HIGH-INTENSITY LASER THERAPY AND TRANSCRANIAL DIRECT CURRENT STIMULATION ON PAIN AND QUALITY OF LIFE IN KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW

A.K. Srivastav¹, A.J. Samuel²

Background: Osteoarthritis is one of the most prevalent conditions among degenerative diseases. Among them, the global prevalence of radiographically confirmed symptomatic knee OA was estimated to be 3.8% and higher in females (4.8%) than in males (2.8%). Studies estimate that 6.8% of the population reported disease adjusted life years (DALY) worldwide, DALY in all ages for knee OA increased from 0.42% to 0.69%. Years lived with disability (YLDs) for knee OA increased from 10.5 million to 17.1 million globally. Therefore, we need to know which interventions are effective for reducing pain and improving the quality of life in chronic patients with knee osteoarthritis. Transcranial direct current stimulation (tDCS) and High-intensity LASER therapy (HILT) are known to be useful for reducing pain and improving quality of life. However, limited evidence is available regarding the effects of tDCS and HILT in chronic knee osteoarthritis.

Purpose: To perform a systematic review on the use of tDCS and HILT for managing pain and improving quality of life in chronic knee osteoarthritis.

Methods: A systematic review of randomized trials was conducted through a systematic literature search in several electronic databases (Cochrane, Scopus, PubMed). Inclusion criteria were the studies which included, patients with chronic knee osteoarthritis, aged 40 to 50 years using pain-relieving interventions of tDCS and HILT with the comparators of no intervention or sham intervention or alternative standard treatment. Outcome measures used such as Visual analogue scale or Numeric rating scale for pain and Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) scale for functional assessment. Studies were assessed using the Cochrane Risk of Bias tool (CRB), Modified Jadad score (MJS) (Total score – 8), and Downs and Black checklist (DBC) (Total score – 27). The internal validity of the included studies was assessed according to the PEDro scale (Total score – 10). Meta-analysis was performed due to the heterogeneity of participants and methods included in the study.

Results: We identified six studies on tDCS treatment and four studies on HILT in chronic knee OA. All included studies reported a significant (p<0.0001) decrease in pain. Study quality was assessed using DBC shows good (20-25) to fair (15-19) quality studies for tDCS, while good (20-25) to poor (≤14) quality studies for HILT. Eight studies indicating a high level of quality (>3) and the remaining two studies achieved lower scores (<3), which indicate lower quality according to the MJS. The Median and Range of the PEDro score of the included study were 8 (6 to 10). The overall risk of bias was low in all the included studies.

Conclusion(s): Interventions involving tDCS and HILT modalities were promising outcomes with moderate evidence that it contributes to decreasing pain and improving quality of life. However, only a few studies reported more significant improvement than sham treatment. Further high-quality RCTs are required to confirm the benefits of tDCS and HILT.  

Implications: tDCS/HILT should be considered when treating patients with chronic knee osteoarthritis. Its effectiveness can be further explored and may prove to be a potential tool in the management of knee osteoarthritis.

Funding, acknowledgements: None.
PROSPERO registration number: CRD42020180832

Keywords: Transcranial direct current stimulation, High-intensity LASER, Knee osteoarthritis

Topic: Orthopaedics

Did this work require ethics approval? No

Institution: Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation

Committee: Maharishi Markandeshwar Institute of Medical Sciences and Research

Reason: Ethical approval is not required as it is a systematic review