A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain.

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).

The Pulsed Nd:YAG Laser Therapy Enhanced Nerve Regeneration via Apoptosis Inhibition in a Rat Crushed Sciatic Nerve Model.

The study was aimed to validate the efficacy of the pulsed Nd:YAG laser on nerve regeneration in a rat sciatic nerve crushed model. 54 Wistar rats were randomly assigned into three groups: shame control, crush control, and laser treated group. For the laser treated group, the pulsed Nd:YAG laser (10 Hz) with 350 mJ per pulse in energy density and 50 J/cm2 in fluence was applied extracorporeally at the lesion site for 12 min to daily deliver 500 J immediately and consecutive 9 days following the crush injury. At week 1, the apoptosis-related activities in the injured nerve were examined (n = 8/each group). The sciatic functional index (SFI) was measured preoperatively and weekly until 4 weeks after the index procedure. The injured nerve and the innervated gastrocnemius muscle histology were assessed at week 4 (n = 10/each group). At week 1, the laser group showed the significant less TUNEL-positive ratio (P < 0.05), and the lower expression of cleaved caspase3/procaspase-3 and beclin-2/beclin-2-associated protein X ratios compared with the crush control. Furthermore, the laser group revealed significantly better SFI since week 1 and throughout the study (P < 0.05, all) compared with the crush control. At week 4, the laser group showed significantly higher axon density, lower myelin g-ratio, and the corresponding higher glycogen expression (P < 0.05, all) in the gastrocnemius muscle compared with those in the crush control. The pulsed Nd:YAG might enhance the injured nerve regeneration via apoptosis inhibition.

CO2 Laser for Esthetic Healing of Injuries and Surgical Wounds with Small Parenchymal Defects in Oral Soft Tissues.

A number of studies have recently demonstrated the effectiveness of CO2 laser irradiation for the repair and regeneration of scar tissue from injuries or surgical wounds. However, such studies of the oral mucosa are highly limited. Previous studies using CO2 laser irradiation have indicated that two factors contribute to esthetic healing, namely, artificial scabs, which are a coagulated and carbonized blood layer formed on the wound surface, and photobiomodulation therapy (PBMT) for suppressing wound scarring and promoting wound healing. This review outlines basic research and clinical studies of esthetic healing with the use of a CO2 laser for both artificial scab formation by high-intensity laser therapy and PBMT in the treatment of injuries and surgical wounds with small parenchymal defects in oral soft tissues. The results showed that the wound surface was covered by an artificial scab, enabling the accumulation of blood and the perfusion necessary for tissue regeneration and repair. Subsequent PBMT also downregulated the expression of transformation growth factor-b1, which is involved in tissue scarring, and decreased the appearance of myofibroblasts. Taken together, artificial scabs and PBMT using CO2 lasers contribute to the suppression of scarring in the tissue repair process, leading to favorable esthetic and functional outcomes of wound healing.

Effectiveness of high-intensity laser therapy in the treatment of patients with frozen shoulder: a systematic review and meta-analysis.

The purpose of this study is to evaluate the effects of high-intensity laser therapy (HILT) in patients with frozen shoulder. PRISMA guidelines were adhered to, and a systematic search was conducted in the PubMed, Web of Science, Scopus, CINAHL, Science Direct, and PEDro databases (last update: September 4, 2023; search period: December 2022-September 2023). The inclusion criteria encompassed RCTs comparing HILT with other physical therapy interventions in frozen patients with frozen shoulders, with or without sham HILT, assessing pain intensity, shoulder ROM, and disability outcomes. The quality of the RCTs was assessed with the Cochrane Risk of Bias tool, and evidence was assessed using the GRADE approach. Five trials met the eligibility criteria and were included in the review and meta-analysis, which pooled results from the visual analog scale (VAS), goniometry, and the shoulder pain and disability index (SPADI). Mean differences (MDs) for pain intensity and disability show a pooled effect in favor of HILT both for VAS (MD = - 2.23 cm, 95% CI: - 3.25, - 1.22) and SPADI (MD = - 10.1% (95% CI = - 16.5, - 3.7), changes that are statistical (p < 0.01) and clinical. The MD for flexion (MD = 9.0°; 95% CI: - 2.36°, 20.3°; p = 0.12), abduction (MD = 3.4°; 95% CI: - 6.9°, 13.7°; p = 0.51), and external rotation (MD = - 0.95°; 95% CI: - 5.36°, 3.5°; p = 0.67) does not show statistical and clinical differences between groups after treatment. PI and disability changes were graded as important due to their clinical and statistical results. HILT into a physical therapy plan reduce pain and disability, but it does not outperform conventional physical therapy in improving shoulder ROM. It is suggested that future RCTs compare the effects of HILT and LLLT to assess their possible differences in their analgesic effects.

