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Injuries and Rehab Tell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.

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Old 10-09-2003, 11:09 AM   #1 (permalink)
Bill Hartman Certified
 
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Bryan,

Can you direct me to some decent studies on the use of lasers for healing purposes ("itis", wounds, etc.). Seems that our medical equipment rep is pushing the new laser units pretty hard (money, money, money!). I'm looking for any studies that may have established some form of standards for the units and any protocols that seemed to have been effective. You assist is much appreciated.

Bill
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Old 10-09-2003, 01:10 PM   #2 (permalink)
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Can you be more specific Bill? What kind of laser is being pushed? I can tell you that the literature I've read on lasers for -itis's and wound healing is really not promising at all. The studies that show positive effects are usually very poorly designed and non-randomized trials, and the studies that are OK quality don't see differences between real laser and placebo laser.If you can get me published journal references from the industrial literature, I can have a look at those too.

And what kind of access to journals do you have?
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Old 10-09-2003, 01:16 PM   #3 (permalink)
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Just a cursory search on Medline has some fairly recent articles. I haven't read the articles themselves yet, but I'll have a better idea where to direct my search when I get more info from you =).

Lucas C. Criens-Poublon LJ. Cockrell CT. de Haan RJ.
Wound healing in cell studies and animal model experiments by Low Level Laser Therapy; were clinical studies justified? a systematic review. [Review] [77 refs]
Lasers in Medical Science. 17(2):110-34, 2002.
Abstract
Based on results of cell studies and animal experiments, clinical trials with Low Level Laser Therapy (LLLT) were performed, which finally did not demonstrate a beneficial effect on outcome of wound healing. The aim of this study was to investigate whether the evidence from cell studies and animal experiments with respect to wound healing was unequivocally in favour of LLLT, which would imply that these models might be adequate to predict treatment response in patients, or that the data of cell studies and animal experiments were inconclusive, which would mean that the clinical trials were based on insufficient evidence. We performed a systematic review of cell studies and animal experiment with LLLT on wound healing. Manuscripts were identified by searching Medline, Embase, and SPIE (the International Society for Optical Engineering). We assessed whether studies showed a beneficial effect of active treatment or not. The effect size was expressed in standardised mean difference [(SMD) the mean outcome measure of the treatment group minus the mean outcome measure of the control group, divided by the pooled standard deviation of these measurements]. In-depth analyses were performed on (1) studies in which inflicted wounds on animals were irradiated and evaluated; (2) studies with primary outcome measures on dimensions with direct reference to wound healing (ranging from acceleration of wound closure to epithelialisation, but excluding surrogate dimensions with regard to wound healing; in this case: tensile strength); (3) animal studies with 'true controls'; (4) studies in which animals functioned as their 'own controls' and (5) studies with the highest methodological quality score. The 36 included studies contained 49 outcome parameters of which 30 reported a positive effect of laser irradiation and 19 did not. Eleven studies presented exact data about the effect of active treatment and controls. The pooled effect size (SMD) over 22 outcome measures of these studies was - 1.05 (95% Cl: - 1.67 to - 0.43) in favour of LLLT. Methodological quality of the studies was poor. In-depth analysis of studies showed no significant pooled effect size in studies with highest methodological quality scores [0.06 (95% CI:- 0.42 to 0.53)]. Summarising the data of cell studies and animal experiments, reviewed in this manuscript, these studies failed to show unequivocal evidence to substantiate the decision for trials with LLLT in a large number of patients. In fact, there were no differences between the results of these experiments and clinical studies. Remarkably, we found that (almost from the introduction on) animal experiments and clinical studies that address the biological effects of LLLT on wound healing, ran simultaneously, rather than in sequence. We conclude that this type of phototherapy should not be considered a valuable (adjuvant) treatment for this selected, generally therapy-refractory condition in humans. [References: 77]

Lagan KM. Clements BA. McDonough S. Baxter GD.
Low intensity laser therapy (830nm) in the management of minor postsurgical wounds: a controlled clinical study.
Lasers in Surgery & Medicine. 28(1):27-32, 2001.
Abstract
BACKGROUND AND OBJECTIVE: The stimulatory effects of low intensity laser therapy (LILT) have been widely published for the treatment of chronic ulceration. In contrast to this previous work, the current study investigated its potential efficacy (by using a dosage of 9 J/cm2) in the management of acute wounds. For this purpose, uncomplicated postoperative wounds after minor podiatric surgery were examined. STUDY DESIGN/MATERIALS AND METHODS: The study was designed as a controlled group study. Ethical approval was granted by the University of Ulster's Research Ethics Committee. Patients (n = 9) presenting with a total of 12 wounds after minor surgical procedures (partial/total nail avulsions/electrosurgery) were recruited from the Podiatry Teaching Clinic, Northern Ireland. Patients attended the clinic once per week for assessment and treatment. Weekly irradiation was performed by using a CBM Master 3 (CB Medico, Copenhagen, Denmark) diode laser (GaAlAs). The physical parameters of the output of this unit were as follows: wavelength, 830 nm; average power output, 30 mW; spot size, 0.1 cm2; irradiance, 300 mW/cm2; continuous wave output. Wound assessment and recording of pain levels were conducted weekly. Wound measurement was completed by using planimetry and digitising methods. RESULTS: Current findings indicated no statistically significant differences between Laser and Control groups for wound closure (P = 0.28 digitising; P = 0.49 planimetry) nor for pain levels reported (P = 0.88). CONCLUSION: It would seem that LILT provides no advantages in the management of minor postoperative wounds over current practice. Despite no apparent benefit of infrared laser at this dosage in the management of acute stage wounds, further research is required to determine its potential efficacy in the management of other wound types.
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Old 10-09-2003, 01:18 PM   #4 (permalink)
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Vecchio P. Cave M. King V. Adebajo AO. Smith M. Hazleman BL.
A double-blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis. [Clinical Trial. Journal Article. Randomized Controlled Trial]
British Journal of Rheumatology. 32(8):740-2, 1993 Aug.
Abstract
Thirty-five patients with rotator cuff tendinitis were randomly allocated to active (CB Medico Master III 830 nm Ga As AL diode) laser or dummy laser treatment twice weekly for 8 weeks. Movement range, painful arc score, resisted movement score and responses to visual analogue scales for night pain, rest pain, movement pain and functional limitation were measured second weekly. All responses improved from baseline but there was no difference between the two groups. These results fail to demonstrate the effectiveness of laser therapy in rotator cuff tendinitis.
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Old 10-09-2003, 01:19 PM   #5 (permalink)
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Given the last study published in english done on humans was 1993 for lasers and tendonitis, it's not looking good. Most reviews looking at clinical management of tendon related pain don't even include sections on lasers anymore.
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Old 10-09-2003, 01:27 PM   #6 (permalink)
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I requested backround on the specific unit. Rumor has it that the equipment rep is providing some form of research to back up the unit. I'll track it down.

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