndrome: a network meta-analysis of randomized controlled trials. Int J Surg 2024; 110:1099-1112. [PMID: 37939115 PMCID: PMC10871620 DOI: 10.1097/js9.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Myofascial pain syndrome (MPS) has an impact on physical health and quality of life for patients, with various noninvasive methods used for relieving myofascial pain. The authors aimed to compare the effectiveness of different noninvasive therapeutic interventions for MPS. MATERIALS AND METHODS The authors searched PubMed, Embase, CINAHL Complete, Web of Science, Cochrane, and Scopus to identify randomized controlled trials describing the effects of any noninvasive treatments in patients with MPS. The primary outcome was pain intensity, while pressure pain threshold and pain-related disability were secondary outcomes. RESULTS The analysis included 40 studies. Manual therapy [mean difference (MD) of pain: -1.60, 95% CI: -2.17 to -1.03; MD of pressure pain threshold: 0.52, 95% CI: 0.19 to 0.86; MD of pain-related disability: -5.34, 95% CI: -8.09 to -2.58], laser therapy (MD of pain: -1.15, 95% CI: -1.83 to -0.46; MD of pressure pain threshold: 1.00, 95% CI: 0.46 to 1.54; MD of pain-related disability: -4.58, 95% CI: -7.80 to -1.36), extracorporeal shock wave therapy (MD of pain: -1.61, 95% CI: -2.43 to -0.78; MD of pressure pain threshold: 0.84, 95% CI: 0.33 to 1.35; MD of pain-related disability: -5.78, 95% CI: -9.45 to -2.12), and ultrasound therapy (MD of pain: -1.54, 95% CI: -2.24 to -0.84; MD of pressure pain threshold: 0.77, 95% CI: 0.31 to 1.22) were more effective than no treatment. CONCLUSION Our findings support that manual therapy, laser therapy, and extracorporeal shock wave therapy could effectively reduce pain intensity, pressure pain threshold, and pain-related disability with statistical significance when compared with placebo. This finding may provide clinicians with appropriate therapeutic modalities for patients with MPS among different scenarios.
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Affiliation(s)
| | - Yang Wang
- Department of Plastic and Reconstructive Surgery, Cell and Matrix Research Institute, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, People’s Republic of China
| | | | - Guoyong Ding
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong
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Xie YH, Liao MX, Lam FMH, Gu YM, Hewith A Fernando WC, Liao LR, Pang MYC. The effectiveness of high-intensity laser therapy in individuals with neck pain: a systematic review and meta-analysis. Physiotherapy 2023; 121:23-36. [PMID: 37812850 DOI: 10.1016/j.physio.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/29/2023] [Accepted: 07/08/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The primary objective of this meta-analysis was to determine whether high-intensity laser therapy (HILT) was effective in improving pain intensity, cervical range of motion (ROM), functional activity, and quality of life (QOL) in individuals with neck pain. DATA SOURCES PubMed, PEDro, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 26, 2022. STUDY SELECTION Randomized controlled trials (RCTs) involving HILT for neck pain were selected. DATA EXTRACTION AND DATA SYNTHESIS Two raters were independent in data extraction. The methodological quality was evaluated using the PEDro scale, and the level of evidence was assessed using the GRADE system. RevMan5.4 was used for meta-analysis. RESULTS Eight RCTs were included and their PEDro scores were moderate to high. Compared with placebo, HILT was effective in improving pain intensity (SMD 2.12, 95%CI 1.24 to 3.00; moderate quality evidence), cervical flexion (SMD 1.31, 95%CI 0.27 to 2.35; moderate quality evidence), extension (SMD 1.43, 95%CI 0.24 to 2.63; moderate quality evidence), right lateral flexion (SMD 1.36, 95%CI 0.15 to 2.56; low-quality evidence). There was a trend of better outcome in functional activity after HILT (SMD 1.73, 95%CI -0.05 to 3.54; low quality evidence). LIMITATIONS There was limited information available on QOL. CONCLUSION HILT may be considered as an adjunctive treatment modality for neck pain. There was moderate quality evidence that HILT may improve pain intensity and cervical ROM in individuals with neck pain, but there was low quality evidence that HILT was not effective in improving functional activity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021254078 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Yu-Hua Xie
- Rehabilitation Medicine Center, The First Dongguan Affiliated Hospital, Guangdong Medical University, 523000 Dongguan, China; School of Rehabilitation Medicine, Gannan Medical University, 341000 Ganzhou, China
| | - Man-Xia Liao
- Rehabilitation Medicine Center, The First Dongguan Affiliated Hospital, Guangdong Medical University, 523000 Dongguan, China
| | - Freddy M H Lam
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, 999077, Hong Kong, China
| | - Yue-Ming Gu
- School of Rehabilitation Medicine, Gannan Medical University, 341000 Ganzhou, China
| | - W C Hewith A Fernando
- School of International Education, Nanjing Medical University, 210000, Nanjing, China
| | - Lin-Rong Liao
- Rehabilitation Medicine Center, The First Dongguan Affiliated Hospital, Guangdong Medical University, 523000 Dongguan, China.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, 999077, Hong Kong, China.