Effects of high-intensity laser therapy on pain, functional status, hand grip strength, and median nerve cross-sectional area by ultrasonography in patients with carpal tunnel syndrome.

The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on pain, functional status, hand grip strength, and median nerve cross-sectional area by ultrasonography in patients with carpal tunnel syndrome. Sixty patients who were diagnosed with carpal tunnel syndrome were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Splint+ exercise and HILT (pulsed mode with a power of 8.0 W and energy density of 8 J/cm2 for 1.40 minutes for every 25 cm2, continuous mode with a power of 3.0 W and energy density of 80 J/cm2 for 11 minutes for each 25 cm2; total 10 sessions 5 days a week) were applied for 2 weeks for the first group, and splint+exercise and sham laser treatment were applied for 2 weeks for the second group. Randomization was undertaken with the assistance of a computer-generated random number table before beginning the treatment processes. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the 3rd month. Hydraulic hand dynamometer was used to measure hand grip strength, visual analog scale (VAS) for pain, Boston CTS Questionnaire to assess function, and ultrasonography to measure median nerve cross-sectional area. The impact of time on the change in VAS levels was found to be of statistical significance within each group of patients (p<0.001), but between-group comparisons did not yield significant results (p<0.454). The effects of time on variations in Boston CTS Questionnaire scores were found to have been of statistical significance for both groups (p<0.001), but significance was not subsequently observed when the results of the two groups were compared on a between-group basis (p=0.226 and p=0.973 for the FSS and SSS, respectively). While time had a statistically significant effect on the change in hand grip strength for both groups (p=0.000), between-group comparisons statistical significance finding in favor of HILT was found in the early period (p=0.012). The time-group association patterns of the groups showed significant difference (p=0.025). While time had a statistically significant effect on the changes in the median cross-sectional areas of the nerve for the patients of both treatment groups (p<0.001), between-group comparisons yielded no findings of statistical significance (p=0.438). The time-group relationship patterns of the groups were found to reflect statistical significance (p=0.001). In conclusion, the results of the research presented here have confirmed that hand grip strength may increase and the median nerve's cross-sectional area may decrease upon the application of high-intensity laser for individuals experiencing CTS. However, this effect was demonstrated here only in the short-term and the evidence was not maintained through the course of follow-up of a longer duration.

Effect of high-intensity laser therapy versus shockwave therapy on selected outcome measures in osteoporotic long-term hemiparetic patients: a randomized control trial.

BACKGROUND: This study aimed to compare the effects of high-intensity laser therapy (HILT) and extracorporeal shock wave therapy (ESWT) in treating consequences of osteoporosis in hemiparetic patients. METHODS: A randomized controlled trial was conducted on hemiplegic patients with osteoporosis. They were randomly classified into three equal groups (n = 40 in each group). The control group received medication and traditional physiotherapy programs for stroke patients. The high-intensity laser (HIL) group received the same intervention as the control group in addition to high-intensity laser therapy. The shock wave (SW) group received the same intervention as the control group in addition to shock wave therapy. The three groups received an intervention that lasted 3 sessions/week for 12 weeks). All groups were assessed before and after therapy for the degree of pain, fall risk, and quality of life. RESULTS: A statistically significant difference (p < 0.05) was found concerning VAS, which had a significant difference in favor of HILT and ESWT groups compared to the control group; however, no significant difference was determined between HIL and SW groups. Regarding the overall stability index, SFBBS, and QUALEFFO-41, there was a significant difference in favor of HIL and SW groups compared to the control group, and a significant difference was found in HIL when compared to SW. CONCLUSION: The current study indicates that the combined traditional physical therapy and HILT and ESWT have clinical significance in improving osteoporotic long-term hemiparetic patients with more favor to HILT. TRIAL REGISTRATION: The study was registered as a clinical trial at ClinicalTrial.gov ID (NCT05616611).

