高强度激光疗法在脊柱疾病治疗中的有效性：一项系统评价与荟萃分析。

The effectiveness of high intensity laser therapy in the management of spinal disorders: A systematic review and meta-analysis.

作者信息

Alayat Mohamed Salaheldien Mohamed, Alshehri Mansour Abdullah, Shousha Tamer Mohamed, Abdelgalil Abdelgalil Allam, Alhasan Hammad, Khayyat Orjwan Khalid, Al-Attar Wesam Saleh

机构信息

Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt.

Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.

出版信息

J Back Musculoskelet Rehabil. 2019;32(6):869-884. doi: 10.3233/BMR-181341.

DOI:10.3233/BMR-181341

PMID:30932879

Abstract

BACKGROUND

Spinal disorders are common health problems which include wide categories of diseases that affect the spinal soft tissues, joints and bone.

OBJECTIVE

The aim of this systematic review was to evaluate the effectiveness of high intensity laser therapy (HILT) on pain and function in patients with spinal disorders.

METHODS

Six databases were searched up to the end of February 2018 including PubMed, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), Open Grey and Grey Literature Report. In addition, the reference lists of all included studies were searched for any relevant studies. PEDro scale and GRADE system were performed to assess the quality of the studies. A meta-analysis was conducted to calculate the overall effect size.

RESULTS

A total of ten randomised controlled trials (RCTs) met the inclusion criteria, with four studies of the efficacy of HILT on neck pain (NP) and six on low back pain (LBP). According to the PEDro scale assessment, only two studies were rated as high quality, while the remainder were rated as fair or low quality. Forest plots showed that HILT with exercise was significantly more effective than placebo HILT with exercise in terms of pain reduction (SMD -1.11; 95% CI -1.42 to -0.80; P< 0.00001; I2 0%) and functional improvement (SMD -1.03; 95% CI -1.33 to -0.72; P< 0.00001; I2 0%). Meta-analyses also showed that HILT alone or HILT with conventional physiotherapy (CPT) significantly provided better outcomes than CPT alone.

CONCLUSIONS

HILT is considered as a complementary modality for pain reduction and function improvement in patients with spinal disorders. However, the quality of the body of evidence was rated from 'very low' to 'low' quality. Further high quality trials are required for standardisation of irradiation parameters and the treatment protocol to establish the efficacy of HILT for spinal disorders.

摘要

背景

脊柱疾病是常见的健康问题，包括影响脊柱软组织、关节和骨骼的多种疾病。

目的

本系统评价旨在评估高强度激光治疗（HILT）对脊柱疾病患者疼痛和功能的有效性。

方法

截至2018年2月底，检索了六个数据库，包括PubMed、MEDLINE、Cochrane对照试验中心注册库（CENTRAL）、物理治疗证据数据库（PEDro）、Open Grey和灰色文献报告。此外，还检索了所有纳入研究的参考文献列表以查找任何相关研究。采用PEDro量表和GRADE系统评估研究质量。进行荟萃分析以计算总体效应量。

结果

共有十项随机对照试验（RCT）符合纳入标准，其中四项研究了HILT对颈部疼痛（NP）的疗效，六项研究了对下背部疼痛（LBP）的疗效。根据PEDro量表评估，只有两项研究被评为高质量，其余被评为中等或低质量。森林图显示，在减轻疼痛方面（标准化均数差-1.11；95%置信区间-1.42至-0.80；P<0.00001；I² 0%）和功能改善方面（标准化均数差-1.；95%置信区间-1.33至-0.72；P<0.00001；I² 0%），联合运动的HILT比联合运动的安慰剂HILT显著更有效。荟萃分析还显示，单独使用HILT或HILT联合传统物理治疗（CPT）比单独使用CPT显著提供更好的结果。