Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up

Abstract

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders causing pain and functional impairment. The purpose of the study is to compare the effects of high-intensity laser therapy (HILT), conventional physical therapy (CPT), and exercise therapy (ET) on pain and function in patients with KOA. The study was designed as an assessor-blind randomized controlled trial. Ninety-three patients (aged between 50 and 75 years) with proved KOA were included and randomly allocated into three groups, and received 12 sessions of HILT, CPT, or ET. The outcomes were pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), timed up and go test (TUG), 6-min walk test (6MWT), and functionality of knee measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Statistical analyses were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. HILT was significantly more effective than the other groups in decreasing the VAS, increasing FROM and improving the scores of WOMAC (total and function subscale) both after treatment and after 12 weeks. The effect of HILT and CPT on the TUG, 6MWT, and WOMAC pain subscale was not significantly different after treatment, and both were better than ET. HILT was significantly better than the others after follow-up, particularly more effective on the stiffness subscale of WOMAC. HILT combined with exercise therapy, as a useful therapeutic approach, could have positive influences on KOA patients.

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References

  1. 1.

    Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L (2016) Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World Report on Ageing and Health. The Gerontologist 56(Suppl_2):S243–S255. https://doi.org/10.1093/geront/gnw002

    Article  PubMed  Google Scholar 

  2. 2.

    Chang G, Xia D, Chen C, Madelin G, Abramson SB, Babb JS, Saha PK, Regatte RR (2015) 7T MRI detects deterioration in subchondral bone microarchitecture in subjects with mild knee osteoarthritis as compared with healthy controls. J Magn Reson Imaging 41(5):1311–1317. https://doi.org/10.1002/jmri.24683

    Article  PubMed  Google Scholar 

  3. 3.

    Collins A, Kulvaranon M, Utturkar G, Spritzer C, Guilak F, Defrate L (2017) In vivo biochemical and biomechanical properties of cartilage are affected by obesity. Osteoarthr Cartil 25:S112–S113. https://doi.org/10.1016/j.joca.2017.02.181

    Article  Google Scholar 

  4. 4.

    Mobasheri A, Rayman MP, Gualillo O, Sellam J, van der Kraan P, Fearon U (2017) The role of metabolism in the pathogenesis of osteoarthritis. Nat Rev Rheumatol 13(5):302–311. https://doi.org/10.1038/nrrheum.2017.50

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Davatchi F, Jamshidi A-R, Banihashemi AT, Gholami J, Forouzanfar MH, Akhlaghi M, Barghamdi M, Noorolahzadeh E, Khabazi A-R, Salesi M (2008) WHO-ILAR COPCORD study (stage 1, urban study) in Iran. J Rheumatol 35(7):1384–1390

    PubMed  Google Scholar 

  6. 6.

    Tak E, Meurs J, Bierma-Zeinstra S, Hofman A, Hopman-Rock M (2017) Changes in disability in older adults with generalized radiographic osteoarthritis: a complex relationship with physical activity. Musculoskeletal Care 15(4):364–372. https://doi.org/10.1002/msc.1182

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Henriksen M, Hansen JB, Klokker L, Bliddal H, Christensen R (2016) Comparable effects of exercise and analgesics for pain secondary to knee osteoarthritis: a meta-analysis of trials included in Cochrane systematic reviews. J Comp Eff Res 5(4):417–431. https://doi.org/10.2217/cer-2016-0007

    Article  PubMed  Google Scholar 

  8. 8.

    Michael JW-P, Schlüter-Brust KU, Eysel P (2010) The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int 107(9):152. https://doi.org/10.3238/arztebl.2010.0152

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    da Costa BR, Vieira ER, Gadotti IC, Colosi C, Rylak J, Wylie T, Armijo-Olivo S (2017) How do physical therapists treat people with knee osteoarthritis, and what drives their clinical decisions? A population-based cross-sectional survey. Physiother Can 69(1):30–37. https://doi.org/10.3138/ptc.2015-83

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Bennell KL, Hinman RS (2011) A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 14(1):4–9. https://doi.org/10.1016/j.jsams.2010.08.002

    Article  PubMed  Google Scholar 

  11. 11.

    Nejati P, Farzinmehr A, Moradi-Lakeh M (2015) The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Med J Islam Repub Iran 29:186

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Pisters MF, Veenhof C, Van Meeteren NL, Ostelo RW, De Bakker DH, Schellevis FG, Dekker J (2007) Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Care Res 57(7):1245–1253. https://doi.org/10.1002/art.23009

    Article  Google Scholar 

  13. 13.

    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 64(4):465–474. https://doi.org/10.1002/acr.21596

    CAS  Article  Google Scholar 

  14. 14.

    Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011) Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. J Physiother 57(1):11–20. https://doi.org/10.1016/S1836-9553(11)70002-9

    Article  PubMed  Google Scholar 

  15. 15.

