Why do patients with low back pain seek care at emergency department? A cross-sectional study.

BACKGROUND: It is unclear why patients with low back pain seek care in emergency departments. OBJECTIVES: We aim to describe the demographic, physical, and psychological characteristics, and reasons for seeking care at emergency departments due to an episode of low back pain. METHODS: This is a cross-sectional study conducted in an emergency department of a public hospital in São Paulo, Brazil, from September 2018 to May 2019. All patients who presented with a new episode of low back pain as the main complaint for seeking care at the emergency department on regular weekdays were invited to participate. We collected data on sociodemographic characteristics, general health characteristics, psychosocial risk factors, and reasons for visiting the emergency department. RESULTS: A total of 200 patients participated. We observed that most patients (68%) were women, with a mean age of 55 years, and who had previous episodes of low back pain (86%). Most patients went to the emergency department because they were worried about their pain (78%) and because they could not control their pain (73%). Patients also choose the emergency department because it is always available, it is free, and provided them good care. CONCLUSIONS: Most patients with low back pain seek care at emergency departments because they were worried about their pain and because the department is always open and does not require appointment. Understanding these reasons is an important step for the implementation of future public policies to make health care more efficient, to reduce unnecessary expenses and to avoid low-value care.

Photobiomodulation Therapy Combined with Static Magnetic Field Reduces Pain in Patients with Chronic Nonspecific Neck and/or Shoulder Pain: A Randomized, Triple-Blinded, Placebo-Controlled Trial.

Photobiomodulation therapy (PBMT) has been used to treat patients with chronic neck and/or shoulder pain. However, it is unknown whether the concurrent use of PBMT and static magnetic field (PBMT-sMF) also has positive effects in these patients. The aim of this study was to investigate the effects of PBMT-sMF versus placebo on pain intensity, range of motion (ROM) and treatment satisfaction in patients with chronic nonspecific neck and/or shoulder pain. A randomized controlled trial, with blinded assessors, therapists and patients was carried out. Seventy-two patients with chronic nonspecific neck and/or shoulder pain were randomized to either active PBMT-sMF (n = 36) or placebo PBMT-sMF (n = 36). Patients were treated twice weekly, over 3 weeks. Primary outcome was pain intensity, measured 15 min after the last treatment session and at 24-, 48-, 72-h, and 7-days after the last treatment. Secondary outcomes were ROM, patient' treatment satisfaction, and adverse effects. PBMT-sMF was able to reduce pain intensity in all time points tested compared to placebo (p < 0.05). There was no difference between groups in the secondary outcomes (p > 0.05). Our results suggest that PBMT-sMF is better than placebo to reduce pain in patients with chronic nonspecific neck and/or shoulder pain at short-term.

Management of acute low back pain in emergency departments in São Paulo, Brazil: a descriptive, cross-sectional analysis of baseline data from a prospective cohort study.

OBJECTIVE: To describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain. DESIGN: A descriptive, cross-sectional analysis of baseline data from a prospective cohort study. SETTING AND PARTICIPANTS: A study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted. OUTCOME MEASURES: Diagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes. RESULTS: Of all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care. CONCLUSION: There is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.

Immediate effects of photobiomodulation therapy combined with a static magnetic field on the subsequent performance: a preliminary randomized crossover triple-blinded placebo-controlled trial.

There is evidence about the effects of photobiomodulation therapy (PBMT) alone and combined with a static magnetic field (PBMT-sMF) on skeletal muscle fatigue, physical performance and post-exercise recovery in different types of exercise protocols and sports activity. However, the effects of PBMT-sMF to improve the subsequent performance after a first set of exercises are unknown. Therefore, the aim of this study was to investigate the effects of PBMT-sMF, applied between two sets of exercises, on the subsequent physical performance. A randomized, crossover, triple-blinded (assessors, therapist, and volunteers), placebo-controlled trial was carried out. Healthy non-athlete male volunteers were randomized and treated with a single application of PBMT-sMF and placebo between two sets of an exercise protocol performed on isokinetic dynamometer. The order of interventions was randomized. The primary outcome was fatigue index and the secondary outcomes were total work, peak work, and blood lactate levels. Twelve volunteers were randomized and analyzed to each sequence. PBMT-sMF decreased the fatigue index compared to the placebo PBMT-sMF at second set of the exercise protocol (MD = -6.08, 95% CI -10.49 to -1.68). In addition, PBMT-sMF decreased the blood lactate levels post-intervention, and after the second set of the exercise protocol compared to placebo (p<0.05). There was no difference between PBMT-sMF and placebo in the remaining outcomes tested. Volunteers did not report adverse events. Our results suggest that PBMT-sMF is able to decrease skeletal muscle fatigue, accelerating post-exercise recovery and, consequently, increasing subsequent physical performance when applied between two sets of exercises.

