Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials
Stausholm MB, Naterstad IF, Joensen J, Lopes-Martins RÁB, Sæbø H, Lund H, Fersum KV, Bjordal JM
BMJ open · 114 citations
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- University or hospital
- Universitetet i Bergen
Based on 1 listed funder(s).
Publication
- Published
- 2019-10-01 · BMJ Open · vol. 9 · issue 10 · p. e031142
- Publisher
- BMJ
- Cited
- 161 citations · more than 94% of similar papers · 3.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 62 works
- Access
- Open access (journal) · CC-BY-NC
- Research areas
- Laser Applications in Dentistry and Medicine · Temporomandibular Joint Disorders · Medical and Biological Ozone Research
- Keywords
- Medicine, Placebo, Meta-analysis, Physical therapy, Osteoarthritis, Visual analogue scale, Low level laser therapy, Randomized controlled trial, Clinical trial, Relative risk, MEDLINE, Subgroup analysis, Publication bias, Knee pain, Rheumatology, Internal medicine, Alternative medicine, Laser therapy, Confidence interval, Pathology
- MeSH
- humans, arthralgia, osteoarthritis, knee, treatment outcome, randomized controlled trials as topic, low-level light therapy
8 authors
From NO, BR, BE
- Martin Bjørn Stausholm · correspondingUniversity of Bergen
- Ingvill Fjell NaterstadUniversity of Bergen
- Jón JoensenUniversity of Bergen
- Rodrigo Álvaro Brandão Lopes‐MartinsUniversidade do Vale do Paraíba; Instituto de Desenvolvimento Sustentável Mamirauá
- Humaira SæbøUniversity of Bergen
- Hans LundWestern Norway University of Applied Sciences; Rode Kruis-Vlaanderen
Abstract
Objectives
Low-level laser therapy (LLLT) is not recommended in major knee osteoarthritis (KOA) treatment guidelines. We investigated whether a LLLT dose-response relationship exists in KOA.
Design
Systematic review and meta-analysis.
Data sources
Eligible articles were identified through PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Central Register of Controlled Trials on 18 February 2019, reference lists, a book, citations and experts in the field.
Eligibility criteria for selecting studies
We solely included randomised placebo-controlled trials involving participants with KOA according to the American College of Rheumatology and/or Kellgren/Lawrence criteria, in which LLLT was applied to participants' knee(s). There were no language restrictions.
Data extraction and synthesis
The included trials were synthesised with random effects meta-analyses and subgrouped by dose using the World Association for Laser Therapy treatment recommendations. Cochrane's risk-of-bias tool was used.
Results
22 trials (n=1063) were meta-analysed. Risk of bias was insignificant. Overall, pain was significantly reduced by LLLT compared with placebo at the end of therapy (14.23 mm Visual Analogue Scale (VAS; 95% CI 7.31 to 21.14)) and during follow-ups 1-12 weeks later (15.92 mm VAS (95% CI 6.47 to 25.37)). The subgroup analysis revealed that pain was significantly reduced by the recommended LLLT doses compared with placebo at the end of therapy (18.71 mm (95% CI 9.42 to 27.99)) and during follow-ups 2-12 weeks after the end of therapy (23.23 mm VAS (95% CI 10.60 to 35.86)). The pain reduction from the recommended LLLT doses peaked during follow-ups 2-4 weeks after the end of therapy (31.87 mm VAS significantly beyond placebo (95% CI 18.18 to 45.56)). Disability was also statistically significantly reduced by LLLT. No adverse events were reported.
Conclusion
LLLT reduces pain and disability in KOA at 4-8 J with 785-860 nm wavelength and at 1-3 J with 904 nm wavelength per treatment spot.
Prospero registration number
CRD42016035587.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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