Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebo-control trial.

The aim of the study was to investigate the effect of high-intensity laser therapy (HILT) in treatment of patients with chronic neck pain (CNP) on cervical range of motion (ROM), pain, and functional activity. Sixty male patients participated in this study with mean (SD) age of 35.47 (4.18) years. Patients were randomly assigned into two groups and treated with HILT plus exercise (HILT + EX) and placebo laser plus exercise (PL + EX) in groups 1 and 2, respectively. The outcomes measured were cervical ROM, pain level by visual analog scale (VAS), and functional activity by neck disability index (NDI) score. Statistical analyses were performed to compare the differences between baseline and post-treatment. The level of statistical significance was set as p < 0.05. Cervical ROM significantly increased after 6 weeks of treatment in all groups. VAS and NDI results showed significant decrease post-treatment in both groups. HILT + EX effectively increased cervical ROM and decreased VAS and NDI scores after 6 weeks of treatment compared to PL + EX. HILT + EX is an effective physical therapy modality for patients with CNP compared to PL + EX therapy.

The combination of HILT + EX effectively increased cervical ROM, functional activity, and reduced pain after 6 weeks of treatment.

Muscle Performance in Neck Pain

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Comments

Derek Miles
Derek Miles
March 23, 2016 at 4:19 pm

I have some major problems with the findings of this study. There is no mention as to how the clinicians were blinded or if one clinician took all ROM measurements as this would change the measurement error in between groups. There is also no mention of how follow up data was collected. Was it immediately after the last treatment session or was the patient brought back in for a final assessment. Did one clinician take all of the ROM measurements or did each clinician measure their own patients. For that matter how many different clinicians participated in the study? Their measurements are much different than normative values for the device they cite using for ROM. The Williams et al paper they cite has cervical flexion values in the 30s with their device but their values were in the 50s for both groups both pre and post treatment. Although three degrees may be statistically significant difference between groups for ROM according to their calculations, 3 degrees is within the standard error of measurement for this device so it cannot be called clinically significant. The same holds true for their conclusions related to VAS as a MCID is 2 points and their difference is barely over one. The NDI difference reported was barely over 2 when lowest MCID difference I could find the literature was 3.5. Also there was no follow up beyond the cessation of treatment. There is no way of determining if the treatment effect lasted. To say that HILT+Ex is an effective physical therapy modality based off of these findings is false. This is a modality that costs patients money and delivers results below any clinically meaningful change.

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