Effect of High-Intensity Laser Therapy versus Extracorporeal Shockwave Therapy: A systematic review and meta-analysis of Randomized controlled trials.

mohammed Abdulla Al-shehri, Haidy Samy, Mariam Hesham Sallam, Manar Hassan Zaghloul, Ahmed Said Ashour, Esraa Ramadan Elbathesh, Hina Vaish, Marwa Shafiek saleh, Hadel Hesham Elkhodary, Mazen Mohamed Sayed, Afnan Hesham Mohamed, Esraa Mohamed Mosaid, Ahmed Ibrahim Abdelhamed, Mariam Ismail Hassan
Purpose:

This study aims to systematically compare HILT versus ESWT in reducing pain and improving functionality in patients with musculoskeletal disorders. 

Methods:

We conducted a comprehensive database search through PubMed, Cochrane Central Registration of Clinical Trials (CENTRAL), Web of Science (WOS), Scopus, Google Scholar, and PEDro databases from inception till June 2024. Two independent reviewers screened the titles and abstracts, while another pair screened the full texts and extracted the relevant data. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included studies and the GRADE approach was used to evaluate the quality of evidence. All analyses were carried out using RevMan 5.4.1 software. 

Results:

Six randomized controlled trials (RCTs) were included, involving 246 patients with MSKDs (Plantar fasciitis, knee osteoarthritis, and subacromial impingement). Two studies showed a high risk of bias and four showed some concerns. Pooled analysis revealed no statistically significant difference between HILT and ESWT in reducing pain (SMD: -0.38; 95% CI: -1.71, 0.94; P = 0.57; GRADE level is low) and improving functional outcomes (SMD: 0.17; 95% CI: - 0.75,1.08; P = 0.72; GRADE level is very low). The overall level of evidence was downgraded due to the high risk of bias, imprecision, and indirectness.

Conclusion(s):

Very low to low-quality evidence suggests no difference between ESWT and HILT in improving functionality and reducing pain in patients with MSKDs. Future high-quality RCTs are needed to sway the decision between ESWT and HILT. 

Implications:

In light of current evidence, clinicians may choose between ESWT and HILT depending on the availability of treatments, patient needs, and cost-effectiveness, as both have the same effect in reducing pain and improving functional abilities in patients with MSKDs. However, our findings are unconfirmed due to very low to low quality of evidence.

Funding acknowledgements:
N/A
Keywords:
ESWT
HILT
Pain
Primary topic:
Musculoskeletal
Second topic:
Orthopaedics
Third topic:
Pain and pain management
Did this work require ethics approval?:
No
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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