What are the variables associated with Altmetric scores?

BACKGROUND: Social media has been used to disseminate the contents of scientific articles. To measure the impact of this, a new tool called Altmetric was created. Altmetric aims to quantify the impact of each article through online media. This systematic review aims to describe the associations between the publishing journal and published article variables and Altmetric scores. METHODS: Searches on MEDLINE, EMBASE, CINAHL, CENTRAL, and Cochrane Library were conducted. We extracted data related to both the publishing article and the publishing journal associated with Altmetric scores. The methodological quality of included articles was analyzed by the Appraisal Tool for Cross-sectional Studies. RESULTS: A total of 19 articles were considered eligible. These articles summarized a total of 573,842 studies. Citation counts, journal impact factor, access counts, papers published as open access, and press releases generated by the publishing journal were associated with Altmetric scores. The magnitude of these associations ranged from weak to strong. CONCLUSION: Citation counts and journal impact factor are the most common variables associated with Altmetric scores. Other variables such as access counts, papers published in open access journals, and the use of press releases are also likely to be associated with online media attention. SYSTEMATIC REVIEW REGISTRATION: This review does not contain health-related outcomes. Therefore, it is not eligible for registration.

Does photobiomodulation therapy combined to static magnetic field (PBMT-sMF) promote ergogenic effects even when the exercised muscle group is not irradiated? A randomized, triple-blind, placebo-controlled trial.

BACKGROUND: The direct application of photobiomodulation therapy (PBMT) using low-level laser therapy (LLLT) and light emitting diodes (LEDs) combined with a static magnetic field (sMF) (PBMT-sMF) to target tissues is shown to improve muscle performance and recovery. Studies have reported possible PBMT effects when a local distant to the target tissue is irradiated. Notably, the extent of these effects on musculoskeletal performance and the optimal site of irradiation remain unclear, although this information is clinically important since these aspects could directly affect the magnitude of the effect. Therefore, we investigated the effects of local and non-local PBMT-sMF irradiations on musculoskeletal performance and post-exercise recovery before an eccentric exercise protocol. METHODS: This randomized, triple-blind (participants, therapists and assessors), placebo-controlled trial included 30 healthy male volunteers randomly assigned to the placebo, local, and non-local groups. Active or placebo PBMT-sMF was applied to 6 sites of the quadriceps muscle of both legs. An eccentric exercise protocol was used to induce fatigue. The primary outcome was peak torque assessed by maximal voluntary contraction (MVC). The secondary outcomes were delayed onset muscle soreness (DOMS) measured by visual analogue scale (VAS), muscle injury assessed by serum creatine kinase activity (CK), and blood lactate levels. Evaluations were performed before the eccentric exercise protocol (baseline), as well as immediately after and 1, 24, 48, and 72 h upon protocol completion. RESULTS: Ten volunteers were randomized per group and analysed for all outcomes. Compared to the placebo and non-local groups, irradiation with PBMT-SMF led to statistically significant improvement (p < 0.05) with regard to all variables in the local group. The outcomes observed in the non-local group were similar to those in the placebo group with regard to all variables.The volunteers did not report any adverse effects. CONCLUSION: Our results support the current evidence that local irradiation of all exercised muscles promotes ergogenic effects. PBMT-sMF improved performance and reduced muscle fatigue only when applied locally to muscles involved in physical activity. TRIAL REGISTRATION: NCT03695458. Registered October 04th 2018.

