Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review.

Purpose The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence. Methods A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement). Results Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data. Conclusion This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET.

[1]  E. Haker,et al.  Effect of laser versus placebo in tennis elbow. , 2020, Scandinavian journal of rehabilitation medicine.

[2]  E. Haker,et al.  Pulsed ultrasound treatment in lateral epicondylalgia. , 2020, Scandinavian journal of rehabilitation medicine.

[3]  L. Bisset,et al.  Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. , 2015, The Journal of orthopaedic and sports physical therapy.

[4]  L. Bisset,et al.  Physiotherapy management of lateral epicondylalgia. , 2015, Journal of physiotherapy.

[5]  O. Christ,et al.  Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis , 2015, BMC Musculoskeletal Disorders.

[6]  Michael R Hamblin,et al.  The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. , 2015, MOJ orthopedics & rheumatology.

[7]  F. Alberta.  CORR Insights®: Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis , 2015, Clinical Orthopaedics and Related Research.

[8]  R. Strauch,et al.  Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis , 2015, Clinical orthopaedics and related research.

[9]  J. Elfar,et al.  Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials , 2014, Hand.

[10]  J. Luk,et al.  Lateral epicondylalgia: midlife crisis of a tendon. , 2014, Hong Kong medical journal = Xianggang yi xue za zhi.

[11]  M. Clarke,et al.  Methodology in conducting a systematic review of systematic reviews of healthcare interventions , 2011, BMC medical research methodology.

[12]  L. Altan,et al.  Investigation of the effect of GaAs laser therapy on lateral epicondylitis. , 2010, Photomedicine and laser surgery.

[13]  Jeremy Grimshaw,et al.  AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. , 2009, Journal of clinical epidemiology.

[14]  drdesforges.  Low Level Laser Therapy For Tendinopathy. , 2008 .

[15]  drdesforges.  Low level laser therapy for tendinopathy. Evidence of a dose-response pattern , 2008 .

[16]  Mark I. Johnson,et al.  Bmc Musculoskeletal Disorders a Systematic Review with Procedural Assessments and Meta-analysis of Low Level Laser Therapy in Lateral Elbow Tendinopathy (tennis Elbow) , 2022 .

[17]  G. Cheing,et al.  Effects of 904-nm low-level laser therapy in the management of lateral epicondylitis: a randomized controlled trial. , 2007, Photomedicine and laser surgery.

[18]  L. Bisset,et al.  A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia , 2005, British Journal of Sports Medicine.

[19]  J. Macdermid,et al.  Rehabilitation for patients with lateral epicondylitis: a systematic review. , 2004, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[20]  G. Tomlinson,et al.  Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. , 2004, Archives of physical medicine and rehabilitation.

[21]  R. Zângaro,et al.  Laser light prevents apoptosis in Cho K-1 cell line. , 2003, Journal of clinical laser medicine & surgery.

[22]  R. Harbour,et al.  A new system for grading recommendations in evidence based guidelines , 2001, BMJ : British Medical Journal.

[23]  J. Basford,et al.  Laser therapy: a randomized, controlled trial of the effects of low intensity Nd:YAG laser irradiation on lateral epicondylitis. , 2000, Archives of physical medicine and rehabilitation.

[24]  R. Smith,et al.  Low-level laser therapy does not aid the management of tennis elbow , 1996 .

[25]  S. Wagstaff,et al.  Low level laser therapy: a prospective double blind trial of its use in an orthopaedic population. , 1995, Injury.

[26]  H. Thorsen,et al.  The effect of low-level laser therapy on musculoskeletal pain: A meta-analysis , 1993, Pain.

[27]  H. Labelle,et al.  Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. , 1992, The Journal of bone and joint surgery. British volume.

[28]  E. Haker,et al.  Lateral epicondylalgia: report of noneffective midlaser treatment. , 1991, Archives of physical medicine and rehabilitation.

[29]  E. Haker,et al.  Is low-energy laser treatment effective in lateral epicondylalgia? , 1991, Journal of pain and symptom management.

[30]  E. Haker,et al.  Laser treatment applied to acupuncture points in lateral humeral epicondylalgia. A double-blind study , 1990, Pain.

[31]  R. Nirschl,et al.  and Electron Microscopy Studies Clinical Features and Findings of Histological, Immunohistochemical, Current Concepts Review - Tendinosis of the Elbow (Tennis Elbow). , 2010 .

[32]  Mark T. Pfefer,et al.  Chiropractic management of tendinopathy: a literature synthesis. , 2009, Journal of manipulative and physiological therapeutics.

[33]  Z. R. Yorgancıoğlu,et al.  The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. , 2008, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[34]  Mark I. Johnson,et al.  'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis. , 2006, Medical hypotheses.

[35]  C. Enwemeka,et al.  Laser photostimulation of collagen production in healing rabbit achilles tendons , 1998, Lasers in surgery and medicine.

[36]  S. Mützell,et al.  LOW LEVEL LASER THERAPY (LLLT) OF TENDINITIS AND MYOFASCIAL PAINS - A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY , 1997 .

[37]  B. Vicenzino,et al.  Lateral epicondylalgia I: epidemiology, pathophysiology, aetiology and natural history , 1996 .

[38]  M Krasheninnikoff,et al.  No effect of low power laser in lateral epicondylitis. , 1994, Scandinavian journal of rheumatology.

[39]  O Vasseljen,et al.  Low level laser versus placebo in the treatment of tennis elbow. , 1992, Scandinavian journal of rehabilitation medicine.