Evaluation of the effect of high-intensity laser therapy (HILT) on function, muscle strength, range of motion, pain level, and femoral cartilage thickness in knee osteoarthritis: randomized controlled study.

This study was designed as a double-blind randomized placebo-controlled study. The aim of this study was to evaluate the effects of high-intensity laser therapy (HILT) on pain, range of motion, function, muscle strength, and femoral cartilage thickness in patients with knee osteoarthritis. Sixty patients who were admitted between November 2021 and April 2022 and diagnosed with knee osteoarthritis based on anamnesis, physical examination, and imaging methods were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Hotpack, transcutaneous electrical nerve stimulation (TENS), exercise (5 days a week for a total of 15 sessions), and HILT (analgesic mode with a power of 10.0 w, energy density of 12 j/cm2, and 2 min for every 25 cm2, biostimulant mode with a power of 5.0 W, energy density of 120 j/cm2, and 10 min for each 25 cm2; total 9 sessions 3 days a week) were applied for 3 weeks for the first group, and hot pack, TENS, exercise (5 days a week for a total of 15 sessions), and sham laser treatment (0 W total 9 sessions 3 days a week) was applied for 3 weeks for the second group. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the third month. A goniometer was used to measure joint range of motion measurement, a visual analog scale (VAS) for pain, WOMAC Osteoarthritis Index to assess pain and function, Biodex System 3 isokinetic device for knee flexion-extension muscle strength measurement, and ultrasonography to measure femoral cartilage thickness. There was no statistically significant difference in VAS, range of motion, WOMAC, muscle strength, and femoral cartilage thickness measurement between the groups, whether before treatment, after treatment or at the third-month follow-up (p > 0.05). There was a statistically significant decrease in pain intensity, an increase in flexion range of motion, WOMAC, and femoral cartilage thickness in both groups (p < 0.005). A statistically significant increase was found in the average peak torque flexion muscle strength measurements at isokinetic 60°/s angular velocities in the post-treatment and third-month checkup compared to the pre-treatment analysis in both groups (p < 0.05). In conclusion, there was no statistically significant difference between HILT + exercise and placebo laser + exercise observed. However, the exercise program performed under the supervision of a physiotherapist has been shown to be effective in improving all parameters.

Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial.

Background: Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. Objective: To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Trial Design: Prospective, randomized, parallel group, patient- and assessor-blinded. Methods: A total of 45 patients (aged: 18-65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18-65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. Results: A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. Conclusion: HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. Trial Registration: ClinicalTrials.gov Identifier: NCT05469672. Funding: None.

[High-intensity laser therapy combined with targeted hand function training for the treatment of grade 1-2 thumb carpometacarpal osteoarthritis].

OBJECTIVE: To explore clinical effect of high-intensity laser therapy(HILT) combined with targeted hand function training on pain and lateral pinch force in grade 1-2 thumb carpometacarpal(CMC) osteoarthritis(OA). METHODS: From April 2020 and April 2022, 42 female patients with thumb CMC OA grade 1 to 2, aged from 58 to 80 years old with an everage of (68.90±7.58) years old were divided into observation group of 21 patients who received HILT and targeted hand function training for 4 weeks, and 21 patients in control group who received ultrashort wave therapy combined with using of an orthosis for 4 weeks. Visual analogue scale(VAS) was applied to evaluate degree of pain, function of finger was evaluated by dynamometer to measure lateral pinch force at baseline, immediately following intervention at 4 and 12 weeks following intervention. RESULTS: VAS and lateral pinch force at immediately and 12 weeks after intervention betwwen two groups were better than that of before intervention(P<0.05). Compared with control group, the degree of pain in observation group improved more(immediately after intervention t=3.37, P<0.05, 12 weeks after intervention t=9.05, P<0.05), lateral pinch force higher than that of control group (immediately after intervention t=-2.55, P<0.05, 12 weeks after intervention t=9.51, P<0.05). CONCLUSION: High-intensity laser therapy combined with targeted hand function training is more effective than traditional methods in improving pain and lateral pinch force in grade 1-2 thumb carpometacarpal osteoarthritis.