    Abbott J, Robertson M, Chapple C, Pinto D, Wright A, de la Barra SL, Baxter G, Theis J-C, Campbell A, Team MT (2013) Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness. Osteoarthr Cartil 21(4):525–534. https://doi.org/10.1016/j.joca.2012.12.014

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Boesen M, Ellegaard K, Henriksen M, Gudbergsen H, Hansen P, Bliddal H, Bartels E, Riis R (2017) Osteoarthritis year in review 2016: imaging. Osteoarthr Cartil 25(2):216–226. https://doi.org/10.1016/j.joca.2016.12.009

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Sasek C (2015) An update on primary care management of knee osteoarthritis. JAAPA 28(1):37–43. https://doi.org/10.1097/01.JAA.0000458853.38655.02

    Article  PubMed  Google Scholar 

  18. 18.

    Alayat MSM, Aly THA, Elsayed AEM, Fadil ASM (2017) Efficacy of pulsed Nd: YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 32(3):503–511. https://doi.org/10.1007/s10103-017-2141-x

    Article  PubMed  Google Scholar 

  19. 19.

    Kheshie AR, Alayat MSM, Ali MME (2014) High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 29(4):1371–1376. https://doi.org/10.1007/s10103-014-1529-0

    Article  PubMed  Google Scholar 

  20. 20.

    Štiglić-Rogoznica N, Stamenković D, Frlan-Vrgoč L, Avancini-Dobrović V, Schnurrer-Luke Vrbanić T (2011) Analgesic effect of high intensity laser therapy in knee osteoarthritis. Coll Antropol 35(2):183–185

    PubMed  Google Scholar 

  21. 21.

    Fan Z-W, Qiu J-S, Kang Z-J, Chen Y-Z, Ge W-Q, Tang X-X (2017) High beam quality 5 J, 200 Hz Nd: YAG laser system. Light Sci Appl 6(3):e17004

    CAS  Article  Google Scholar 

  22. 22.

    Benavides O, de la Cruz ML, Gil AF, Jimenez JL (2015) Experimental study on reflection of high-intensity nanosecond Nd: YAG laser pulses in ablation of metals. Opt Lasers Eng 68:83–86

    Article  Google Scholar 

  23. 23.

    Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM (2014) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian speaking patients with knee osteoarthritis. Arch Bone Jt Surg 2(1):57

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL (2015) Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2:1–29

    Google Scholar 

  25. 25.

    Viliani T, Carabba C, Mangone G, Pasquetti P (2012) High intensity pulsed Nd: YAG laser in painful knee osteoarthritis: the biostimulating protocol. Energy for Health 9:18–22. https://www.asalaser.com/sites/default/files/documenti/energy-forhealth/high_intensity_pulsed_ndyag_knee_osteoarthritis.pdf

  26. 26.

    Sabbahi S (2009) Clinical experience using HilterapiaⓇ in ‘knee arthrosis’. Energy for Health 4:24

    Google Scholar 

  27. 27.

    Kim G-J, Choi J, Lee S, Jeon C, Lee K (2016) The effects of high intensity laser therapy on pain and function in patients with knee osteoarthritis. J Phys Ther Sci 28(11):3197–3199. https://doi.org/10.1589/jpts.28.3197

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Angelova A, Ilieva EM (2016) Effectiveness of high intensity laser therapy for reduction of pain in knee osteoarthritis. Pain Res Manag 2016:1–11. https://doi.org/10.1155/2016/9163618

    Article  Google Scholar 

  29. 29.

    Wyszyńska J, Bal-Bocheńska M (2018) Efficacy of high-intensity laser therapy in treating knee osteoarthritis: a first systematic review. Photomed Laser Surg. https://doi.org/10.1089/pho.2017.4425

  30. 30.

    Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG, Ranieri M, Fiore P (2009) Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther 89(7):643–652. https://doi.org/10.2522/ptj.20080139

    Article  PubMed  Google Scholar 

  31. 31.

    Fortuna D, Rossi G, Grigolo B, Buda R, Bilotta T, Giannini S, Mondardini P, Masotti L, Crovace A (2005) High intensity laser therapy in the treatment of deep ostochondral defect. Pilot study in an animal model. Osteoarthr Cartil 13(Supplement A):86

    Google Scholar 

  32. 32.

    Tascioglu F, Armagan O, Tabak Y, Corapci I, Oner C (2004) Low power laser treatment in patients with knee osteoarthritis. Swiss Med Wkly 134(17–18):254–258

    PubMed  Google Scholar 

  33. 33.

