A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)
A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)
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DOI：
10.1186/1471-2474-9-75
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发表时间：
2008-05-29
影响因子：
2.3
通讯作者：
Johnson, Mark I.
中科院分区：
文献类型：
--
作者：
Bjordal, Jan M.;Lopes-Martins, Rodrigo A. B.;Johnson, Mark I.
背景资料：最近的综述表明，低水平激光治疗（LLLT）是无效的外侧肘肌腱病变（LET）没有评估有效性的治疗程序和剂量或影响先前类固醇injections.Methods：系统评价与荟萃分析，与主要结果的措施疼痛缓解和/或全球改善和亚组分析的方法质量，波长和治疗程序。确定了18项随机安慰剂对照试验（RCT），其中13项RCT（730例患者）符合荟萃分析的标准。12项随机对照试验满足一半或一半以上的方法学标准。Egger的图形测试，显示了负方向的偏见，出版偏见。其中10项试验包括因类固醇注射失败或其他治疗失败，或症状持续时间长或严重基线疼痛而导致预后不良的患者。疼痛缓解的加权平均差（WMD）为10.2 mm [95% CI：3.0 - 17.5]，总体改善的RR为1.36 [1.16 - 1.60]。针对针灸穴位的试验报告了阴性结果，波长为820，830和1064 nm的试验也是如此。在一个由5项904 nm激光试验和1项632 nm波长试验组成的亚组中，直接照射肘外侧肌腱止点，缓解疼痛的WMD分别为17.2 mm [95% CI：8.5 - 25.9]和14.0 mm [95% CI：7.4至20.6]，而904 nm组仅报告了整体疼痛改善的RR为1.53 [95% CI：1.28至1.83]。该亚组中的LLLT剂量范围为0.5至7.2焦耳。无痛握力、疼痛压力阈值、病假和治疗结束后3至8周的随访数据等次要结局指标显示，一致的显著结果有利于相同LLLT亚组（p < 0.02）。没有严重的副作用reported.Conclusion：LLLT管理与最佳剂量的904 nm和可能的632 nm波长直接到外侧肘肌腱止点，似乎提供短期的疼痛缓解和较少的残疾在LET，无论是单独和结合运动方案。这一发现与以前的审查结论相矛盾，这些审查未能评估治疗程序，波长和最佳剂量。
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.