EFFECTIVENESS OF LOW-LEVEL LASER THERAPY ON WOUND HEALING AND PAIN REDUCTION IN PATIENTS WITH MEDIAN STERNOTOMY: A SYSTEMATIC REVIEW

M. Murugan¹, S. Ramakrishnan², R. Regan³, A. Arumugam^2,4,5

¹PSG College of Physiotherapy, Physiotherapy, Coimbatore, India, ²University of Sharjah, Department of Physiotherapy, College of Health Sciences, Sharjah, United Arab Emirates, ³AIMST University, Physiotherapy, Kedah, Malaysia, ⁴University of Sharjah, Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, Sharjah, United Arab Emirates, ⁵University of Sharjah, Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, Sharjah, United Arab Emirates

Background: In the previous two decades, the incidence of postsurgical complications following median sternotomy has remained unchanged. Owing to the shortcomings of conventional therapies in wound healing, alternative solutions are sought. Photobiomodulation with low-level laser therapy (LLLT) has become a preferred therapy for augmenting tissue repair and stimulating immediate analgesia by releasing local neurotransmitters and endorphins or through anti-inflammatory effects.

Purpose: The objective of this review was to evaluate the effect of LLLT, used alone or in combination with conventional therapies, on wound healing and pain reduction in patients with median sternotomy.

Methods: Seven databases (Cochrane (CENTRAL), MEDLINE (via PubMed), CINAHL (via EBSCO), AMED (via EBSCO), Physiotherapy Evidence Database (PEDro), and Scopus) were searched using database-specific search terms from their inception until August 2022. Only randomized controlled trials that investigated the effects of LLLT used as monotherapy or in combination with other conventional therapies in patients with median sternotomy were included. Screening, data extraction and judgement of risk of bias (using the JBI critical appraisal checklist for randomized controlled trials) were performed by 3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the pain and wound healing following median sternotomy. The review protocol has been registered in PROSPERO (CRD42020203011) and published in a peer-reviewed journal (DOI: 10.11124/JBIES-20-00428).

Results: Five studies including a total of 255 participants (mean age: 51-69 years; 222 males and 33 females) met the eligibility criteria and were included in the review. LLLT was employed either as monotherapy or in combination with conventional therapies in the acute to sub-acute phase after median sternotomy. The risk of bias score calculated using the JBI tool showed low risk of bias for all but two domains (treatment allocation concealment and assessor blinding) for the included studies. There was moderate certainty of evidence for the effects of LLLT on pain reduction (measured by VAS) and incision healing post-median sternotomy owing to serious weaknesses in inconsistency and imprecision domains of the GRADE tool. Very low certainty was evident for the effects of LLLT on improving McGill pain questionnaire scores, sternal separation, and activities of daily living because of serious weaknesses in the GRADE domains of inconsistency, indirectness, and imprecision of the findings.

Conclusions: There were only five randomized controlled trials eligible for inclusion in the review, and the evidence synthesis revealed only moderate certainty in current evidence for employing LLLT to patients who underwent median sternotomy to relieve pain and augment wound healing in the acute to subacute phase post-surgery.

Implications: Using LLLT in the acute/subacute phase post-median sternotomy can promote early pain relief and wound healing. Further high-quality randomized controlled trials are warranted to substantiate the effects of such photobiomodulation interventions on post-surgical pain, wound healing and other relevant outcome measures.

Funding acknowledgements: None

Keywords:
LASER Therapy
Pain Scale
Sternal Separation

Topics:
Cardiorespiratory
Critical care
Pain & pain management

Did this work require ethics approval? No

Reason: The study design is a Systematic Review and does not involve collection of any human data.