    Alghadir A, Omar MTA, Al-Askar AB, Al-Muteri NK (2014) Effect of low-level laser therapy in patients with chronic knee osteoarthritis: a single-blinded randomized clinical study. Lasers Med Sci 29(2):749–755. https://doi.org/10.1007/s10103-013-1393-3

    Article  PubMed  Google Scholar 

  34. 34.

    Hochman B, Pinfildi CE, Nishioka MA, Furtado F, Bonatti S, Monteiro PK, Antunes AS, Quieregatto PR, Liebano RE, Chadi G (2014) Low-level laser therapy and light-emitting diode effects in the secretion of neuropeptides SP and CGRP in rat skin. Lasers Med Sci 29(3):1203–1208. https://doi.org/10.1007/s10103-013-1494-z

    Article  PubMed  Google Scholar 

  35. 35.

    Hsieh R-L, Lo M-T, Liao W-C, Lee W-C (2012) Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Arch Phys Med Rehabil 93(5):757–764. https://doi.org/10.1016/j.apmr.2012.01.003

    Article  PubMed  Google Scholar 

  36. 36.

    Hsieh Y-L, Hong C-Z, Chou L-W, Yang S-A, Yang C-C (2015) Fluence-dependent effects of low-level laser therapy in myofascial trigger spots on modulation of biochemicals associated with pain in a rabbit model. Lasers Med Sci 30(1):209–216. https://doi.org/10.1007/s10103-014-1654-9

    Article  PubMed  Google Scholar 

  37. 37.

    Gworys K, Gasztych J, Puzder A, Gworys P, Kujawa J (2012) Influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis. Ortop Traumatol Rehabil 14(3):269–277. https://doi.org/10.5604/15093492.1002257

    Article  PubMed  Google Scholar 

  38. 38.

    Hegedűs B, Viharos L, Gervain M, Gálfi M (2009) The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg 27(4):577–584. https://doi.org/10.1089/pho.2008.2297

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Navratil L, Dylevsky I (1997) Mechanisms of the analgesic effect of therapeutic lasers in vivo. Laser Ther 9(1):33–39. https://doi.org/10.5978/islsm.9.33

    Article  Google Scholar 

  40. 40.

    Niemz MH (2013) Laser-tissue interactions: fundamentals and applications. Springer Science & Business Media, Berlin

    Google Scholar 

  41. 41.

    Oral A, Ilieva E, Küçükdeveci A, Varela E, Valero R, Berteanu M, Christodoulou N (2013) Local soft tissue musculoskeletal disorders and injuries. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 49(5):727–742

    CAS  PubMed  Google Scholar 

  42. 42.

    Rossi G, Fortuna D, Tarantino C, Flamini G, Masoti L (2006) HILT high intensity laser therapy. E.L.En., Italy

  43. 43.

    Weng M-C, Lee C-L, Chen C-H, Hsu J-J, Lee W-D, Huang M-H, Chen T-W (2009) Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Kaohsiung J Med Sci 25(6):306–315. https://doi.org/10.1016/S1607-551X(09)70521-2

    Article  PubMed  Google Scholar 

  44. 44.

    Alayat MSM, Atya AM, Ali MME, Shosha TM (2014) Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial. Lasers Med Sci 29(3):1065–1073. https://doi.org/10.1007/s10103-013-1472-5

    Article  PubMed  Google Scholar 

  45. 45.

    Youssef EF, Muaidi QI, Shanb AA (2016) Effect of laser therapy on chronic osteoarthritis of the knee in older subjects. Lasers Med Sci 7(2):112–119. https://doi.org/10.15171/jlms.2016.19

    Article  Google Scholar 

  46. 46.

    Dekker J, van Dijk GM, Veenhof C (2009) Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol 21(5):520–524. https://doi.org/10.1097/BOR.0b013e32832e6eaa

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank the participants for their valuable time, consent, and excellent cooperation. The authors gratefully acknowledge the valuable help of the academic members and the staff of the Sports Medicine Clinic of Hazrat Rasool Hospital.

Funding

This project was supported by a grant from the Iran University of Medical Sciences (Project # 95-04-30-28639). The Iran University of Medical Sciences is the only organization providing financial support to research works of the faculty members of Iran University of Medical Sciences without any investment interest.

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Correspondence to Azar Moezy.

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Ethical approval

The Research Ethics Committee of Iran University of Medical Sciences approved the study (95-04-30-28639) and the study has been performed based on the latest version of the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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The patients signed a written Persian consent form and announced their agreement to study and for publication of the results with respect to the confidentiality of personal data.

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Nazari, A., Moezy, A., Nejati, P. et al. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up. Lasers Med Sci 34, 505–516 (2019). https://doi.org/10.1007/s10103-018-2624-4

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Keywords

  • Exercise therapy
  • High-intensity laser therapy
  • Knee osteoarthritis
  • Pain
  • Physical therapy
  • RCT
  • WOMAC