Comparison between Low-Level and High-Intensity Laser Therapy as an Adjunctive Treatment for Knee Osteoarthritis: A Randomized, Double-Blind Clinical Trial.

BACKGROUND: Low-level (LLLT) and high-intensity laser therapy (HILT) can be beneficial additions to knee osteoarthritis (KOA) rehabilitation exercises; however, it is still being determined which electrophysical agent is more effective. AIM: To compare the effects of LLLT and HILT as adjuncts to rehabilitation exercises (LL + EX and HL + EX) on clinical outcomes in KOA. METHODS: Thirty-four adults with mild-to-moderate KOA were randomly allocated to either LL + EX or HL + EX (n = 17 each). Both groups underwent their respective intervention weekly for twelve weeks: LL + EX (400 mW, 830 nm, 10 to 12 J/cm2, and 400 J per session) or HL + EX (5 W, 1064 nm, 19 to 150 J/cm2, and 3190 J per session). The laser probe was placed vertically in contact with the knee and moved in a slow-scan manner on the antero-medial/lateral sides of the knee joint. Participants' Knee Injury and Osteoarthritis Outcome Score (KOOS), Numerical Pain Rating Scale (NPRS), active knee flexion, and Timed Up-and-Go test (TUG) were assessed. RESULTS: Post intervention, both groups showed improvements in their KOOS, NPRS, active knee flexion, and TUG scores compared to baseline (p < 0.01). The mean difference of change in KOOS, NPRS, and active knee flexion scores for the HL + EX group surpassed the minimal clinically important difference threshold. In contrast, the LL + EX group only demonstrated clinical significance for the NPRS scores. CONCLUSIONS: Incorporating HILT as an adjunct to usual KOA rehabilitation led to significantly higher improvements in pain, physical function, and knee-related disability compared to LLLT applied in scanning mode.

High-intensity laser therapy in low back pain management: a systematic review with meta-analysis.

Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT) promises to decrease pain intensity in LBP patients. The aim of this work was to evaluate the effect of HILT in adult LBP patients. We searched for randomized controlled studies (RCTs) published before January of 2023. Our primary outcome was pain intensity, while our secondary outcomes included disability and flexibility scores. We synthesized the evidence using RevMan v.5.4 and assessed methodological quality with the Oxford/Jadad scale and the Cochrane collaboration's risk of bias tool 1. The model favors the HILT group over the control group in terms of pain intensity after treatment (MD with 95% CI is -1.65 [-2.22, -1.09], p-value < 0.00001, I2=67%), Oswestry disability index (MD with 95% CI is -0.67 [-1.22, -0.12], p-value = 0.02, I2=73%), and Roland disability index (MD with 95% CI is -1.36 [-1.76, -0.96], p-value <0.00001, I2=0%). The patients in the high-intensity laser therapy had statistically significantly lower (low back) pain intensity compared to the patients in the control group. Based on three RCTs, our model also showed the positive effect of the HILT on LBP in terms of the Oswestry disability index and Roland disability index.

Three-dimensional irradiance and temperature distributions resulting from transdermal application of laser light to human knee-A numerical approach.

The use of light for therapeutic applications requires light-absorption by cellular chromophores at the target tissues and the subsequent photobiomodulation (PBM) of cellular biochemical processes. For transdermal deep tissue light therapy (tDTLT) to be clinically effective, a sufficiently large number of photons must reach and be absorbed at the targeted deep tissue sites. Thus, delivering safe and effective tDTLT requires understanding the physics of light propagation in tissue. This study simulates laser light propagation in an anatomically accurate human knee model to assess the light transmittance and light absorption-driven thermal changes for eight commonly used laser therapy wavelengths (600-1200 nm) at multiple skin-applied irradiances (W cm-2 ) with continuous wave (CW) exposures. It shows that of the simulated parameters, 2.38 W cm-2 (30 W, 20 mm beam radius) of 1064 nm light generated the least tissue heating -4°C at skin surface, after 30 s of CW irradiation, and the highest overall transmission-approximately 3%, to the innermost muscle tissue.

