ABSTRACT
BACKGROUND: Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle. PURPOSE: This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain. METHODS: A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES). RESULTS: Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function. CONCLUSION: PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol. REGISTRATION: PROSPERO registration number (CRD42021292930).
Subject(s)
Ankle Injuries , Low-Level Light Therapy , Humans , Low-Level Light Therapy/methods , Ankle Injuries/radiotherapy , Sprains and Strains/radiotherapy , Treatment Outcome , Edema/radiotherapyABSTRACT
Objective: This systematic review aimed to investigate the efficacy of photobiomodulation therapy (PBMT) on pain and pressure pain threshold (PPT) in patients with myofascial pain syndrome (MPS) of the upper trapezius muscle. Materials and methods: A total of 17 studies (944 patients) were included; data regarding participants, intervention parameters, outcome measures, time of measurement, and follow-up were extracted. Evaluation of the methodological quality was performed by Physiotherapy Evidence Database (PEDro) scale. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. A meta-analysis was performed on 16 studies, and standardized mean difference (SMD), corresponding 95% confidence interval (CI), and overall effect size (ES) were calculated. Results: Meta-analysis using a random-effect model was performed to evaluate the effects of PBMT alone or PBMT plus exercise (EX) compared with placebo, medical treatment, physical therapy (PT) modality, manual therapy, or complementary PT. Assessment according to the PEDro scale revealed 12 high-quality, 3 fair-quality, and 2 low-quality studies. According to the GRADE system, studies exhibited low to medium quality of evidence, with medium ES [SMD -0.54 (95% CI -1.05 to -0.02)] for studies using PBMT alone and large ES [SMD -0.80 (95% CI -1.35 to -0.26)] for PBMT+EX. Conclusions: The present systemic review revealed that PBMT is an effective PT modality for reducing pain and increasing PPT in patients with MPS of the upper trapezius. PBMT, when combined with EX, had more significant effects in reducing pain and increasing PPT compared with controls. The low-quality studies with low to moderate quality of evidence limit the confidence in the effect estimate and recommend further high-quality studies for standardization of treatment protocols and irradiation parameters. PROSPERO registration number: CRD42021241155.
Subject(s)
Low-Level Light Therapy , Myofascial Pain Syndromes , Superficial Back Muscles , Humans , Myofascial Pain Syndromes/radiotherapy , Physical Therapy Modalities , PainABSTRACT
Purpose: To investigate the effectiveness of perturbation-based training (PBT) on balance and balance confidence in patients with stroke. Methods: Systematic searching was performed from inception to November 2021. The inclusion criteria were RCTs assessed the effectiveness of PBT in patients with stroke. Data regarding participants, intervention parameters, outcome measures, follow-up, and main results were extracted. The outcomes were balance and balance confidence. Methodological quality and quality of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system; respectively. Data analysis: A total of 7 articles )271 patients) were included. A meta-analysis using a random-effect model was performed on 6 studies. Standardized mean difference (SMD) with a 95% confidence interval was calculated for balance and balance confidence. Results: PEDro scale revealed 5 good-quality and 2 fair-quality studies. The currently available evidence showed significant effect of PBT in improving balance (SMD 0.60 [95% CI 0.15-1.06]; P = .01; very low-quality evidence) and non-significant in improving balance confidence (SMD 0.11 [95% CI -0.24 to 0.45]; P = .55; low-quality evidence). Conclusion: PBT may improve balance in patients with stroke, however its effect on balance confidence was limited. The quality of the evidence was low or very low with little confidence in the effect estimate, which suggests further high-quality trials are required. Registration: PROSPERO registration number (CRD42021291474).
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.
