A Clinical Efficacy Study Of High Intensity Laser Therapy For Non-specific Neck Pain

Part 1 The Effectiveness of High Intensity Laser Therapy in Individuals with Neck Pain: A Systematic Review and Meta-AnalysisObjective: To explore the clinical effectiveness of high-intensity laser therapy(HILT)on pain intensity,range of motion(ROM)of cervical vertebra,functional disability,and quality of life(QOL)in individuals with neck pain.Methods: The literature data were obtained from Pub Med,PEDro,Embase,Cochrane Library,Web of Science,and Clinical Trials.gov,which searched from its inception to March 26,2022.Two raters independently selected the randomized controlled trial(RCT)involving HILT for neck pain and extracted the data.Outcome measures were included at least one of pain intensity,cervical ROM,functional disability or QOL.The methodological quality was evaluated using the PEDro scale,and the GRADE system was used to evaluate the level of evidence.Rev Man5.4 software was used for metaanalysis.Results: A total of eight RCTs were included,involving 603 subjects.The PEDro scores were moderate to high.Compared with placebo,HILT significantly reduced pain intensity(VAS,WMD=1.85 cm,95%CI[1.31,2.38],P < 0.01),cervical flexion(WMD= 5.52°,95%CI [1.76,9.28],P<0.05),extension(WMD=5.13°,95%CI [1.44,8.82],P<0.05),right lateral flexion(WMD=3.50°,95%CI [2.50,4.50],P<0.05),and marginally significantly improved left lateral flexion,right rotation,or left rotation(P=0.06~0.10);no significant difference was seen in terms of functional disability(NDI,WMD=5.47 points,95%CI [-2.06,13.00],P=0.15).Compared with the other conventional physical therapy(CPT),HILT experienced greater improvements in pain intensity(VAS,WMD=1.48 cm,95% CI [0.74,2.23],P<0.01),neck disability index score(WMD=7.33 points,95%CI [3.03,11.63],P<0.01),and only cervical flexion (WMD=4.71°,95%CI [0.23,9.19],P=0.04);a similar efficacy was found in terms of cervical extension(WMD=2.81°,95%CI [-0.20,5.82],P=0.07),right lateral flexion(WMD=2.33°,95%CI [-1.56,6.22],P=0.24),left lateral flexion(WMD=1.88°,95%CI [-1.86,5.61],P=0.32).The quality of evidence supporting HILT was “very low” to “moderate”.No adverse reactions were found in the HILT.Conclusion: HILT can be considered as one of the conservative modalities for neck pain.HILT significantly improved pain and ROM in individuals with neck pain compared to placebo and was more effective in improving pain,cervical ROM and functional disability compared to other CPT.It seemed that HILT was superior to other CPT for guiding clinical decisions.Part 2 A Randomized Controlled Trial of the Immediate Effects of High Intensity Laser Therapy for Non-specific Neck PainObjective: By comparing the immediate clinical efficacy of high intensity laser therapy(HILT)plus exercise with sham laser therapy plus exercise in patients with non-specific neck pain(NNP),the mechanism of HILT for NNP was explored to provide theoretical guidance for the clinical application of HILT.Methods: This study was the randomized controlled,single-center,double-blind clinical trial.A total of 28 volunteers with NNP were screened and included from patients with neck pain who attended the outpatient clinic of Rehabilitation Medicine Center,The First Dongguan Affiliated Hospital,Guangdong Medical University from September 2022 to January 2023.They were randomly assigned to the experimental group(HILT plus exercise)and the control group(sham laser plus exercise).Both groups received only one session treatment.The visual analogue scale(VAS),cervical ROM,neck tissues(splenius capitis muscle,semispinalis capitis muscle,neck fascia)stiffness and neck disability index(NDI)were assessed for each patient with NNP before and after treatment.All data were processed and analyzed by SPSS 25.0 statistical software.The difference(P<0.05)was statistically significant.Results: Before treatment,there was no statistical difference between two groups on the general data,VAS scores,cervical ROM,neck tissues(splenius capitis muscle,semispinalis capitis muscle,neck fascia)stiffness and NDI scores(P>0.05),which mean that two groups were comparable.After treatment,the VAS scores,cervical ROM,neck tissues(splenius capitis muscle,semispinalis capitis muscle,neck fascia)stiffness and NDI scores of patients in each group were statistically significantly different compared with those before treatment(P<0.05);the results of comparison between two groups showed that the HILT group was more effective(P<0.05)than the control group in reducing VAS scores,increasing cervical lateral flexion and improving neck muscles(splenius capitis muscle and semispinalis capitis muscle)stiffness,but there were no statistical differences between the two groups in other outcome measure indexes(P>0.05).Conclusion: HILT plus exercise can immediately reduce pain,increase cervical lateral flexion and improve superficial neck muscles(splenius capitis muscle and semispinalis capitis muscle)stiffness for patients with NNP,but there was no significant immediate effect in functional disability.