High-intensity laser for the treatment of pain: systematic review / Laser de alta intensidade para tratamento da dor: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the most prevalent causes of disability in the world, and the adverse effects promoted by analgesics can limit therapeutic success. In this context, laser appears as a complementary therapy that can enhance analgesia without increasing the incidence of undesirable adverse events. The aim of this study was to carry out a systematic review on the effectiveness and efficiency of high intensity laser (HIL) in the treatment of pain. CONTENTS: A systematic search was carried out in Medline, LILACS, Pubmed and PEDro, from July 2020 to August 2022. The keywords pain, chronic pain, high intensity laser and treatment were considered. The quality of selected studies was assessed using the PEDro scale. Included systematic reviews were assessed for methodological quality using the AMSTAR tool. The main measure studied was pain intensity. 227 studies were found and, based on the inclusion and exclusion criteria, 32 articles were read in full, whit one being excluded for not assessing pain. Musculoskeletal disorders corresponded to 70,96% of the assessed diseases and the visual analogue scale (VAS) was the only pain measurement tool used in 100% of the studies. Approximately 57% of the studies were of high methodological quality (PEDro=7). In 53,84% of the trials, HIL was used as a single intervention, and in 46,16% it was associated whit exercises. In 96.15% of clinical trials and 100% of systematic reviews there were positive effects of HIL on pain. CONCLUSION: HIL is an effective modality for analgesia by promoting significant pain relief, rapid recovery and improvement in patient's quality of life, in a safe way. The diversity in irradiation parameters (dose, duration, interval and number of sessions) used, indicates the need for further randomized studies to establish its long-term efficiency.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das causas mais prevalentes de incapacidade no mundo, e os efeitos adversos promovidos pelos analgésicos podem limitar o sucesso terapêutico. Nesse contexto, surge o laser como terapia complementar que pode potencializar a analgesia, sem aumentar incidência de eventos adversos indesejáveis. O objetivo deste estudo foi realizar uma revisão sistemática sobre a eficácia e a eficiência do laser de alta intensidade (LAI) no tratamento da dor. CONTEÚDO: Foi realizada uma busca sistemática nas plataformas Medline, LILACS, Pubmed e PEDro, de julho de 2020 a agosto de 2022. As palavras chaves dor, dor crônica, laser de alta intensidade e tratamento foram consideradas. A qualidade dos estudos clínicos selecionados foi avaliada utilizando a escala PEDro. As revisões sistemáticas incluídas foram avaliadas quanto à qualidade metodológica através da ferramenta AMSTAR. A principal medida estudada foi a intensidade de dor. Foram encontrados 227 estudos e com base nos critérios de inclusão e exclusão, 32 artigos foram lidos na íntegra, tendo sido excluído um por não avaliar a dor. As desordens musculoesqueléticas corresponderam a 70,96% das doenças avaliadas e a escala analógica visual (EAV) foi a única ferramenta de mensuração da dor utilizada em 100% dos estudos. Aproximadamente 57% dos estudos tinham alta qualidade metodológica (PEDro=7). Em 53,84% dos ensaios o LAI foi utilizado como intervenção única, e em 46,16% foi associado a exercícios. Em 96,15% dos ensaios clínicos e 100% das revisões sistemáticas, o LAI promoveu alívio da dor. CONCLUSÃO: O LAI é uma modalidade eficaz para analgesia ao promover significativo alívio da dor, rápida recuperação e melhora na qualidade de vida dos pacientes de forma segura. A diversidade nos parâmetros de irradiação (dose, duração, intervalo e número de sessões) empregados, indica a necessidade de mais estudos randomizados para estabelecer sua eficiência em longo prazo.

Effects of radial extracorporeal shockwave therapy versus high intensity laser therapy in individuals with plantar fasciitis: A randomised clinical trial.