Subject(s)
Bell Palsy , Low-Level Light Therapy , Humans , Bell Palsy/radiotherapy , Double-Blind Method , Lasers , Low-Level Light Therapy/methodsABSTRACT
Objective: The aim of this systematic review and meta-analysis was to investigate the effectiveness of telerehabilitation on improving balance and functional mobility in stroke survivors. Methods: Comprehensive searching was conducted from inception to May 2022. The inclusion criteria were studies evaluating the effectiveness of telerehabilitation in stroke survivors. Data regarding participants, intervention, outcome measures, and main results were extracted. PEDro scale and the Grading of Recommendations Assessment Development and Evaluation (GRADE) were used to assess the methodological quality and quality of evidence, respectively. Data Analysis: A total of fourteen articles) 594 patients) were included. A meta-analysis using a random-effect model was performed on thirteen studies )530 patients). Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for balance and functional mobility. Results: PEDro scale revealed ten good-quality studies, three fair-quality studies, and one poor-quality study. According to the available evidence, telerehabilitation has a small effect size in improving both balance (SMD 0.33 [95% CI 0.03 to 0.63]; P =0.03; low quality of evidence) and functional mobility (SMD 0.27 [95% CI 0.02 to 0.52]; P =0.03; low quality of evidence). Conclusion: Telerehabilitation may improve balance and functional mobility in stroke survivors. However, it is evident that more high-quality research is required due to the existence of low to very low-quality evidence with limited confidence in the effect estimate. Registration: PROSPERO registration number (CRD42022306410).
ABSTRACT
[Purpose] To investigate the effect of pulsed Nd:YAG laser combined with the progressive pressure release technique (PPRT) and exercises in the treatment of myofascial trigger points (MTrPs) in patients with myofascial pain syndrome (MPS). [Participants and Methods] A total of 50 patients with MTrPs in the upper trapezius muscle participated in the study. The patients were randomly assigned to two groups and treated with laser plus PPRT (Laser + PPRT group) or placebo laser and exercises (PL + PPRT group). The laser was applied for eight MTrPs with a 50â J/point. PPRT was applied for 30 seconds for each point. Exercises included strengthening and stretching exercises applied three times per week for four weeks. A visual analogue scale (VAS) and pressure pain threshold (PPT) were used to measure pain and pain threshold, respectively. A cervical range of motion device (CROM) was used to measure the cervical range of motion. [Results] Both treatment groups showed significant improvement in CROM, PPT, and VAS post-treatment with a more significant effect in the Laser + PPRT group compared to the PL + PPRT group. [Conclusion] PPRT and exercises alone or that in combination with laser therapy were effective in the treatment of active MTrPs in patients with MPS.
ABSTRACT
Pulsed Nd:YAG laser (1064 nm) is a recent modality that is used for the rehabilitation of musculoskeletal disorders, but there is no evidence about its thermal effects. The aim of the study was to investigate the changes in local skin temperature (LST) after the application of a pulsed Nd:YAG laser to healthy subjects. The study participants were 30 male subjects with an average age of 21.96 (± 0.92) years. A rectangular area (15 × 10 cm2) was marked at the front of the dominant thigh and scanned with a laser beam at 3000 J with 20 J/cm2 for 15 min. The other thigh was considered as a control side. The minimum, average, and maximum LSTs were measured using a thermographic camera. The measurements were performed before laser application, immediately after, and then every minute until the LST returned to the pre-treatment value. An independent t test and repeated measures ANOVA were used to analyze the changes in LST. The level of significance was set at p < 0.05. The pulsed Nd:YAG laser significantly increased the minimum, average, and maximum LSTs in comparison with the control. The increase was significant for up to 5 min after the application, and it took 10 min to reach the baseline values. The level of increase was 1.23-4.03 °C, and the average increase was 2.6 °C. The pulsed Nd:YAG laser significantly increased the minimum, average, and maximum LSTs of the thigh area in normal subjects, and the thermal effect lasted for 5 min after application.
