低水平激光疗法治疗膝骨关节炎疼痛和残疾的疗效：随机安慰剂对照试验的系统评价和荟萃分析。
Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials.
机构信息
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
出版信息
BMJ Open. 2019 Oct 28;9(10):e031142. doi: 10.1136/bmjopen-2019-031142.
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.
目的
低水平激光疗法（LLLT）不被推荐用于治疗主要膝关节骨关节炎（KOA）。本研究旨在探讨 KOA 中是否存在 LLLT 剂量反应关系。
设计
系统评价和荟萃分析。
数据来源
于 2019 年 2 月 18 日通过 PubMed、Embase、护理学和联合健康文献累积索引、物理治疗证据数据库和 Cochrane 对照试验中心注册库检索合格文献，同时检索参考文献、书籍、引文和该领域的专家。
纳入研究的标准
我们仅纳入了符合美国风湿病学会和/或 Kellgren/Lawrence 标准的 KOA 参与者的随机安慰剂对照试验，这些试验中 LLLT 应用于参与者的膝关节。无语言限制。
数据提取和综合
采用随机效应荟萃分析对纳入的试验进行综合分析，并根据世界激光治疗协会的治疗建议按剂量进行亚组分析。采用 Cochrane 偏倚风险工具进行评估。
结果
共纳入 22 项试验（n=1063）进行荟萃分析。偏倚风险不显著。总体而言，与安慰剂相比，LLLT 在治疗结束时（14.23mm 视觉模拟量表（VAS；95%CI 7.31 至 21.14））和治疗结束后 1 至 12 周的随访期间（15.92mm VAS；95%CI 6.47 至 25.37））显著减轻了疼痛。亚组分析显示，与安慰剂相比，推荐剂量的 LLLT 在治疗结束时（18.71mm（95%CI 9.42 至 27.99））和治疗结束后 2 至 12 周的随访期间（23.23mm VAS（95%CI 10.60 至 35.86））显著减轻了疼痛。从推荐剂量的 LLLT 获得的疼痛缓解在治疗结束后 2 至 4 周的随访期间达到峰值（31.87mm VAS 显著优于安慰剂（95%CI 18.18 至 45.56））。LLLT 还可显著减轻残疾。未报告不良反应。
结论
在 4 至 8 J 的 785-860nm 波长和 1 至 3 J 的 904nm 波长下，LLLT 可减轻 KOA 的疼痛和残疾。
PROSPERO 注册号：CRD42016035587。
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