Friday, October 03, 2014 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.