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).

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.

Effect of high-intensity laser therapy in patients with non-specific chronic neck pain: study protocol for a randomized controlled trial.

BACKGROUND: Chronic non-specific neck pain (CNNP) is a prevalent musculoskeletal disorder known for its significant disability and economic burden, ranking second only to low back pain in musculoskeletal conditions. Physical therapy offers effective interventions for CNNP, including low-level laser therapy (LLLT). High-intensity laser therapy (HILT) is a recent treatment for musculoskeletal pain, but studies that support its use in CNNP are limited. The objective of this study is to assess the effect of high-intensity laser therapy on pain intensity in patients with CNNP, given the existing evidence on LLLT for this condition. METHODS: This is a 2-arm, randomized, placebo-controlled trial with blinded evaluators. The research will be carried out in the laboratory of physical agents at the Andrés Bello University, Campus Casona de las Condes. Eligible participants include the entire internal and external community associated with Andrés Bello University suffering from chronic non-specific NP. Participants will be stratified by sex (4 subgroups) and randomized into 2 study groups: group 1 (HILT and stretching exercises) and group 2 (sham HILT and stretching exercises). Treatments will be performed twice a week for 4 weeks with 3 assessments: before treatment (T0), at the end of treatment (T1), and 12 weeks after treatment (follow-up) (T2). The main outcomes will be pain intensity at rest, pain intensity at movement (active cervical movements: flexion, extension, right and left side bending, and right and left rotation), and pain pressure threshold (average obtained for six evaluation points). Secondary outcome measures will include neck range of motion in the sagittal, coronal, and transverse planes and neck disability. DISCUSSION: In this study, HILT's effects on patients with non-specific NP will be compared to those of a sham laser intervention. This RCT will offer new evidence regarding the potential benefits of HILT in terms of pain intensity, range of movement, and disability in people suffering with non-specific NP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05689788. January 19, 2023.

Level of satisfaction and correlation between the performance and self-evaluation of physical therapy students in the objective structured clinical examination (OSCE) when using physical agents

Introduction: Objective structured clinical examination (OSCE) is a validated instrument that allows measuring clinical skills in health sciences students; thus, it is important to know the students' level of satisfaction with this strategy, as well as the correlation between performance and self-evaluation. Objectives: To determine the correlation between the performance and self-evaluation (perceived performance) of Chilean physical therapy students in an OSCE designed to assess their clinical skills when using physical agents, and to assess their level of satisfaction with it. Materials and methods: Cross-sectional study conducted in 111 physical therapy students who participated in an OSCE consisting of seven stations. Performance checklists were used at each station (passing score: 70% of the maximum score per station) and students were administered 2 perception surveys for self-evaluation purposes and for determining their level of satisfaction with the OSCE. The Spearman Rho test was performed to determine the correlation between station scores and the students' self-evaluation (significance level of p<0.05). Results: Median scores higher than the passing score were observed in 5 stations (S1=66, IQR: 52-70; S2=55, IQR: 45-60; S3=60, IQR: 50-69; S4=65, IQR: 55-73; S7=40, IQR: 33-45), except for the strengthening and parameter interpretation stations (S5=54, IQR:46-65; S6=10, IQR: 9-13). A positive significant correlation was found between the OSCE scores and the students' self-evaluation in five stations (S3: p =0.042; S4: p <0.0001; S5: p =0.000; S6: p =0.000; S7: p <0.0001). The students' level of satisfaction with the OSCE was high, with 89.18% of them stating they agreed with how it was organized. Conclusion: The OSCE allowed the evaluation of the participants' clinical skills when using physical agents. Also, their performance in the OSCE was consistent with their self-evaluation, which proves the usefulness of the instrument. The students' high level of satisfaction with this methodology supports its use, since they acknowledge both its contribution and the importance of using similar tools to improve their training.

Introducción. La evaluación clínica objetiva estructurada (ECOE) es un instrumento validado que permite medir las habilidades clínicas de los estudiantes de ciencias de la salud, por lo que es importante conocer su nivel de satisfacción con esta estrategia, así como la correlación entre desempeño y autoevaluación. Objetivos. Determinar la correlación entre el desempeño y la autoevaluación (desempeño percibido) de estudiantes chilenos de fisioterapia en una ECOE diseñada para evaluar sus habilidades clínicas a la hora de usar agentes físicos, y evaluar su nivel de satisfacción con esta herramienta. Materiales y métodos. Estudio transversal realizado en 111 estudiantes de fisioterapia que participaron en una ECOE de 7 estaciones. Se utilizaron listas de verificación de desempeño en las estaciones (nota aprobatoria: 70% de la nota máxima por estación) y 2 encuestas de percepción para la autoevaluación y determinar el nivel de satisfacción de los estudiantes con la ECOE. Se realizó la prueba de Rho de Spearman para determinar la correlación entre los puntajes por estación y la autoevaluación (nivel de significancia p <0.05). Resultados. Se observaron medianas de puntajes superiores al aprobatorio en 5 estaciones (E1=66, RIC: 52-70; E2=55, RIC: 45-60; E3=60, RIC: 50-69; E4=65, RIC: 55-73; E7=40, RIC: 33-45), pero no en las estaciones de fortalecimiento e interpretación de parámetros (E5=54, RIC: 46-65; E6=10, RIC: 9-13). Se observó una correlación positiva y significativa entre los puntajes de la ECOE y la autoevaluación en cinco estaciones (E3: p =0.042; E4: p <0.0001; E5: p=0.000; E6: p =0.000; E7: p <0.0001). El nivel de satisfacción con la ECOE fue alto, con un 89.18% de aprobación respecto a cómo fue organizada. Conclusión. La ECOE permitió evaluar las habilidades clínicas de los participantes al usar agentes físicos, siendo sus puntajes consistentes con la autoevaluación, lo que demuestra la utilidad del instrumento. El alto nivel de satisfacción con esta metodología da soporte a su uso, ya que los estudiantes reconocen su aporte y la importancia de usar herramientas similares para mejorar su formación.