Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Characteristics of the included RCTs
| N° | Title | Author Year Country | Sample size (n) men women mean age (years) ± DE | EG | Intervention | HILT Parameters | Sessions | Outcomes (measuring instrument) | Evaluation time |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study | Dundar et al. (2015) [28] | n = 76 | EG = 38 (men: 0; women: 38) | EG = HILT + exercise (stretching, ROM and strength exercise) | Scan and punctual application | 15 (3 weeks) | Pain (VAS) Cervical ROM (Inclinometer) | T0: baseline |
| 2 | Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial | Alayat et al. (2020) [29] | n = 50 | EG = 25 (men: 12; women: 18) | EG = HILT + PPRT + exercises (stretching and strength exercises) | Punctual application | 12 (4 weeks) | Pain intensity (VAS) | T0: baseline |
| 3 | High intensity laser therapy on pain in patients with myofascial trigger points | Ahmed et al. (2020) [30] | n = 50 | EG = 25 (men: 9; women: 16) | EG = HILT + TENS + US + stretching exercise | Punctual application | 8 (4 weeks) | Pain intensity (VAS) | T0: baseline |
PEDro scale score of the analyzed RCTs
| Clinical trial number | Author year of publication | PEDro scale criteria | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Criteria 1 | Criteria 2 | Criteria 3 | Criteria 4 | Criteria 5 | Criteria 6 | Criteria 7 | Criteria 8 | Criteria 9 | Criteria 10 | Criteria 11 | Total score | ||
| 1 | Dundar et al. (2014) [28] | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 8/10 |
| 2 | Alayat et al. (2020) [29] | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 6/10 |
| 3 | Ahmed et al. (2020) [30] | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 4/10 |
Evidence quality by GRADE (Grading ofrecommendation, assessment, development, and evaluation) for adding HILT in a physical therapy program for myofascial pain management at the end of treatment (after four weeks) (outcome: pain intensity at rest)
| Certainty assessment | No of patients | Effect | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | be used high intensity laser therapy added to a physical therapy program | a physical therapy program without laser therapy | Relative (95% CI) | Absolute (95% CI) | Certainty | Importance |
| Pain intensity at rest (follow-up: mean 4 weeks; assessed with: Visual analogue scale (VAS); Scale from: 0 to 10cm) | ||||||||||||
| 3 [28,29,30] | Randomized trials | seriousa,b,c,d | seriouse | not seriousf | seriousg | none | 88 | 88 | – | MD 1.23 cm fewer (2.7 fewer to 0.24 more) | ⨁Very lowh | Important |
Results and statistical comparisons for pain, ROM, neck disability and life quality of HILT groups in the analyzed RCTs
| Study | Outcomes and measurement tools | T0: Baseline mean ±SD | T1: Evaluation at 4 weeks mean ±SD | T2: Evaluation at 12 weeks mean ±SD | p – value intragroup | p-value intragroup | p-value between groups at T1 |
|---|---|---|---|---|---|---|---|
| Dundar (2014) [28] | Pain at rest (VAS) (cm) | 5.9 ± 1.4 | 2.7 ± 1.2 | 2.6 ± 1.2 | <0.001* | <0.001* | <0.001* |
| Pain at movement (VAS) (cm) | 6.1 ± 1.6 | 3.1 ± 1.1 | 3.1 ± 1.2 | ||||
| Pain at night (VAS) (cm) | 4.7 ± 2.7 | 1.8 ± 1.4 | 1.6 ± 1.5 | ||||
| ROM-Cervical flexion(°) | 54.7 ± 9.4 | 57.2 ± 8.4 | 57.4 ± 8.6 | 0.002* | 0.001* | 0.842 | |
| ROM-Cervical extensión (°) | 49.3 ± 7.5 | 52.1 ± 7.9 | 52.2 ± 8,5 | 0.003* | 0.004* | 0.865 | |
| ROM-Right cervical lateral flexion (°) | 40.1 ± 6.7 | 44.2 ± 5.7 | 45.5 ± 3,8 | <0.001* | <0.001* | 0.462 | |
| ROM-Left cervical lateral flexion(°) | 42.4 ± 6.8 | 45.6 ± 6.7 | 46.4 ± 6.2 | 0.413 | |||
| ROM-Right cervical rotation (°) | 75.3 ± 7.2 | 81.4 ± 8.2 | 81.5 ± 7.8 | 0.785 | |||
| ROM-Left cervical rotation (°) | 77.4 ± 6.3 | 83.1 ± 7.3 | 82.9 ± 7.9 | 0.612 | |||
| Neck disability index (%) | 32.6 ± 6.6 | 21.1 ± 6.3 | 20.3 ± 6.22 | <0.001* | |||
| SF-36,PF-domain | 57.7 ± 12.2 | 73.5 ± 11.4 | 72.9 ± 13.1 | <0.001* | |||
| SF-36,RL-domain | 51.7 ± 20.8 | 69.8 ± 15.4 | 70.5 ± 11.7 | ||||
| SF-36,BP-domain | 44.9 ± 15.6 | 61.2 ± 13.7 | 60.8 ± 14.7 | ||||
| SF-36,GH-domain | 51.8 ± 12.3 | 68.3 ± 11.9 | 69.4 ± 12.9 | ||||
| SF-36,V-domain | 48.0 ± 10.8 | 54.6 ± 9.8 | 55.6 ± 10.4 | 0.003* | 0.002* | 0.467 | |
| SF-36,SF-domain | 57.3 ± 8.9 | 72.8 ± 10.6 | 73.1 ± 11.3 | <0.001* | <0.001* | <0.001* | |
| SF-36,RLEP-domain | 48.3 ± 19.7 | 65.1 ± 16.2 | 66.3 ± 17.3 | ||||
| SF-36,GMH-domain | 49.1 ± 9.9 | 55.7 ± 9.6 | 56.3 ± 8.9 | 0.005* | 0.003* | 0.854 | |
| Alayat (2020) [29] | Pain at rest (VAS) (cm) | 8.03 ± 0.72 | 1.43 ± 0.773 | / | / | ||
| Pain pressure threshold(kg/cm2) | 1.61 ± 0.37 | 2.85 ± 0.49 | / | <0.05* | / | <0.05* | |
| ROM – Cervical flexion (°) | 47.83 ± 2.94 | 59.46 ± 3.17 | / | / | |||
| ROM – Cervical extension (°) | 46.73 ± 3.54 | 61.0 ± 4.1 | / | / | |||
| ROM – Right cervical lateral flexion (°) | 30.6 ± 2.35 | 41.5 ± 1.59 | / | / | |||
| ROM – Left cervical lateral flexion (°) | 31.96 ± 2.17 | 42.76 ± 2.92 | / | / | |||
| ROM – Right cervical rotation (°) | 48.93 ± 3.08 | 64.36 ± 2.17 | / | / | |||
| ROM – Left cervical rotation (°) | 49.66 ± 2.97 | 64.03 ± 1.99 | / | / | |||
| Ahmed (2020) [30] | Pain at rest (VAS) (cm) | 6.68 ± 1.24 | 2.6 ± 0.7 | / | <0.01* | / | <0.01* |