| Objective: The purpose of this study is to explore the contradictory results due to the large differences in the therapeutic doses and acupoints used in different studies,and to update the evidence on the clinical efficacy of laser acupuncture in the treatment of KOA.Methods: A literature search was conducted from the establishment of the database to August 2020 in 10 Chinese and English databases at home and abroad.The experimental group only uses laser acupuncture treatment,and does not limit the intervention methods of the control group.Fake laser,placebo,and conventional treatment are all available.Inquire about randomized controlled trials of laser treatment KOA in Chinese and English.Outcome indicators are outcome indicators: Visual Analog Pain Scale(VAS),Numerical Pain Score(NRS),Western Ontario and Mc Master University(WOMAC)Osteoarthritis Index.Two reviewers independently extracted data from these trials and used the CONSORT statement and the Cochrane risk assessment tool to evaluate the quality of the literature.Revman5.3 and Stata15.1 software were used to analyze the data.The data included in the analysis are the mean and standard deviation of the difference before and after the intervention,the effect size is the standardized mean difference(SMD),and the negative value is that the intervention group is better than the control group.Results: Among 669 studies,10 randomized controlled trials(1146patients in total)met the inclusion criteria.80% of the included literature was after 2010,and the quality of 70% of the literature was rated as a high-quality level above level III.(1)In the main results,the short-term results of laser acupuncture treatment showed that when the dose is appropriate and the acupoint selection is appropriate,the effect size SMD=-1.52,95%CI=[-0.71,-1.32],and significant(Z= 12.23,P<0.05),achieving a large effect size,which means that laser acupuncture can significantly reduce the short-term pain of KOA patients when the dose and acupoint selection are appropriate;(2)When the dose is appropriate but the acupoint selection is too small,the effect size SMD=-0.43,95%CI=[CI=-0.70,-0.15],and significant(Z=3.05,P<0.05),which is a medium effect size,which means that when the dose of laser acupuncture is appropriate,even if the acupuncture points are too small,It can reduce the short-term pain of KOA patients to a certain extent;(3)When the dose of laser acupuncture is too low,the effect size SMD=-0.21,95%CI=[CI=-0.41,-0.01],although there is a statistical difference(Z =2.01,P<0.05),but there is only a small effect,which shows that the therapeutic dose of laser acupuncture largely determines the therapeutic effect.(4)The Egger’s bias test based on the treatment dose is too low gives P=0.523>0.05;the Egger’s bias test based on the appropriate treatment dose gives P=0.666>0.05,because the P values are all greater than0.05,it can be judged that the included studies are not published Bias.(2)Among the secondary results,laser acupuncture can reduce the subjective pain of KOA patients and improve the stiffness of the knee joint in the short and long term,but it cannot affect the function of the knee joint.The limitation of this study is the inconsistency of active laser parameters and acupoint selection in intervention measures.This is the biggest reason for the combined heterogeneity of the effect size.Although the subgroup analysis was carried out in a quantitative way in this study,further analysis is needed.Strictly unified laser treatment dose and large sample clinical trials of acupoint selection.Conclusion: When the laser intervention parameters and acupoint selection are appropriate,laser acupuncture can effectively reduce the subjective perception of knee pain in KOA patients and relieve the stiffness of the knee joint,and this effect will not disappear in the subsequent follow-up period,but laser acupuncture It cannot affect the progression of knee osteoarthritis.PROSPERO registration number: CRD42020211479... |
PDF Full Text Request