A Randomized, Double-Blind Study on the Combined Effects of Low-Level Laser Therapy and Exercise on Pain, Functional Level, and Range of Motion in Patients with Chronic Non-Specific Low Back Pain Combined Effects of LLLT and Exercise on Pain: A Randomized Controlled Trial
Main Article Content
Abstract
OBJECTIVE: To investigate the combined effects of low-level laser therapy (LLLT) in conjunction with an exercise program (LLLT group) compared to exercise alone (control group) on pain, functional level, and range of motion in patients with chronic non-specific low back pain (CNLBP).
METHODS: Sixty participants with CNLBP were randomized and divided into 2 groups: laser group (30 participants) and control group (30 participants). Both groups were assigned the same homework exercises (once a day, 3 days a week for 4 weeks). The assessments were performed at baseline and 4 weeks after low-level laser therapy application 3 times per week for 4 weeks. Pain level (visual analogue scale), functional level (the Oswestry low back pain disability questionnaires Thai version) and range of motion (Schober’s test) were evaluated.
RESULTS: The participants who completed the study totaled 60, with 30 in the LLLT group and 30 in the control group. Both groups showed statistically significant differences in improved pain level and functional level (p < 0.001) from baseline to the 4th week, with the exception of range of motion in the control group (p = 0.644). Outcome of mean difference across the intervention arm for group comparison analysis indicated statistically significant differences in favor of the experimental group across all measures (p < 0.01, p < 0.03 and p < 0.01, respectively).
CONCLUSION: Combining LLLT with exercise significantly reduced pain, improved functional ability, and increased lumbar range of motion, providing a more effective treatment for Thai patients with CNLBP compared to exercise alone. The Minimal Clinically Important Difference for Visual Analog Scale (0.211) and Oswestry Disability Index (0.216) confirmed that the improvements at week 4 were clinically significant beyond natural recovery.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24(6):769-81.
Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015:49:1.
Yiengprugsawan V, Hoy D, Buchbinder R, Bain C, Seubsman S, Sleigh AC. Low back pain and limitations of daily living in Asia: longitudinal findings in the Thai cohort study. BMC Musculoskelet Disord 2017;18(1):19.
Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166(7):514-30.
Baroncini A, Maffulli N, Schäfer L, Manocchio N, Bossa M, Foti C, et al. Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis. Sci Rep 2024;14:11546.
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011;20(1):19-39.
Demetrious J. Guidelines in the evaluation and management of low back pain. N C Med J 2008;69(2):175.
Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P et al. Low back pain. J Orthop Sports Phys Ther 2012;42(4):1-57.
George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA et al. Interventions for the management of acute and chronic low back pain. J Orthop Sports Phys Ther 2021;51(11):1-60.
Vallone F, Benedicenti S, Sorrenti E, Schiavetti I, Angiero F. Effect of diode laser inthe treatment of patients with nonspecific chronic low back pain: a randomized controlled trial. Photomed Laser Surg 2014;32(9):490-4.
Jang H, Lee H. Meta-analysis of pain relief effects by laser irradiation on joint areas. Photomed Laser Surg 2012;30(8):405-17.
Farivar S, Malekshahabi T, Shiari R. Biological effects of low level laser therapy. J Lasers Med Sci 2014;5(2):58-62.
Huang Z, Ma J, Chen J, Shen B, Pei F, Kraus VB. The effectiveness of low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther 2015;17:360.
Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother 2003;49(2):107-16.
Abdelbasset WK, Nambi G, Alsubaie SF, Abodonya AM, Saleh AK, Ataalla NN, et al. A randomized comparative study between high-intensity and low-level laser therapy in the treatment of chronic nonspecific low back pain. Evid Based Complement Alternat Med 2020:1-6.
World Associated Laser Therapy. Dosage recommendations [internet]. 2010 [cited 2019 Sep 11]. Available from: http://WALT Recommendations - WALT (waltpbm.org)
Hadi M, Ali SV, Isa MZ, Zeidi BM. Low level laser therapy (LLLT) for chronic low back pain (LBP). Eur J Res 2009;29(1):76-81.
Roach KE, Brown MD, Dunigan KM, Kusek CL, Walas M. Test-retest reliability of patient reports of low back pain. J Orthop Sports Phys Ther 1997;26(5):253-9.
Sanjaroensuttikul N. The Oswestry low back pain disability questionnaire (version 1.0) Thai version. J Med Assoc Thai 2007;90(7):1417-22.
Tousignant M, Poulin L, Marchand S, Viau A, Place C. The modified-modified schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil 2005;27(10):553-9.
Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial. Aust J Physiother 2007;53(3):155-60.
Benedetti F, Mayberg HS, Wager TD, Stohler CS, Zubieta JK. Neurobiological mechanisms of the placebo effect. J Neurosci 2005;25(45):10390-402.
Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol 2015;2(5):1-16.
Glazov G, Yelland M, Emery J. Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials. Acupunct Med 2016;34(5):328-41.
Rubira APFA, Rubira MC, Rubira LA, Comachio J, Magalhães MO, Marques AP. Comparsion of the effect of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic non-specific low back pain: a randomized controlled clinical trial. Adv Rheumatol 2019;59(1):57.
Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M. Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers Surg Med 2003;32:233-8.
van Lennep JHPA, Trossèl F, Perez RSGM, Otten RHJ, van Middendorp H, Evers AWM, et al. Placebo effects in low back pain: a systematic review and meta-analysis of the literature. Eur J Pain 2021;25(9):1876-97.
Mouelhi Y, Jouve E, Castelli C, Gentile S. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes 2020;18(1):136.
Malec JF, Ketchum JM. A standard method for determining the minimal clinically important difference for rehabilitation measures. Arch Phys Med Rehabil 2020;101(6):1090-4.
Taylor NF, Dodd KJ, Shields N, Bruder A. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother 2007;53(1):7-16.