Rufus R. Noble Goals low-level lasers (LLLT) should not be considered in knee osteoarthritis (KOA) treatment guidelines. We examined whether an LT dose-response relation is present in KOA.
Design Meta-analysis and systematic review.
Sources of data Articles that are eligible were discovered by PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Central Register of Controlled Trials on February 18, 2019, references lists and citations. as well as experts within the area.
Eligibility criteria for choosing studies We only included placebo-controlled studies that were randomized and randomized to people suffering from KOA by the American College of Rheumatology and Kellgren/Lawrence criteria. LLLT was administered to the participants’ knee(s) in these trials. There were no restrictions on language.
Extraction of data, as well as Synthesis The trial included was synthesized using random effects meta-analyses. They were subgrouped by dose based on The World Association for Laser Therapy treatment guidelines. Cochrane’s risk-of-bias tool was utilized.
Results 22 trials (n=1063) were meta-analyzed. The risk of bias was not significant. Overall the pain reduction was significant with LLLT when compared to placebo at the conclusion of treatment (14.23 the mm of Visual Analogue Scale (VAS; 95% confidence interval 7.31 and 21.14)) as well as during follow-ups one to twelve weeks after the end of therapy (15.92 millimeters VAS (95 percent of CI 6.47 and 25.37)). A subgroup analysis found that pain was diminished by the suggested LLLT dosages, compared with placebo after therapy (18.71 millimeters (95 percent 95% CI 9.42 up to 27.99)) as well as during subsequent follow-ups from 2-12 weeks after the conclusion of treatment (23.23 the VAS was an mm (95 percent of the interval 10.60 up to 35.86)). The decrease in pain resulting from the suggested LLLT doses was most significant at follow-ups two weeks following the conclusion treatment (31.87 mm VAS, which was significantly more critical than the placebo (95 percent 95% confidence interval 18.18 up to 45.56)). Disability was statistically diminished considerably due to LLLT. No adverse events were reported.
Final Conclusion LLLT eases disability and pain in KOA with 4-8J using the wavelength of 785-860 nm and 1 J, which has a 904 nm wavelength for each treatment spot.
PROSPERO registration code CRD42016035587.
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Strengths and drawbacks of this study
- The study was conducted in accordance with an elaborate a priori procedure, which contained the guidelines for subgroups of laser dose.
- No restrictions on language were imposed. Four (18 percent) of the trials were described in non-English languages.
- Meta-analyses were carried out to assess the impact of low-level laser treatment on pain as time passed.
- Three individuals independently extracted the data from the trial papers to ensure the high reliability of meta-analyses.
- The review does not include quality-of-life analyses as well as a thorough disability time-effect analysis as well as a direct examination of low-level laser therapies and other treatments.
Introduction
About 13 percent of females and 10 percent of males within the age group of 60+ years are affected by knee osteoarthritis (KOA) in the USA. 1 KOA is a degenerative, inflammatory condition that affects the joint in all its forms and is characterized by increasing loss of cartilage and caused by pain, disability and diminished QoL. (QoL). 1 An increase in inflammation is associated with increased pain intensity and faster KOA disease development. 1 2
A few of the more conservative treatment alternatives that can be used to treat KOA include exercises, non-steroidal anti-inflammatory drugs (NSAIDs), and low-level laser therapy that is anti-inflammatory (LLLT). It is known that exercise therapy can reduce disability and pain as well as improves the quality of life for people with KOA. 3 4 NSAIDs are the recommended treatment in the majority of KOA treatment guidelines. It is most likely the most commonly prescribed category of therapy for osteoarthritis, even though the use of the drugs can cause adverse side adverse effects, five of which are a problem, mainly since the condition requires long-term care. In addition, a newly published meta-analysis of a network shows that the effectiveness in relieving pain NSAIDs in KOA beyond placebo is minimal or moderate (depending on the drug type). 6 Also, in the initial systematic review of this subject, the effect of pain relief of NSAIDs was found to be just 10.1 millimeters on the 1-100 millimeter Visual Analogue Scale (VAS), superior to the placebo. 7
LT is a non-invasive treatment modality,8 9 which has been reported to induce anti-inflammatory effects.9-14 LT was compared with NSAID in rats with KOA by Tomazoni et al. in a laboratory; NSAID (10 mg diclofenac/knee/session) and LT (830 nm wavelength, 6 J/knee/session) reduced similar levels of inflammatory cells and metalloproteinase (MP-3 and MP-13). Furthermore, LLLT reduced the expression of proinflammatory cytokines (interleukin-1b (IL-1b) and IL-6, as well as tumor necrosis factors a) prostaglandin, myeloperoxidase, and prostaglandin E 2 significantly more than NSAID did. 10 11
LLLT was administered to rabbits suffering from KOA 3 times a week for eight weeks in a study that was placebo-controlled conducted by Wang and colleagues. 12 At the end of weeks 6 and 7, they discovered that LT was significantly less painful and synovitis, as well as produced IL-1b inducible nitric oxide synthase and MP-3. It also slowed down the loss of metallopeptidase inhibitor 1. Two weeks afterward, LLLT had significantly reduced MP-1 and MP-13 as well as reduced the reduction of aggrecan, collagen II, and transforming growth factor-beta, and the earlier changes were maintained. 12 These results indicate that the benefits of LLLT are heightened over time.
Pallotta and colleagues 14 conducted a study of LLLT in rats suffering from knee inflammation. They showed that despite LT (810 millimeters) significantly increasing the cyclooxygenase (COX-1 as well COX-2) expression, it reduced various other inflammatory factors such as leucocyte infiltration, myeloperoxidase the IL-6 and IL-1, and particularly prostaglandin E 2. Pallotta and colleagues 14 speculated that the rise in COX levels due to LLLT could be a factor in the creation of mediators that trigger inflammation that contributes to the end of the inflammatory process.
LLLT is not a recommended treatment in the significant osteoarthritis treatment guidelines. LLLT to treat KOA was discussed in the European League Against Rheumatism’s osteoarthritis guidelines (2018); however, it was not advised, 15 and in the Osteoarthritis Research Society International guidelines (2018). In both approaches, it was stated that LLLT is not a primary intervention in treating KOA. 16
It could be because of the contradicting results from two systematic reviews that were recently published on the subject. 8 17 The contradicting results could result from omitting relevant studies 8-17-23 and the unresolved dose-related IT problems. There was only one study. Huang and colleagues 17 conducted an LLLT dose-response interaction study in KOA by subdividing the trials according to laser dose. However, they should have considered that the World Association for Laser Therapy (WALT) suggests applying four times the amount of laser using continuous irradiation compared to superposed radiation. 22 24-26 Therefore, it needed to be clarified whether LLLT is efficient in KOA, and therefore, we spotted an urgent need for a brand new systematic review.
This review aimed to determine the efficacy of using LLLT in KOA for knee pain, disability, and QoL. We limited our analysis to placebo-controlled randomized clinical studies (RCTs) to reduce the potential bias.
