CMEMS - UMinho, University of Minho, Guimarães, Portugal.
Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal.
Phys Ther. 2024 Aug 2;104(8). doi: 10.1093/ptj/pzae073.
Photobiomodulation (PBM) is not implemented in routine clinical management for knee osteoarthritis. This study aims to systematically investigate the effects of PBM in patients with knee osteoarthritis, comparing with placebo to understand its true clinical effects.
PubMed, EMBASE, Web of Science, and Cochrane databases were searched up to October 2023. Randomized placebo-controlled trials applying PBM versus placebo were included. Study characteristics, intervention parameters, and patient-reported and physical examination outcome measures were collected. The risk of bias was judged using the Cochrane risk-of-bias tool for randomized trials (version 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to interpret the certainty of results.
Ten studies were included comprising 542 participants. All studies were judged with unclear to a high risk of bias. Meta-analysis for pain at rest (6 studies) showed that PBM significantly reduced pain at rest as compared to placebo (-0.7 [95% CI = -1.1 to -0.2]), moderate effect, very low certainty of evidence, whereas for the Timed "Up & Go" Test (three studies), no significant effect was detected. Statistically significantly within-group (PBM) mean improvement was detected for pain, Lequesne Index, and gait performance outcomes, but not always clinically relevant or significant when compared to placebo.
PBM reduces pain intensity in patients with knee osteoarthritis and may improve disability. However, the very low certainty of evidence does not allow to recommend its isolated use but may be used to complement other widely recommended therapies. More rigorous clinical trials and the revision of the recommended dosage guidelines are warranted to increase the strength of evidence.
The findings indicate that photobiomodulation can reduce pain and improve disability in patients with knee osteoarthritis. However, researchers should continue to investigate isolated photobiomodulation intervention versus placebo and extend the dosage guidelines to other types of light emitters.
光生物调节（PBM）并未应用于膝骨关节炎的常规临床治疗。本研究旨在系统评估 PBM 对膝骨关节炎患者的疗效，通过与安慰剂进行对比，以了解其真实的临床效果。
检索 PubMed、EMBASE、Web of Science 和 Cochrane 数据库，检索时限截至 2023 年 10 月。纳入应用 PBM 与安慰剂进行对比的随机安慰剂对照试验。收集研究特征、干预参数以及患者报告和体格检查结果测量指标。使用 Cochrane 偏倚风险评估工具（版本 2）和推荐评估、制定与评估分级（GRADE）评估偏倚风险，并解释结果的确定性。
纳入 10 项研究，共 542 名参与者。所有研究均存在低至高的偏倚风险。6 项研究的静息痛 meta 分析显示，与安慰剂相比，PBM 可显著减轻静息痛（-0.7[95%CI=-1.1 至-0.2]），中等效应，极低证据确定性；而 3 项研究的“Timed 'Up & Go' Test”则未发现显著效果。与安慰剂相比，PBM 组的疼痛、Lequesne 指数和步态表现的组内平均改善具有统计学意义，但并不总是具有临床相关性或显著差异。
PBM 可减轻膝骨关节炎患者的疼痛强度，可能改善其残疾程度。然而，极低的证据确定性不允许推荐其单独使用，但可作为其他广泛推荐治疗方法的补充。需要开展更严格的临床试验和修订推荐剂量指南，以提高证据强度。
研究结果表明，光生物调节可减轻膝骨关节炎患者的疼痛并改善其残疾程度。然而，研究人员应继续调查单独的光生物调节干预与安慰剂的对比，并将剂量指南扩展到其他类型的发光体。