This study aimed to compare the effects of radial extracorporeal shockwave therapy (rESWT) to the effects of high-intensity laser therapy (HILT) in the treatment of individuals with plantar fasciitis. Thirty-two individuals with unilateral plantar fasciitis were randomized into two groups: rESWT and HILT. In each group, the individuals underwent the intervention two sessions per week, for three weeks. Outcome measures included morning pain, resting pain, pain at 80 newtons (N) pressure, skin blood flow and temperature, plantar fascia (PF) and flexor digitorum brevis (FDB) thickness, and Foot Function Index (FFI). There was no significant difference in baseline characteristics of the individuals in both groups. All outcome measures, except skin blood flow and temperature, and FDB thickness, were significantly different (p < 0.05) over time. Skin blood flow was significantly different between groups at the end of the program. Either HILT or rESWT could alleviate pain in individuals with plantar fasciitis significantly. However, HILT was better at reducing FFI (functional limitation domain) rather than rESWT. This study was a randomized clinical trial and was approved by Mahidol University-Central Institutional Review Board (MU-CIRB) following the Declaration of Helsinki, COA no. MU_CIRB 2020/207.0412, the Thai Clinical Trials Registry (TDTR) numbered TCTR2021012500.

Short-term Effectiveness of High-intensity Laser Therapy in De Quervain Tenosynovitis: A Prospective, Randomized, Controlled Study.

Objective: The effectiveness of high-intensity laser therapy (HILT) has been demonstrated in some musculoskeletal repetitive strain injury disorders. This study aimed to determine the short-term effectiveness of HILT in de Quervain tenosynovitis (DQT). Methods: Sixty-four patients with DQT diagnosis (32 males, 32 females; 18-65 years) were randomly divided into two groups. A short opponens splint was applied to both groups and HILT to the treatment group and sham HILT to the control group once a day, on alternate days, 3 days a week, for 5 weeks. Pre- and post-treatment evaluations were made using a visual analog scale (VAS); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire; Short Form-36 Health Survey; and hand grip strength test. Results: The demographic results (age, gender, duration of complaint, body mass index, occupational group) of both groups were similar (p>0.05). The pre-treatment measured values were similar in both groups (p>0.05). After a 5-week treatment, a significant improvement was observed in all parameters in both groups. Post-treatment, hand grip strength levels were statistically higher in the HILT group than in the sham therapy group, and VAS levels were significantly lower (p<0.001). Conclusions: HILT is a non-invasive and reliable method that increases grip strength and decreases pain in DQT.

[High-intensity laser therapy in clinical medicine: scientometric analysis of evidence of effectiveness]. / Vysokointensivnaya lazeroterapiya v klinicheskoi meditsine: naukometricheskii analiz dokazatel'stv effektivnosti.

INTRODUCTION: High-intensity laser technologies are widely used in modern restorative medicine, and indications for their use are expanding annually. These technologies are effective, potentially safe methods of treating many diseases. with pronounced therapeutic effects. PURPOSE OF RESEARCH: Analysis of scientific evidence of the effectiveness and safety of high-intensity laser therapy in patients with various diseases. MATERIAL AND METHODS: A comprehensive scientometric analysis of evidence-based studies of the effectiveness and safety of high-intensity laser therapy methods was carried out according to electronic databases (Google scholar, PEDro, PubMed, Cochrane DATABASE) for the period from 2006 to 2021. RESULTS: High-intensity laser therapy has a wide range of significantly pronounced therapeutic effects. and it is an effective method of treating patients with various diseases. Various technologies and methods of its application are widely used in various fields of clinical medicine. Individually developed therapy protocols are needed, with optimal exposure parameters for each patient, intervals between procedures. CONCLUSION: It is advisable to develop more reliable and standard evaluation criteria, regular generalization and analysis of existing evidence, careful planning and implementation of further large-scale randomized controlled trials to study the effects of high-intensity laser radiation both as a single effect and as part of combinations with other treatment methods. The effectiveness of combination therapy requires further analysis in the course of conducting new benign clinical trials.

A Preliminary Study of the Influence of High Intensity Laser Therapy (HILT) on Skin Surface Temperature and Longissimus Dorsi Muscle Tone Changes in Thoroughbred Racehorses with Back Pain.

