Systematischer Review und Metaanalyse der in der PEDro Datenbank gelisteten randomisierten, kontrollierten Studien zur Lasertherapie am Stütz- und Bewegungsapparat

Sommer, Stefan (2024): Systematischer Review und Metaanalyse der in der PEDro Datenbank gelisteten randomisierten, kontrollierten Studien zur Lasertherapie am Stütz- und Bewegungsapparat. Dissertation, LMU München: Medizinische Fakultät

Abstract

1) Laser therapy has been established over the last 40 years as a safe and effective conservative treatment method for various diseases of the musculoskeletal system. This is evidenced by, among other things, almost 10,000 publications that are currently found under the keyword “low level laser therapy” in PubMed (https://pubmed.ncbi.nlm.nih.gov/). However, this wealth of information makes it almost impossible to obtain a comprehensive overview of the current state of research on laser therapy in evidence-based medicine. In this context, the freely available Physiotherapy Evidence Database ("PEDro database") (www.pedro.org.au) established and maintained by the Institute for Musculoskeletal Health, School of Public Health at the University of Sydney (Sydney, Australia) is a useful and attractive alternative (in Germany this database would rather be called the “database of evidence-based conservative orthopedics”). With over 60,000 randomized, controlled studies, systematic reviews and clinical guidelines, PEDro represents a unique source of information for clinical practice. A systematic analysis of all studies on laser therapy for various diseases of the musculoskeletal system listed in the PEDro database is currently not available in the literature. 2) The aim of the present work was to test the following hypothesis: based on a systematic review and a meta-analysis of all studies listed in the PEDro database on laser therapy for diseases of the musculoskeletal system, a concrete guideline for laser therapy for these diseases can be derived. 3) For this purpose, the PEDro database was searched on March 23, 2021 using the search term “laser”. Of the 768 studies found, 200 reviews and 365 studies that were not relevant to the topic were excluded in a multi-stage process. The remaining 203 studies were indication-specific (plantar fasciopathy, Achilles tendinopathy, knee osteoarthritis, osteoarthritis of the hand, carpal tunnel syndrome, tennis elbow, subacromial impingement, tendinopathy of the supraspinatus tendon, non-specific lumbar back pain, non-specific shoulder pain, non-specific neck pain, tension-type headache, myofascial pain syndrome, rheumatoid arthritis and fibromyalgia) divided into 5 categories (Category 1: better results with the laser therapy than with the sham treatment or the control therapy; Category 2a: good results with both the laser therapy and with the sham treatment; Category 2b: good results with both the laser therapy and with the Control therapy; Category 3: good results neither with the laser therapy nor with the sham treatment or the control therapy; Category 4: good results only with the sham treatment or the control therapy, but not with the laser therapy). In addition, a total of 17 different parameters were read from each study, which could fundamentally have influenced the study results. Finally, it was checked for each study whether it was suitable for an indication-specific meta-analysis and whether the corresponding indication had been examined in at least three studies (this criterion was met for the indications knee osteoarthritis, carpal tunnel syndrome, tennis elbow, subacromial impingement, non-specific lumbar back pain, non-specific shoulder pain, myofascial pain syndrome and rheumatoid arthritis). The entire analysis was carried out according to the so-called “PRISMA” criteria (Preferred Reporting Items for Systematic Reviews and Metaanalyses). 4) The systematic review represented >40 years of clinical research on laser therapy and showed that the vast majority of the studies examined could be assigned to categories 1 and 2b, meaning that laser therapy achieved a significant reduction in pain. The indication-specific meta-analyses represented 35 years of clinical research on laser therapy and showed a statistically significantly better effect of laser therapy than sham or non-treatment for all indications examined. However, a direct dependence of the 17 parameters examined on the results of the studies could not be proven for any of the indications examined. Therefore, the hypothesis formulated at the beginning had to be rejected. 5) In summary, the field of laser therapy is characterized by a seemingly absurd heterogeneity of the 17 parameters examined in the present study. It could not be conclusively assessed whether this extreme heterogeneity is due to the fact that 97 different laser therapy devices were used in the 203 studies examined. However, the fact that in over 30 of the studies examined not even the name and manufacturer of the laser therapy device used was mentioned (which de facto makes the corresponding studies not reproducible) indicates that there is a lot of catching up to do in this area. 6) Overall, it would be a great pity if based on the published studies laser therapy for various diseases of the musculoskeletal system were to fall into disrepute as a "trial and error" method, especially in the academic world, and not find the place in modern conservative orthopedics based on their potential demonstrated both in basic research and in many clinical studies.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Lasertherapie, PEDro
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 25. Juli 2024
• 1. Bericht­erstatter:in: Schmitz, Christoph