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Research Studies on Laser Therapy

 

ARTHRITIS / OSTEOARTHRITIS RESEARCH STUDIES

THE CLINICAL EFFICACY OF LOW-POWER LASER THERAPY ON PAIN AND FUNCTION IN CERVICAL OSTEOARTHRITIS.

Oezdemir F, Birtane M, Kokino S
Clinical Rheumatology. 2001; 20(3): 181-184.

Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

IMPROVEMENT OF PAIN AND DISABILITY IN ELDERLY PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS OF THE KNEE TREATED WITH NARROW-BAND LIGHT THERAPY.

Stelian J, Gil I, Habot B et al.
J Am Geriatr Soc. 1992; 40: 23-26.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open.

Patients were treated twice daily, 15 minutes each time, for 10 days. The patients treated themselves after instruction.

Total dose for each session was 10.3 J for red and 11.1 for infrared.

Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated.

There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2 months to 1 year.

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THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE.

Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.

Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p<0.05). There was no significant change in range of motion of the Knee.

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CLINICAL APPLICATION OF GaAlAs 830 NM DIODE LASER (LLLT) IN TREATMENT OF RHEUMATOID ARTHRITIS

Kanji Aoada, Yasutaka Ytani, Akira Sakawa and Akira Shimazu - Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected Joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level. The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognised in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data). From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAIAs diode laser system (830 nm, 60 mW CIW). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement?, good (clearly apparent improvement), and unchanged (little or no improvement). For, pam attenuation, scores were: excellent — 59.6%; good — 30.4%; unchanged — 10%. For ROM improvement the scores were: excellent — 12.6%; good — 43.7%; unchanged — 43.7 Yo. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

INFARED DIODE LASER IN LOW REACTIVE-LEVEL LASER THERAPY (LLLT) FOR KNEE OSTEOARTHROSIS

Laser Therapy 1991, 3:149-153
M. A. Trelles, J. Rigau, P. Sala, G. Calderhead and T. Ohshiro

Degenerative joint disease (DJD) in particular in the knee. is difficult to, cure successfully at present often requiring surgical intervention. In addition the chronic DJD patient often exhibits symptoms cl both a physiological and psychological nature. A study is presented using high reactive-level laser therapy (LLLT) with an 830 nm infra red continuous wave gallium aluminium (or aluminium) arsenide (GaAlAs) diode laser with an output power of 60 mW. in light contact Laser therapy for a population of 40 patients (power density of approximately 3 W/cm2). Four points around the patella were irradiated for 60 s each (energy density of 18 J/cm2 per point. total of 72 J/cm2 per session) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immediately after at 4 months after the final LLT session. All other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT and returned to their original pretherapy medication. The side effects were minimal LLLT is concluded to to be safe, effective and non-invasive alternative to conventional surgical and medical treatment modalities for DJD patients.

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A SYSTEMATIC REVIEW OF LOW LEVEL LASER THERAPY (LLLT) WITH LOCATION-SPECIFIC DOSES FOR PAIN FROM CHRONIC JOINT DISORDERS.

Aust J Physiother 2003;49(2):107-16
Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

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THE CLINICAL EFFICACY OF LOW-POWER LASER THERAPY (LLLT) ON PAIN AND FUNCTION IN CERVICAL OSTEOARTHRITIS.

Clin Rheumatol 2001;20(3):181-4
Ozdemir F, Birtane M, Kokino S.

Department of Physical Therapy and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey.
Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LLLT) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

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IMPROVEMENT OF PAIN AND DISABILITY IN ELDERLY PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS OF THE KNEE TREATED WITH NARROW-BAND LIGHT THERAPY (LLLT).

J Am Geriatr Soc. 1992; 40: 23-26
Jean Stelian, MD, Israel Gil, MD, Beni Habot, MD, Michal Rosenthal, MD, Iulian Abramovici, MD, Nathalia Kutok, MD, and Auni Khahil, MD

Objective: To evaluate the effects of low-power light therapy (LLLT) on pain and disability in elderly patients with degenerative osteoarthritis in the knee.

Design: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters.
Patients: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients) and placebo (17 patients). Infrared and placebo emitters were double-blinded.
Interventions: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.
Main Outcome Measures: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial. Results: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red and infrared treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo respectively)

Conclusions: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee. Degenerative osteoarthritis (DOA) is the most common rheumatic disorder of man and causes pain and disability especially in elderly people.1 Autopsy surveys show that degenerative changes in joints begin as early as the second decade of life. 2 Roentgenographic studies conducted in the United States showed osteoarthritic changes in 4 percent of persons under 24 years of age in 85 percent at 75 to 79 years of age. Symptomatic manifestations of osteoarthritis increase with ageing, reflecting disease changes that begin in early life and progress slowly over a period of many decades. 3-4

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