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  • Laser Therapy a Slight Winner in Analysis of Electrotherapy Modalities for Adhesive Capsulitis

    It could be that low-level laser therapy (LLLT) is a useful electrotherapy modality for treatment of adhesive capsulitis, but the effects are marginal and evidence is a long way from conclusive, according to a new Cochrane review of randomized controlled and controlled clinical trials (abstract here). The study is part of a larger update of a Cochrane review on physical therapy interventions for shoulder pain.

    Researchers hoped to evaluate the effectiveness of a range of electrotherapy interventions in addition to LLLT, including pulsed electromagnetic field therapy, therapeutic ultrasound, interferential current, and transcutaneous electrical nerve stimulation, both in relation to placebos and other interventions and in relation to each other.

    What they found was that evidence was lacking in nearly all parameters, and nothing conclusive could be drawn from the 19-trial, 1,249-participant review they studied—with 1 possible exception.

    Although authors provided plenty of qualifications to their findings, they did acknowledge low- to moderate-quality support for the use of LLLT in a few ways: it may be slightly better than placebo "in terms of global treatment" at 6 days; and it may be "an effective adjunct" to exercise in reduction of pain up to 4 weeks, and increase in function up to 4 months.

    Authors were not able to render any conclusions beyond those related to LLLT, mostly because of design flaws in trials, all but one of which were downgraded to "low" or "very low" quality primarily because of unclear allocation concealment, lack of blinding, and small sample sizes. In fact, they write, even findings that pointed to possible benefits may change if and when better quality research is conducted. "Further high-quality trials may show even smaller effect estimates than those summarized in this review," they write.

    In the article, authors call for further high-quality research that compares various electrotherapy modalities, evaluates effectiveness versus placebo, and analyzes their use in combination with manual therapy and exercise. Authors also point out a need for studies that examine long-term effects of the modalities, citing the fact that most of the trials they studied "have only assessed outcomes during treatment or in the weeks following cessation."

    APTA members have access to the complete article through PTNow ArticleSearch.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • This is deceptive, the headline makes it look like there is an advantage with this intervention but reading the text shows you that the research was low or very low quality. Hardly worth publishing or commenting on. Headline should have read "predominance of low quality research questions uselfulness of modality". "Nothing conclusive could be drawn from the 19-trial, 1,249-participant review" certainly does not agree with "It could be that low-level laser therapy (LLLT) is a useful electrotherapy modality for treatment of adhesive capsulitis." The authors of this article contradict themselves.

      Posted by jeff kallberg on 10/3/2014 9:25 PM

    • Is there a concern about doing low laser therapy in the home for a home care patient on Medicare ?

      Posted by Sarah Zarbock on 7/14/2015 4:52 PM

    • Why couldn't this author lay out the findings from the best paper in this review? LLLT plus exercise was better than exercise and placebo. Better ROM, Better Pain scores at 4 weeks and better function at 4 months post treatment. From the Abstract: "Moderate quality evidence from one trial (63 participants) indicated that LLLT plus exercise for eight weeks probably results in greater improvement when measured at the fourth week of treatment." "The mean pain score at four weeks was 51 points with placebo plus exercise, while with LLLT plus exercise the mean pain score was 32 points on a 100 point scale (mean difference (MD) 19 points, 95% CI 15 to 23; absolute risk difference 19%, 95% CI 15% to 23%). The mean function impairment score was 48 points with placebo plus exercise, while with LLLT plus exercise the mean function impairment score was 36 points on a 100 point scale (MD 12 points, 95% CI 6 to 18; absolute risk difference 12%, 95% CI 6 to 18). Mean active abduction was 70 degrees with placebo plus exercise, while with LLLT plus exercise mean active abduction was 79 degrees (MD 9 degrees, 95% CI 2 to 16; absolute risk difference 5%, 95% CI 1% to 9%). No participants in either group reported adverse events. LLLT's benefits on function were maintained at four months." I believe this information has some merit.

      Posted by Mark Callanen, PT, DPT, OCS on 2/20/2019 4:41 PM

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