PAIN+ CPN

OBJECTIVE: Photobiomodulation (PBM) is not implemented in routine clinical management for knee osteoarthritis. This study aims to systematically investigate the effects of PBM in patients with knee osteoarthritis, comparing with placebo to understand its true clinical effects. METHODS: PubMed, EMBASE, Web of Science, and Cochrane databases were searched up to October 2023. Randomized placebo-controlled trials applying PBM versus placebo were included. Study characteristics, intervention parameters, and patient-reported and physical examination outcome measures were collected. The risk of bias was judged using the Cochrane risk-of-bias tool for randomized trials (version 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to interpret the certainty of results. RESULTS: Ten studies were included comprising 542 participants. All studies were judged with unclear to a high risk of bias. Meta-analysis for pain at rest (6 studies) showed that PBM significantly reduced pain at rest as compared to placebo (-0.7 [95% CI = -1.1 to -0.2]), moderate effect, very low certainty of evidence, whereas for the Timed "Up & Go" Test (three studies), no significant effect was detected. Statistically significantly within-group (PBM) mean improvement was detected for pain, Lequesne Index, and gait performance outcomes, but not always clinically relevant or significant when compared to placebo. CONCLUSION: PBM reduces pain intensity in patients with knee osteoarthritis and may improve disability. However, the very low certainty of evidence does not allow to recommend its isolated use but may be used to complement other widely recommended therapies. More rigorous clinical trials and the revision of the recommended dosage guidelines are warranted to increase the strength of evidence. IMPACT: The findings indicate that photobiomodulation can reduce pain and improve disability in patients with knee osteoarthritis. However, researchers should continue to investigate isolated photobiomodulation intervention versus placebo and extend the dosage guidelines to other types of light emitters.

Discipline Area	Relevance to Practice	Is this News?	Score
Rehab Clinician (OT/PT)

Rehab Clinician (OT/PT) rater

At this time, evidence does not recommend PBM for use in routine clinical practice as an isolated modality for the treatment of knee OA. This study confirms that recommendation. The study suggests that PBM may reduce pain and disability, however any potential benefits found were of very low certainty and unclear clinical relevance. Knee OA is a significant socioeconomic burden; future PBM research also needs to include cost analyses to consider the utility of this modality during clinical practice for the treatment of knee OA.

Rehab Clinician (OT/PT) rater

As a treating physical therapist, I find this information useful but not all together new. It is different than the recommendations of multiple CPG's, so the utility may be limited.

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