Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials

Martin Bjørn Stausholm, Ingvill Fjell Naterstad, Jon Joensen, Rodrigo Álvaro Brandão Lopes-Martins, Humaira Sæbø, Hans Lund, Kjartan Vibe Fersum, Jan Magnus Bjordal, Martin Bjørn Stausholm, Ingvill Fjell Naterstad, Jon Joensen, Rodrigo Álvaro Brandão Lopes-Martins, Humaira Sæbø, Hans Lund, Kjartan Vibe Fersum, Jan Magnus Bjordal

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.

Keywords: knee osteoarthritis; laser therapy; meta-analysis; phototherapy; systematic review.

Conflict of interest statement

Competing interests: JMB and RÁBL-M are post-presidents and former board members of World Association for Laser Therapy, a non-for-profit research organization from which they have never received funding, grants or fees. The other authors declared that they had no conflict of interests related to this work.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart illustrating the trial identification process. CENTRAL, Cochrane Central Register of Controlled Trials; CINAHL, Cumulative Index to Nursing and Allied Health Literature; LLLT, low-level laser therapy; PEDro, Physiotherapy Evidence Database.
Figure 2
Figure 2
Pain results from immediately after the end of therapy. LLLT, low-level laser therapy.
Figure 3
Figure 3
Pain results from follow-ups 1–12 weeks after the end of therapy. LLLT, low-level laser therapy.
Figure 4
Figure 4
Disability results from immediately after the end of therapy. LLLT, low-level laser therapy.
Figure 5
Figure 5
Disability results from follow-ups 1–12 weeks after the end of therapy. LLLT, low-level laser therapy.
Figure 6
Figure 6
Risk-of-bias plot of the included trials. The trials are ranked by mean pain effect estimates, that is, more laser positive results in the bottom of the figure; the plot is based on the results from the main pain analyses (immediately after the end of therapy, primarily).
Figure 7
Figure 7
Pain time-effect profile (recommended low-level laser therapy (LLLT) doses versus placebo-control). Values on the y-axis are mm Visual Analogue Scale (VAS) pain results. Positive VAS score indicates that the recommended LLLT doses are superior to placebo. The related forest plot is available (online supplementary material). **The recommended LLLT doses are highly statistically significantly superior to placebo (p≤0.01).

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