Safety and Effectiveness of Low-Level Laser Therapy in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis
Journal of Lasers in Medical Sciences,
Vol. 8 No. 3 (2017),
30 August 2017
Low Level Laser Therapy was introduced as an alternative non-invasive treatment for osteoarthritis, but its effectiveness is still controversial. The main objective of this article was to determine the safety and efficacy of LLLT in patients with knee osteoarthritis. In order to gather evidence, main medical databases as well as relevant websites were browsed without time limit. We searched with appropriate keywords and strategies. After quality assessment of studies, study data were extracted by two reviewers. Standard mean difference proposed through Inverse Variance was used in the meta-analysis using the random-effects model. Twelve values were used for the evaluation of heterogeneity. A total of 823 studies, 14 RCTs were selected after final review. There was a signiﬁcant difference between LLLT and Placebo in pain at rest (p=0.02), pain at activity (p=0.01), total pain (p=0.03), WOMAC function (p=0.01), WOMAC stiffness (p=0.02) and WOMAC total (p<0.0001) in favor of the LLLT. There was no signiﬁcant difference between LLLT and Placebo in WOMAC pain (p=0.09) and range of motion (p=0.1). In spite of some positive findings, this meta-analysis lacked data on how LLLT effectiveness is affected with important factors: wavelength, energy density, treatment duration, numbers of sessions the treatment, severity of KOA and site of application.
- Low level laser therapy
How to Cite
Le TK, Montejano LB, Cao Z, Zhao Y, Ang D. Health care costs in US patients with and without a diagnosis of osteoarthritis. J Pain Res 2012; 5:23–30.
Badley EM, Rasooly I, Webster GK. Relative importance of musculoskeletal disorders as a cause of chronic health prob-lems, disability and health care utilization: findings from the 1990 Ontario Health Survey. J Rheumatol 1994; 21:505-14.
Chen D. Updated therapy in elderly patients with Knee osteoarthritis. Int J Gerontol. 2007 ;( 1):31-39. doi: 10.1016/s1873-9598(08)70021-8.
Gupta S, Hawker GA, Laporte A, Croxford R, Coyte PC. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology. 2005; 44:1531-1537. doi: 10.1093/rheumatology/kei049.
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet 2011;377(9783): 2115 e26 .
Melo MD, Pompeo KD, Brodt GA, Baroni BM, da Silva Junior DP, Vaz MA. Effects of neuromuscular electrical stimulation and low-level laser therapy on the muscle architecture and func-tional capacity in elderly patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil 2014, http:// dx.doi.org/10.1177/0269215514552082.
Youseﬁ-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamarani M, et al. Low level laser therapy for nonspeciﬁ c low-back pain. Cochrane Database Syst Rev 2008; 16(2):Cd005107.
Farivar S, Malekshahabi T, Shiari R. Biological Effects of Low Level Laser Therapy. J Lasers Med Sci 2014;5(2):58-62 .
Herman JH, Khosla RC. In vitro effects of Nd:YAG laser radiation on cartilage metabolism. J Rheumatol 1988; 15(12):1818 e 26
Huang Z, Chen J, Ma J, Shen B, Pei F, Kraus V. Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and Cartilage 2015; 23; 1437e1444.
Higgins JP, Green S Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [Updated March 2011]. The Cochrane Collaboration http://www.cochrane.org/training/cochrane-handbook
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327(7414):557 e60.
Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, et al.Efﬁ cacy of low level laser therapy associ-ated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehabil 2012; 26(6):523 e 33.
Alghadir A, Omar MT, Al-Askar AB, Al-Muteri NK. Effect of low-level laser therapy in patients with chronic knee osteoar-thritis: a single-blinded randomized clinical study. Lasers Med Sci 2014; 29(2):749e55.
Al Rashoud AS, Abboud RJ, Wang W, Wigderowitz C. Efﬁ cacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial. Physiotherapy 2014; 100(3):242 e8.
Fukuda VO, Fukuda TY, Guimar ~aes M , Shiwa S, Lima BDC, Martins R, et al. Short-term efﬁ cacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial. Rev Bras Ortop 2011; 46(5):526e 33.
Gur A, Cosut A, Sarac AJ, Cevik R, Nas K, Uyar A. Efﬁcacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: a double-blind and randomized controlled trial. Lasers Surg Med 2003; 33(5):330 e 8.
Hegedus B, Viharos L, Gervain M, Galﬁ M. The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial. Photomedicine and Laser Surgery 2009; 27: 577–584.
Hinman RS, McCrory P, Pirotta M, Relf I, Forbes A, Crossley KM, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA 2014; 312(13):1313 e 22.
Kheshie AR, Alayat MS, Ali MM. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 2014; 29(4):1371 e6.
Rayegani SM, Bahrami MH, Elyaspour D, Saeedi M, Sanjri H. Therapeutic Effects of Low Level Laser Therapy (LLLT) in Knee Osteoarthritis, Compared to Therapeutic Ultrasound: J Lasers Med Sci 2012; 3(2):71-4
Shen, X., Zhao, L., Ding, G., et al. (2009). Effect of combined laser acupuncture on knee osteoarthritis: a pilot study. La-sers Med. Sci. 24, 129–136.
Stelian J, Gil I, Habot B, Rosenthal M, Abramovici I, Kutok N and Khalil A (1992): Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy. Journal of American Geriatric Society 40: 23-26.
Tascioglu F, Armagan O, Tabak Y, Corapci I, Oner C. Low power laser treatment in patients with knee osteoarthritis. Swiss Med Wkly 2004; 134(17e 18):254e 8.
Youssef EF, Muaidi QI, Shanb AA. Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. J Lasers Med Sci. 2016; 7(2):112-119.
Yurtkuran M, Alp A, Konur S, Ozcakir S, Bingol U. Laser acupuncture in knee osteoarthritis: a double-blind, random-ized controlled study. Photomed Laser Surg 2007; 25(1):14e 20.
Revill SI, Robinson JO, Rosen M and Hogg MI. The reliability of a linear analogue for evaluating pain. Anaesthesia 1976; 31: 1191–1198.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J and Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833–1840.
Marques AP. Manual de goniometria, second edition. Editora Manole, 2003.
Bulow PM, Jensen H, Danneskiold-Samsoe B. Low power Ga-Al-As laser treatment of painful osteoarthritis of the knee. A double-blind placebo-controlled study. Scand J Rehabil Med 1994; 26(3):155e 9.
- Abstract Viewed: 2368 times
- PDF Downloaded: 760 times