Stausholm Martin Bjørn, Bjordal Jan Magnus
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMC Musculoskelet Disord. 2021 Jan 12;22(1):71. doi: 10.1186/s12891-020-03902-1.
We read with interest the article by Gomes et al. entitled: "Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: A randomised, placebo-controlled clinical trial". Gomes et al. concluded that the low-level laser therapy (LLLT) did not reduce knee osteoarthritis pain when applied as an adjunct to exercise therapy. We argue that Gomes et al. neglected relevant laser treatment recommendations in the conduct and reporting of the trial.Gomes et al. did not state the Joules per treatment spot applied. We calculated the Joules applied from other laser information in the report and found that it is too low of a dose according to the World Association for Laser Therapy (WALT) guidelines. Furthermore, we have published a meta-analysis of 22 placebo-controlled trials demonstrating a significant difference in pain-relieving effect between doses in adherence and non-adherence to the WALT guidelines. However, neither the WALT guidelines, nor our meta-analysis was mentioned by Gomes et al.Moreover, Gomes et al. did not state whether the output power of the laser device was measured, and this is concerning because in the city of São Paulo, where the trial was conducted, most laser devices have been found to deliver less of a dose than specified by the manufacturers.In summary, we found that the best available evidence regarding effective and ineffective LLLT dosing from systematic reviews was neglected in the conduct and reporting of the trial, and that the laser device may not have been calibrated.
我们饶有兴趣地阅读了戈麦斯等人撰写的题为《膝关节骨关节炎患者运动计划与电物理疗法相结合：一项随机、安慰剂对照临床试验》的文章。戈麦斯等人得出结论，低强度激光疗法（LLLT）作为运动疗法的辅助手段应用时，并未减轻膝关节骨关节炎疼痛。我们认为，戈麦斯等人在试验的实施和报告过程中忽略了相关激光治疗建议。戈麦斯等人未说明每个治疗点所施加的焦耳数。我们根据报告中的其他激光信息计算了所施加的焦耳数，发现根据世界激光治疗协会（WALT）的指南，该剂量过低。此外，我们发表了一项对22项安慰剂对照试验的荟萃分析，结果表明，遵循和未遵循WALT指南的剂量在止痛效果上存在显著差异。然而，戈麦斯等人既未提及WALT指南，也未提及我们的荟萃分析。此外，戈麦斯等人未说明是否测量了激光设备的输出功率，这令人担忧，因为在进行该试验的圣保罗市，发现大多数激光设备所提供的剂量低于制造商规定的剂量。总之，我们发现，在试验的实施和报告过程中，忽视了来自系统评价的关于LLLT有效和无效剂量的最佳现有证据，并且激光设备可能未经过校准。