Can photobiomodulation therapy be an alternative to pharmacological therapies in decreasing the progression of skeletal muscle impairments of mdx mice?

OBJECTIVE: To compare the effects of photobiomodulation therapy (PBMT) and pharmacological therapy (glucocorticoids and non-steroidal anti-inflammatory drugs) applied alone and in different combinations in mdx mice. METHODS: The animals were randomized and divided into seven experimental groups treated with placebo, PBMT, prednisone, non-steroidal anti-inflammatory drug (NSAIDs), PBMT plus prednisone and PBMT plus NSAID. Wild type animals were used as control. All treatments were performed during 14 consecutive weeks. Muscular morphology, protein expression of dystrophin and functional performance were assessed at the end of the last treatment. RESULTS: Both treatments with prednisone and PBMT applied alone or combined, were effective in preserving muscular morphology. In addition, the treatments with PBMT (p = 0.0005), PBMT plus prednisone (p = 0.0048) and PBMT plus NSAID (p = 0.0021) increased dystrophin gene expression compared to placebo-control group. However, in the functional performance the PBMT presented better results compared to glucocorticoids (p<0.0001). In contrast, the use of NSAIDs did not appear to add benefits to skeletal muscle tissue in mdx mice. CONCLUSION: We believe that the promising and optimistic results about the PBMT in skeletal muscle of mdx mice may in the future contribute to this therapy to be considered a safe alternative for patients with Duchenne Muscular Dystrophy (DMD) in a washout period (between treatment periods with glucocorticoids), allowing them to remain receiving effective and safe treatment in this period, avoiding at this way periods without administration of any treatment.

Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments: A Cross-sectional Study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). SUMMARY OF BACKGROUND DATA: LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. METHODS: This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. RESULTS: A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. CONCLUSION: Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. LEVEL OF EVIDENCE: 2.

Effects of photobiomodulation therapy combined to static magnetic field in strength training and detraining in humans: protocol for a randomised placebo-controlled trial.

INTRODUCTION: In recent years, it has been demonstrated that photobiomodulation therapy (PBMT) using low-level laser therapy and/or light-emitting diode therapy combined to static magnetic field (sMF) has ergogenic effects, improving muscular performance and accelerating postexercise recovery. However, many aspects related to these effects and its clinical applicability remain unknown. Therefore, the aim of this project is to evaluate the ergogenic effects of PBMT/sMF in detraining after a strength-training protocol. METHODS AND ANALYSIS: The study will be a randomised, triple-blind, placebo-controlled clinical trial. Healthy male volunteers will be randomly distributed into four experimental groups: PBMT/sMF before training sessions + PBMT/sMF during detraining, PBMT/sMF before training sessions + placebo during detraining, placebo before training sessions + PBMT/sMF during detraining and placebo before training sessions + placebo during detraining. Strength-training sessions will be carried out over 12 weeks, and the detraining period will occur during the 4 weeks after. The muscular strength and the structural properties of quadriceps will be analysed. ETHICS AND DISSEMINATION: This study was approved by the Research Ethics Committee of Nove de Julho University. The results from this study will be disseminated through scientific publications in international peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER: NCT03858179.

Photobiomodulation therapy before futsal matches improves the staying time of athletes in the court and accelerates post-exercise recovery.

This study aimed to analyze PBMT effects on futsal player's performance and recovery in a non-controlled field environment. It is a randomized, triple-blinded, placebo-controlled, crossover clinical trial. The research included six professional athletes and in each match phototherapy treatments were performed before matches (40 minutes), blood samples were collected before treatments, and samples immediately after the end of the matches and 48 h after. Furthermore, videos were analyzed to quantify the time athletes spent on the pitch and the distance they covered. PBMT was performed at 17 sites of each lower limb (40 mins before matches), employing a cluster with 12 diodes (4 laser diodes of 905 nm, 4 LEDs of 875 nm, and 4 LEDs of 640 nm, 30 J per site). The performance of the athlete could be quantified considering the time on the pitch and the distance covered; the biochemical markers evaluated were creatine kinase, lactate dehydrogenase, blood lactate, and oxidative damage to lipids and proteins. PBMT significantly increased the time of staying in the pitch and a significant improvement in all the biochemical markers evaluated. No statistically significant difference was found for the distance covered. Pre-exercise PBMT can enhance performance and accelerate recovery of high-level futsal players.

