A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow)
Bjordal JM, Lopes-Martins RA, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI
BMC musculoskeletal disorders · 143 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación independiente
Según la declaración de financiación del texto completo.
Publicación
- Publicado
- 2008-05-29 · BMC Musculoskelet Disord · vol. 9 · número 1 · pág. 75
- Editorial
- BioMed Central
- Citado
- 300 citas · más que el 81% de estudios similares · 1.9× el promedio de su campo
- Referencias
- 74 trabajos
- Acceso
- Acceso abierto (revista) · CC-BY
- Áreas de investigación
- Laser Applications in Dentistry and Medicine · Tendon Structure and Treatment · Musculoskeletal pain and rehabilitation
- Palabras clave
- low-level laser therapy, lateral epicondylitis, analgesia, laser wavelength, 904 nm laser, treatment dose, acupuncture points, grip strength, pressure pain threshold, sick leave, disability, exercise therapy, publication bias, methodological quality of trials, long-term follow-up
- MeSH
- elbow joint, humans, tennis elbow, therapeutics, tendinopathy, randomized controlled trials as topic, low-level light therapy
7 autores
- Jan Magnus Bjordal🇳🇴 · autor de correspondenciaHøgskolen i Bergen; University of Bergen
- Rodrigo AB Lopes-Martins🇧🇷Universidade de São Paulo
- Jón Joensen🇳🇴Høgskolen i Bergen; University of Bergen
- Christian Couppé🇩🇰University of Copenhagen; Bispebjerg Hospital
- Anne Elisabeth Ljunggren🇳🇴University of Bergen
- Apostolos Stergioulas🇬🇷University of Peloponnese
- Mark I. Johnson🇬🇧Leeds Beckett University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.
Methods
Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.
Results
18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger's graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.
Conclusion
LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.
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