Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, 7591538, Las Condes, Santiago de Chile, Chile.
Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.
Lasers Med Sci. 2024 May 6;39(1):124. doi: 10.1007/s10103-024-04069-0.
The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).
本系统评价的目的是评估高强度激光疗法（HILT）对颈痛患者疼痛、残疾和活动范围的影响。通过检索 PubMed、Web of Science、Scopus、CINAHL、Science Direct、Cochrane 图书馆、PEDro 数据库和 Google Scholar（更新于 2024 年 1 月 7 日）等数据库，查找针对颈痛障碍的 HILT 的随机对照试验（RCT）。研究人员使用 Rayyan 网络应用程序审查了来自不同数据库的文章标题和摘要。使用 Cochrane 偏倚风险工具评估研究质量，并使用 GRADE 方法制定基于证据的推荐意见。对有意义的结局进行了荟萃分析，计算了平均差值（MD）的汇总效应，同时给出了 95%置信区间（95%CI）。有 20 项研究符合选择标准，并有可能被纳入荟萃分析。在治疗结束时，疼痛强度的 VAS（95%CI：-18.4，-9.7）、颈椎伸展（9 项 RCT）的 3.9°（95%CI：1.9，6.7）和颈痛指数（NDI）的残疾减少（12 项 RCT）的 -8.3%（95%CI：-14.1，-4.1）的汇总 MD 具有统计学意义（p<0.01），均有利于 HILT。只有疼痛强度的结果与文献中报道的最小临床重要差异（MCID）一致。总体而言，证据被认为是显著的，但确定性较低，这归因于 RCT 中观察到的异质性和一些偏倚风险。HILT 结合其他物理治疗干预措施，特别是治疗性运动，在减轻颈痛和残疾以及增加颈椎伸展方面具有有效性，这基于中等水平的证据。本综述强调，当 HILT 用于治疗肌筋膜疼痛、颈椎神经根病和慢性颈痛时，可获得最有利的结果。PROSPERO 注册号：CRD42023387394（注册日期，2023 年 1 月 14 日）。