Photobiomodulation therapy protects skeletal muscle and improves muscular function of mdx mice in a dose-dependent manner through modulation of dystrophin.

This study aimed to analyze the protective effects of photobiomodulation therapy (PBMT) with combination of low-level laser therapy (LLLT) and light emitting diode therapy (LEDT) on skeletal muscle tissue to delay dystrophy progression in mdx mice (DMD mdx ). To this aim, mice were randomly divided into five different experimental groups: wild type (WT), placebo-control (DMD mdx ), PBMT with doses of 1 J (DMD mdx ), 3 J (DMD mdx ), and 10 J (DMD mdx ). PBMT was performed employing a cluster probe with 9 diodes (1 x 905nm super-pulsed laser diode; 4 x 875nm infrared LEDs; and 4 x 640nm red LEDs, manufactured by Multi Radiance Medical®, Solon - OH, USA), 3 times a week for 14 weeks. PBMT was applied on a single point (tibialis anterior muscle-bilaterally). We analyzed functional performance, muscle morphology, and gene and protein expression of dystrophin. PBMT with a 10 J dose significantly improved (p < 0.001) functional performance compared to all other experimental groups. Muscle morphology was improved by all PBMT doses, with better outcomes with the 3 and 10 J doses. Gene expression of dystrophin was significantly increased with 3 J (p < 0.01) and 10 J (p < 0.01) doses when compared to placebo-control group. Regarding protein expression of dystrophin, 3 J (p < 0.001) and 10 J (p < 0.05) doses also significantly showed increase compared to placebo-control group. We conclude that PBMT can mainly preserve muscle morphology and improve muscular function of mdx mice through modulation of gene and protein expression of dystrophin. Furthermore, since PBMT is a non-pharmacological treatment which does not present side effects and is easy to handle, it can be seen as a promising tool for treating Duchenne's muscular dystrophy.

Photobiomodulation therapy for the improvement of muscular performance and reduction of muscular fatigue associated with exercise in healthy people: a systematic review and meta-analysis.

Researches have been performed to investigate the effects of phototherapy on improving performance and reduction of muscular fatigue. However, a great variability in the light parameters and protocols of the trials are a concern to establish the efficacy of this therapy to be used in sports or clinic. The aim of this study is to investigate the effectiveness, moment of application of phototherapy within an exercise protocol, and which are the parameters optimally effective for the improvement of muscular performance and the reduction of muscular fatigue in healthy people. Systematic searches of PubMed, PEDro, Cochrane Library, EMBASE, and Web of Science databases were conducted for randomized clinical trials to March 2017. Analyses of risk of bias and quality of evidence of the included trials were performed, and authors were contacted to obtain any missing or unclear information. We included 39 trials (861 participants). Data were reported descriptively through tables, and 28 trials were included in meta-analysis comparing outcomes to placebo. Meta-analysis was performed for the variables: time until reach exhaustion, number of repetitions, isometric peak torque, and blood lactate levels showing a very low to moderate quality of evidence and some effect in favor to phototherapy. Further investigation is required due the lack of methodological quality, small sample size, great variability of exercise protocols, and phototherapy parameters. In general, positive results were found using both low-level laser therapy and light-emitting diode therapy or combination of both in a wavelength range from 655 to 950 nm. Most of positive results were observed with an energy dose range from 20 to 60 J for small muscular groups and 60 to 300 J for large muscular groups and maximal power output of 200 mW per diode.

Pre-Exercise Infrared Photobiomodulation Therapy (810 nm) in Skeletal Muscle Performance and Postexercise Recovery in Humans: What Is the Optimal Power Output?