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High-Intensity Laser Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med 2023; 12:jcm12041479. [PMID: 36836014 PMCID: PMC9963402 DOI: 10.3390/jcm12041479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
High-intensity laser therapy (HILT) is one of the therapeutic approaches used in the treatment of musculoskeletal disorders (MSD). The main objective of this study was to examine the effectiveness of HILT for reducing pain and improving functionality in people with MSD. Ten databases were systematically searched for randomized trials published up to 28 February 2022. Randomized clinical trials (RCTs) assessing the effectiveness of HILT on MSD were included. The main outcome measures were pain and functionality. In total, 48 RCTs were included in the qualitative synthesis and 44 RCTs in the quantitative analysis. HILT showed a decrease on the pain VAS (mean difference (MD) = -1.3 cm; confidence interval (CI) 95%: -1.6 to -1.0) and an improvement in functionality (standardized mean difference (SMD) = -1.0; CI95%: -1.4 to -0.7), with low and moderate quality of evidence, respectively. A greater effect was observed when compared with control than with other conservative treatments, both on pain (χ2 = 20.6; p < 0.001) and functionality (χ2 = 5.1; p = 0.02). Differences in the effectiveness of HILT were found depending on the location (χ2 = 40.1 p < 0.001), with further improved functionality in MSD of the knee and shoulder. HILT is an effective treatment for improving pain, functionality, range of motion, and quality of life in people with MSD, although these findings must be treated with caution due to the high risk of bias in the studies. Further clinical trials should be well designed to lower the risk of bias.
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Alayat MSM, Battecha KH, Elsodany AM, Alzahrani OA, Alqurashi AKA, Jawa AT, Alharthi YS. Effectiveness of Photobiomodulation Therapy in the Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Systematic Review and Meta-Analysis. Photobiomodul Photomed Laser Surg 2022; 40:661-674. [DOI: 10.1089/photob.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mohamed Salaheldien Mohmed Alayat
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Mecca, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Dokki, Egypt
| | - Kadrya Hosney Battecha
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Mecca, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Dokki, Egypt
| | | | - Omer Abdulaziz Alzahrani
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - AbdulAziz Talal Jawa
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Yazan Saleh Alharthi
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Mecca, Saudi Arabia
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Tehrani MR, Nazary-Moghadam S, Zeinalzadeh A, Moradi A, Mehrad-Majd H, Sahebalam M. Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci 2022; 37:3333-3341. [PMID: 35962884 DOI: 10.1007/s10103-022-03626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022]
Abstract
Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.
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Affiliation(s)
- Mohammad Reza Tehrani
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Mehrad-Majd
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad Sahebalam
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Effectiveness of multiwave locked system laser on the treatment of patients with idiopathic Bell's palsy: a randomized double-blind placebo controlled trial. Lasers Med Sci 2022; 37:3495-3502. [PMID: 35881208 DOI: 10.1007/s10103-022-03616-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
The objective of this study is to investigate the effect of scanning and point application of multiwave locked system (MLS) laser therapy on the recovery of patients with idiopathic Bell's palsy (IBP). A randomized double-blind placebo-controlled trial was carried out on 60 patients with subacute BP. Patients were randomly assigned into three groups of 20 patients each. Facial massage and facial exercises were applied to all patients. Group one received MLS laser as a manual scanning technique (10 J/cm2, area 50cm2, total energy 500 J). Group two received MLS laser using point application technique (10 J/point, 8 points, total 80 J). Group three received placebo laser. House-Brackmann scale (HBS) and facial disability index (FDI) were used to evaluate the facial recovery. Assessment was performed at baseline and after 3 and 6 weeks of treatment. Comparison within and between groups was performed statistically with significance level p < 0.05. Results showed significant improvement in the FDI and HBS after treatment in all groups. Both scanning and point application significantly improved the score of FDI and HBS more than placebo group. Scanning technique combined with facial massage and exercises had a more significant effect than the point application group or the placebo group in improving FDI and HBS scores after 3 and 6 weeks of treatment. The MLS laser is an effective physiotherapy method used for the treatment of patients with IBP. MLS laser in scanning or point application techniques was more effective than exercise alone with greater effect of scanning technique than point application technique.
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