Subject(s)
Lasers, Solid-State , Skin Temperature/physiology , Cross-Over Studies , Humans , Light , Low-Level Light Therapy , Male , Prospective Studies , Young AdultABSTRACT
OBJECTIVE: The purpose of the present study was to investigate the long-term effect of pulsed Nd:YAG laser on the treatment of rotator cuff tendinopathy. METHODS: Sixty patients with rotator cuff tendinopathy participated and completed the study. The mean age was 50.2 ± 3.6 years. Participants were randomly assigned to one of two groups: the control group and the treatment group. Both groups were treated with an exercise program, in addition to the pulsed Nd:YAG laser received by the treatment group and the "sham" laser received by the control group, both for three sessions per week for 4 weeks. Outcome measures included pain, assessed by the visual analog scale, and range of motion (ROM), assessed using a traditional goniometer, while the shoulder pain and disability index were used to evaluate the functional recovery of the shoulder joint. Evaluation was carried out before treatment, immediately after treatment, 3 months posttreatment, and 6 months posttreatment. Statistical analyses were used to investigate the effect of interventions and to compare the study groups' pretreatment, posttreatment, and at follow-up points. The significance level was set to p < 0.05. RESULTS: Pain was significantly decreased after treatment and at follow-up points, while ROM and shoulder functions were significantly improved after treatment and at follow-up intervals in both groups. The improvement was more significant in the treatment group than in the control group posttreatment and at follow-up intervals. CONCLUSIONS: Pulsed Nd:YAG laser combined with an exercise program seems to be more effective in the treatment of patients with rotator cuff tendinopathy than a sham laser with exercises.
Subject(s)
Lasers, Solid-State/therapeutic use , Low-Level Light Therapy , Rotator Cuff , Tendinopathy/radiotherapy , Exercise Therapy , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Recovery of Function , Tendinopathy/rehabilitation , Treatment OutcomeABSTRACT
[Purpose] To determine the efficacy of high intensity laser therapy (HILT) versus pulsed electromagnetic field (PEMF) in the treatment of primary dysmenorrhea. [Subjects and Methods] This was a randomized clinical trial that included 52 girls diagnosed with primary dysmenorrhea and who were assigned randomly into two groups of equal numbers. The treatment was three sessions every cycle for three consecutive cycles where group (A) included those participants treated with HILT 15â min/session and group (B) those who were treated with PEMF 30â min/session. All patients were evaluated before starting the treatment as well as after the end of treatment by present pain intensity scale and the prostaglandin level in blood and pain relief scale at the end of treatment for both groups. [Results] The results showed a significant decrease in the severity of pain, statistically significant decrease in prostaglandin level in blood, and a statistically significant pain alleviation in both groups. With comparison between both groups there was a statistically significant decrease in the severity of pain, significant decrease in the blood levels of PGF2α, in group (A) than group (B). [Conclusion] Both HILT and PEMF are effective in the treatment of primary dysmenorrhea with HILT being superior to PEMF.
ABSTRACT
The aim of the present study was to investigate and compare the effects of high intensity laser therapy (HILT) and low level laser therapy (LLLT) on the treatment of patients with Bell's palsy. Forty-eight patients participated in and completed this study. The mean age was 43 ± 9.8 years. They were randomly assigned into three groups: HILT group, LLLT group, and exercise group. All patients were treated with facial massage and exercises, but the HILT and LLLT groups received the respective laser therapy. The grade of facial recovery was assessed by the facial disability scale (FDI) and the House-Brackmann scale (HBS). Evaluation was carried out 3 and 6 weeks after treatment for all patients. Laser treatments included eight points on the affected side of the face three times a week for 6 successive weeks. FDI and HBS were used to assess the grade of recovery. The scores of both FDI and HBS were taken before as well as 3 and 6 weeks after treatment. The Friedman test and Wilcoxon signed ranks test were used to compare the FDI and HBS scores within each group. The result showed that both HILT and LLLT significantly improved the recovery of patients with Bell's palsy. Moreover, HILT was the most effective treatment modality compared to LLLT and massage with exercises. Thus, both HILT and LLLT are effective physical therapy modalities for the recovery of patients with Bell's palsy, with HILT showing a slightly greater improvement than LLLT.
