Exploring the efficacy of low-level laser therapy and exercise for knee osteoarthritis

Abstract

Background: Knee Osteoarthritis (KOA) is a prevalent, chronic disorder with excessive functional, social and economic burdens. The goal of treatment is to alleviate the symptoms and slow the progression. Documenting the effects of exercise and LLLT as co-modalities in the management of KOA allows practitioners to implement this management tool as part of KOA rehabilitation, resulting in the earlier discharge from a supervised rehabilitation setting. 
 Objective: The purpose of this study was to determine the effect of low-level laser therapy (LLLT) in the treatment of knee osteoarthritis (KOA). A randomised controlled trial (RCT) was conducted on 111 participants (aged between 40-75 years) diagnosed with KOA. Participants were randomised into an exercise (n=39), LLLT (n=40), or a combined exercise-LLLT (n=32) group. 
 Methods: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was used to assess pain and functionality. Knee range of motion was assessed using a goniometer, and the one-minute timed sit–to-stand test measured physical functionality at four time points: (T1) baseline, (T2) post 12-session intervention, (T3) one-month post intervention and (T4) three-month’s post intervention. Knee circumference was measured using a measuring tape. 
 Results: WOMAC pain and functionality scale and knee circumference scores decreased in all three groups (P<0.05), but the combined exercise-LLLT group demonstrated better outcomes than the LLLT or exercise alone groups respectively. The combined exercise-LLLT group showed better acute and long-term benefits with participants experiencing a 3.5 centimetre decrease in knee circumference, 24 point improvement in the WOMAC pain and functionality scale, and a four repetition increase in physical functionality. 
 Conclusion: The findings suggest that LLLT is a viable tool for managing KOA when used in conjunction with physical exercise.

Effect of Low-Level Laser Therapy on Knee Range of Motion and Functional Abilities After Total Knee Arthroplasty

“…Mechanistically, LLL therapy can reduce the severity of pain by lowering prostaglandin E2, inhibiting the onset of pain, and activating substances that control the inflammatory process [29]. Our results are also consistent with those of a study that examined the effectiveness of LLL therapy and exercise in the treatment of knee osteoarthritis using the WOMAC index to assess pain and functionality, showing good improvement on 24 questions in the WOMAC index stated [30]. Furthermore, our results agree with those of a meta-analysis and systematic review on the safety and effectiveness of LLL therapy in OA knee patients, which concluded that LLL therapy demonstrated significant differences in WOMAC score [31].…”

Adjunctive electrophysical therapies used in addition to land-based exercise therapy for osteoarthritis of the hip or knee: A systematic review and meta-analysis

“…All studies, except one, which was a quasi-randomised trial [ 25 ], were RCTs and all trials employed a parallel group design. Nineteen studies compared the adjunctive EPT plus exercise therapy to a placebo EPT and exercise [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ], whilst 22 compared against exercise only [ 9 , 11 , 19 , 20 , 22 , [34] , [35] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [57] ].…”

“…Seventeen trials compared two groups [ 11 , 23 , 25 , [28] , [29] , [30] , 33 , 36 , 39 , 41 , [43] , [44] , [45] , 48 , 49 , 54 ], 15 included three groups [ 9 , 19 , 20 , 22 , 27 , 31 , 34 , 37 , 38 , 40 , 46 , 47 , 51 , 55 , 56 ], five compared four groups [ 21 , 24 , 42 , 50 , 52 ], one compared five groups [ 57 ] and one trial had six different arms, comparing three EPTs to placebo counterparts [ 26 ]. The number of groups eligible for inclusion is shown in Table 1 , with two groups included in 27 studies [ 11 , 19 , 20 , [23] , [24] , [25] , 28 , 30 , 33 , 36 , 39 , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , 53 , 54 , 57 , …”

“…Nine EPTs were investigated, including TENS [ 34 , 35 ], laser therapy [ 10 , [22] , [23] , [24] , 28 , 30 , 31 , 38 , 41 , 42 , 51 , 62 ], IFT [ 9 , 25 , 47 , 52 ], US [ 36 , 52 , 55 ], shortwave [ 26 , 45 , 47 , 52 ], shockwave [ 46 , 59 ], heat therapy [ 44 , 50 , 57 ], NMES [ 20 , 63 ] and EMG biofeedback [ 48 , 49 ]. Interventions varied between 8 and 60 treatments, delivered between 2 weeks and 11 months.…”

Team approach to osteoarthritis management: Viewpoints of biokineticists and physiotherapists in South Africa

“…[3,6] Thus therapeutic exercise and symptom relief treatment modalities offered by biokineticists and physiotherapists are important for optimal OA management, [3] particularly as evidence shows a favourable effect compared with sedentary individuals. [7][8][9] The above research highlights the indispensable role each profession plays in the management of OA at the different phases of the rehabilitation process.…”