The reason for undertaking this study was to investigate soft tissue response to high-intensity laser therapy (HILT) by measuring changes in skin surface temperature and longissimus dorsi muscle tone in the thoracolumbar back area in Thoroughbreds with back pain and diagnosed with and without Kissing Spines Syndrome (KSS). Thoroughbreds aged 3-4 years with clinically presented back pain underwent a radiological examination (to assess a lack or presence of KSS) and longissimus dorsi muscle palpation (to assess muscle tone and pain degree). The subjects were divided into two groups, those with KSS (n = 10) and those without KSS (n = 10). A single HILT treatment on the longissimus dorsi muscle, on the left side, was performed. Thermographic examination and palpation were repeated before and after HILT to assess changes in skin surface temperature and muscle pain response. In both groups, HILT caused a significant increase in skin surface temperature of 2.5 °C on average and a palpation score reduction of 1.5 degrees on average (p = 0.005 for both measurements), without differences in any outcome measures between the groups. Furthermore, the correlation between changes in the average skin surface temperature and the average palpation scores in horses with and without KSS were negative (rho = 0.071 and r = -0.180, respectively; p > 0.05). The results of the present study are encouraging, but further studies with larger samples, a longer follow-up period and comparisons with placebo control groups are needed to draw a more valid conclusion.

High-Intensity Laser Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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.

Effects of High-Intensity Laser Therapy (HILT) on Skin Surface Temperature and Vein Diameter in Healthy Racehorses with Clipped and Non-Clipped Coat.

The aim of this study was to investigate the differences in the effects of high-intensity laser therapy (HILT) on skin surface temperature and vein diameter in the carpal joint region in racehorses with clipped and non-clipped treatment areas. The study included 20 Thoroughbreds split into two equal groups: clipped coat and non-clipped coat. Horses underwent thermographic examination to detect changes in skin surface temperature at the medial surface of the carpal joint, followed by ultrasonographic examination to assess changes in the diameter of the medial palmar vein before and after HILT. The increase in skin surface temperature after HILT was significantly lower in the group with clipped coat than in the non-clipped group. The group with clipped coat showed a greater increase in vessel diameter. There was a significantly weak negative correlation between the changes in average skin surface temperature and vein diameter in both groups. In conclusion, an efficient photothermal effect can be achieved in skin with a non-clipped coat and clipping the treatment area increases photobiostimulation of the tissue, while reducing the photothermal effect. Further research is needed to specify the parameters for the treatment of skin with clipped and non-clipped coat in order to perform effective laser therapy.

Effectiveness of high intensity laser therapy on pain, grip strength and median nerve conductivity in pregnant women with carpal tunnel syndrome: A randomized controlled trial.

STUDY DESIGN: Single-blind randomized controlled trial. INTRODUCTION: High-intensity laser therapy (HILT) was recently introduced to the physiotherapy field as a treatment option for patients with carpal tunnel syndrome (CTS). However, evidence about its effectiveness on pregnant women with CTS is sparse. PURPOSE OF STUDY: To test the effectiveness of HILT combined with a conventional physical therapy program to reduce pain intensity, sensory and motor nerve distal latency, and increase grip strength in pregnant women with CTS compared with the physical therapy alone. METHODS: Fifty-four pregnant women with mild to moderate CTS were randomized and further allocated into two groups. The HILT group (n = 27) received both HILT and conventional physical therapy, and the control group (n = 27) received only physical therapy, including nerve and tendon gliding exercises and the use of an orthotic device. Participants received the interventions at the University Hospital (omitted for review) three times per week for 5 weeks. An 11-points numerical pain rating scale, electromyography, and a handheld dynamometer were used for data collection before and after the treatment. RESULTS: Participants from both groups presented significant improvement in the median nerve motor nerve distal latency (MNDL), sensory nerve distal latency, numerical pain rating scale, and handgrip strength after the intervention. The between-group difference showed more improvements in participants of the HILT group on reducing pain intensity, mean difference (MD) = -3.11 (-4.1 to 2.1), and sensory nerve distal latency, MD = -0.3 (-0.5 to -0.1) compared with the control group. DISCUSSION: HILT produced greater improvement in outcomes of pregnant women with mild to moderate CTS whichsuggests that adding HILT to traditional CTS physical therapy protocol is beneficial and safe. CONCLUSIONS: High-intensity laser therapy combined with a standard physical therapy program for CTS in pregnant women is better than the physical therapy program alone to improve pain intensity and median nerve sensory distal latency.