高强度激光治疗腕管综合征患者有效性的系统评价与荟萃分析。

A systematic review and meta-analysis of the effectiveness of high-intensity laser therapy in patients with carpal tunnel syndrome.

作者信息

de la Barra Ortiz Hernán Andrés, Avila Mariana Arias, Parizotto Nivaldo Antonio, Liebano Richard Eloin

机构信息

Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.

Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.

出版信息

Physiotherapy. 2025 Mar 5;128:101780. doi: 10.1016/j.physio.2025.101780.

DOI:10.1016/j.physio.2025.101780

PMID:40121869

Abstract

OBJECTIVES

This systematic review aimed to evaluate the effects of high-intensity laser therapy (HILT) on pain intensity, disability, and electrophysiological parameters in individuals diagnosed with carpal tunnel syndrome (CTS).

DATA SOURCES AND SYNTHESIS

A search of electronic databases, including PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated until February 18, 2025), was conducted for randomized controlled trials (RCTs).

DATA EXTRACTION AND QUALITY ASSESSMENT

Data were extracted independently by three researchers. The quality of RCTs was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool, while evidence certainty was evaluated with the GRADE approach. Primary outcomes included pain intensity, with secondary outcomes comprising electrophysiological parameters and disability.

RESULTS

Nine RCTs met inclusion criteria. Most studies exhibited a low risk of bias across RoB2 domains, except for outcome measurement, resulting in an overall RoB of 44%. Meta-analyses demonstrated that HILT, alone or combined with interventions such as splinting, exercise, TENS, vitamin B supplements, or ergonomic modifications, significantly reduced pain (SMD = 0.7 to 1.6) and disability (SMD = 0.68). Electrophysiological improvements included enhanced distal motor latency (SMD = 0.98) and sensory conduction velocity (SMD = 0.8), particularly when combined with median nerve gliding or splinting.

CONCLUSION

This review confirms HILT's effectiveness in reducing pain and disability and improving electrophysiological parameters in CTS. However, evidence certainty remains moderate to low. Future RCTs should standardize outcome measures to evaluate HILT's clinical impact beyond statistical significance, and comparative studies with LLLT are needed to refine laser therapy protocols.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023470170 (October 17, 2023). CONTRIBUTION OF THE PAPER.

摘要

目的

本系统评价旨在评估高强度激光治疗（HILT）对诊断为腕管综合征（CTS）的个体的疼痛强度、功能障碍和电生理参数的影响。

数据来源与综合分析

对电子数据库进行检索，包括PubMed、科学网、Scopus、CINAHL、科学Direct、Cochrane图书馆、PEDro数据库和谷歌学术（更新至2025年2月18日），以查找随机对照试验（RCT）。

数据提取与质量评估

由三位研究人员独立提取数据。使用Cochrane偏倚风险（RoB）2.0工具评估RCT的质量，同时采用GRADE方法评估证据确定性。主要结局包括疼痛强度，次要结局包括电生理参数和功能障碍。

结果

九项RCT符合纳入标准。除结局测量外，大多数研究在RoB2各领域的偏倚风险较低，总体RoB为44%。荟萃分析表明，单独使用HILT或与夹板固定、运动、经皮电刺激神经疗法（TENS）、维生素B补充剂或工效学改进等干预措施联合使用，可显著减轻疼痛（标准化均数差[SMD]=0.7至1.6）和功能障碍（SMD=0.68）。电生理改善包括远端运动潜伏期延长（SMD=0.98）和感觉传导速度加快（SMD=0.8），特别是与正中神经滑动或夹板固定联合使用时。