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A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain

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Abstract

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.

PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

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Acknowledgements

Exercise and Rehabilitation Sciences Institute Andres Bello University; School of Physical Therapy Andres Bello University; Federal University of São Carlos; Coordination for the Improvement of Higher Education Personnel (CAPES).

Funding

This study was partially funded by the Higher Education Personnel Improvement Coordination (CAPES, Finance code 001, Brazil). Role of funding sources: The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Avenida Fernández Concha 700, 7591538, Las Condes, Santiago de Chile, Chile

    Hernán Andrés de la Barra Ortiz

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

    Hernán Andrés de la Barra Ortiz, Mariana Arias & Richard Eloin Liebano

  3. Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA

    Richard Eloin Liebano

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Contributions

The idea for the research was performed by Hernán Andrés de la Barra Ortiz. All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by Hernán Andrés de la Barra Ortiz, Mariana Arias Avila, and Richard Eloin Liebano. The first draft of the manuscript was written by Hernán Andrés de la Barra Ortiz, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hernán Andrés de la Barra Ortiz.

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This systematic review was registered with the number CRD42023387394 at the International prospective register of systematic reviews (PROSPERO). Registration date, 14 January 2023.

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de la Barra Ortiz, H.A., Arias, M. & Liebano, R.E. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain. Lasers Med Sci 39, 124 (2024). https://doi.org/10.1007/s10103-024-04069-0

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