Objectives: Recently, high-intensity laser therapy has been used in the therapeutic protocols for pain management. We aimed to evaluate the clinical efficacy of high-intensity laser therapy versus other different modalities for improving lateral epicondylitis symptoms. Methodology: We conducted a systematic review and meta-analysis on prospective randomized controlled trials from PubMed, Embase, Scopus, Web of Science, and Science Direct until June 2021 using relevant key words. We analyzed the data using Review Manager software (RevMan 5.4). Results: Six randomized controlled trials with 344 patients were included. There is low-quality evidence that high-intensity laser therapy generates a small reduction on pain intensity compared with a control group either during activity (mean difference = −0.98, 95% confidence interval = −1.6 to −0.35, P = 0.002) or during rest (mean difference = −0.98, 95% confidence interval = −1.68 to −0.09, P = 0.03). In addition, there is low-quality evidence that high-intensity laser therapy provides small improvements in quality of life (physical component) compared with control (mean difference = 9.76, 95% confidence interval = 2.69 to 16.83, P < 0.0001). Conclusions: High-intensity laser therapy is an effective therapeutic modality to reduce pain and improve quality of life (36-item short form health survey physical component) in patients experiencing persistent symptoms of lateral epicondylitis. However, grip strength, hand function, and quality of life (36-item short form health survey) did not show significant differences between high-intensity laser therapy and other therapies.

Background Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain. Methods We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted. Results Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = − 0.48, 95% CI [− 0.79, − 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = − 0.51, 95% CI (− 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection. Conclusion Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed.

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The aim of this study was to examine the effects of combining extracorporeal shock wave therapy or local corticosteroid injections with a conventional physical therapy (CPT) program for patients with shoulder impingement syndrome. Design: This was a prospective single-blinded, randomized controlled study. Methods: Sixty patients with unilateral shoulder impingement syndrome >3 mos were allocated to group A (a 4-wk program of CPT plus a single local corticosteroid injection of 40 mg triamcinolone acetonide mixed with 1% xylocaine, n = 20), group B (CPT only, n = 20), and group C (CPT plus extracorporeal shock wave therapy, 2000 impulses, 0.2-0.3 mJ/mm 2 , one session per week for 3 wks, n = 20). Subacromial space, shoulder pain and disability index, and shoulder range of motion were assessed at baseline and 4 and 12 wks posttreatment. Results: There were no between-group differences at 4 wks. At the 12-wk follow-up, no significant differences were found between groups A and B. There was a significant difference in favor of group C compared with group A with the expectation of shoulder internal rotation and subacromial space. Group C was also superior to group B in all outcomes except for subacromial space. Conclusion: The addition of extracorporeal shock wave therapy to CPT induced more noticeable intermediate-term effects than CPT plus local corticosteroid injection or CPT alone.

Background and Study Aim. Cerebral palsy is a broad term for a variety of non-progressive, resulting in physical impairment, movement dysfunction, and poor posture. The purpose of the study was to compare the effectiveness in the Halliwick aquatic exercise versus conventional land-based therapy on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Material and Methods. In this randomized controlled trial, (n=34) children diagnosed with spastic Cerebral palsy were randomly assigned into either the Halliwick concept group (n=17) or active control (conventional exercising group) (n=17). A physiotherapist performed the sessions with participants  three times a week, 45 minutes duration over 12 weeks. An independent pediatric rehabilitation specialist assessed the children’s gross motor function using the gross motor function measures (sitting, crawling and kneeling, standing, walking, running, and jumping). Results. After the intervention, both Halliwick concept group and conventional exercising group significantly improved activities of sitting, crawling & kneeling, standing and walking, running and jumping. Besides, the estimate of the effect of the Halliwick exercises on sitting, standing and walking, running & jumping activities was more clinically significant than conventional exercises, with sitting; MD = -0.06 [95%, CI; -0.19 to 0.32], standing; MD = 0.14 [95%, CI; -0.15-0.31], and walking, running & jumping activities; MD = -0.09 [95%, CI; -0.11 to 0.20]. None of the between-group differences for any remaining outcomes was significant. Conclusion. Aquatic exercises based on the Halliwick concept are better than conventional exercises to improve sitting, standing and walking, running and jumping activities in children aged 3 to 5 years with spastic cerebral palsy.