BACKGROUND: Photobiomodulation therapy (PBMT) has recently been used to alleviate postexercise muscle fatigue and enhance recovery, demonstrating positive results. A previous study by our research group demonstrated the optimal dose for an infrared wavelength (810 nm), but the outcomes could be optimized further with the determination of the optimal output power. OBJECTIVE: The aim of the present study was to evaluate the effects of PBMT (through low-level laser therapy) on postexercise skeletal muscle recovery and identify the best output power. MATERIALS AND METHODS: A randomized, placebo-controlled double-blind clinical trial was conducted with the participation of 28 high-level soccer players. PBMT was applied before the eccentric contraction protocol with a cluster with five diodes, 810 nm, dose of 10 J, and output power of 100, 200, 400 mW per diode or placebo at six sites of knee extensors. Maximum isometric voluntary contraction (MIVC), delayed onset muscle soreness (DOMS) and biochemical markers related to muscle damage (creatine kinase and lactate dehydrogenase), inflammation (IL-1ß, IL-6, and TNF-α), and oxidative stress (catalase, superoxide dismutase, carbonylated proteins, and thiobarbituric acid) were evaluated before isokinetic exercise, as well as at 1 min and at 1, 24, 48, 72, and 96 h, after the eccentric contraction protocol. RESULTS: PBMT increased MIVC and decreased DOMS and levels of biochemical markers (p < 0.05) with the power output of 100 and 200 mW, with better results for the power output of 100 mW. CONCLUSIONS: PBMT with 100 mW power output per diode (500 mW total) before exercise achieves best outcomes in enhancing muscular performance and postexercise recovery. Another time it has been demonstrated that more power output is not necessarily better.

Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial.

Cryotherapy for post-exercise recovery remains widely used despite the lack of quality evidence. Photobiomodulation therapy (PBMT) studies (with both low-level laser therapy and light-emitting diode therapy) have demonstrated positive scientific evidence to suggest its use. The study aims to evaluate PBMT and cryotherapy as a single or combined treatment on skeletal muscle recovery after eccentric contractions of knee extensors. Fifty healthy male volunteers were recruited and randomized into five groups (PBMT, cryotherapy, cryotherapy + PBMT, PMBT + cryotherapy, or placebo) for a randomized, double-blinded, placebo-controlled trial that evaluated exercise performance (maximum voluntary contraction (MVC)), delayed onset muscle soreness (DOMS), and muscle damage (creatine kinase (CK)). Assessments were performed at baseline; immediately after; and at 1, 24, 48, 72, and 96 h. Comparator treatments was performed 3 min after exercise and repeated at 24, 48, and 72 h. PBMT was applied employing a cordless, portable GameDay™ device (combination of 905 nm super-pulsed laser and 875- and 640-nm light-emitting diodes (LEDs); manufactured by Multi Radiance Medical™, Solon - OH, USA), and cryotherapy by flexible rubber ice packs. PBMT alone was optimal for post-exercise recovery with improved MVC, decreased DOMS, and CK activity (p < 0.05) from 24 to 96 h compared to placebo, cryotherapy, and cryotherapy + PBMT. In the PBMT + cryotherapy group, the effect of PBMT was decreased (p > 0.05) but demonstrated significant improvement in MVC, decreased DOMS, and CK activity (p < 0.05). Cryotherapy as single treatment and cryotherapy + PBMT were similar to placebo (p > 0.05). We conclude that PBMT used as single treatment is the best modality for enhancement of post-exercise restitution, leading to complete recovery to baseline levels from 24 h after high-intensity eccentric contractions.

What is the best moment to apply phototherapy when associated to a strength training program? A randomized, double-blinded, placebo-controlled trial : Phototherapy in association to strength training.

The effects of phototherapy (or photobiomodulation therapy) with low-level laser therapy (LLLT) and/or light-emitting diodes (LEDs) on human performance improvement have been widely studied. Few studies have examined its effect on muscular training and no studies have explored the necessary moment of phototherapy irradiations (i.e., before and/or after training sessions). The aim of this study was to determine the optimal moment to apply phototherapy irradiation when used in association with strength training. Forty-eight male volunteers (age between 18 to 35 years old) completed all procedures in this study. Volunteers performed the strength training protocol where either a phototherapy and/or placebo before and/or after each training session was performed using cluster probes with four laser diodes of 905 nm, four LEDs of 875 nm, and four LEDs of 640 nm-manufactured by Multi Radiance Medical™. The training protocol duration was 12 weeks with assessments of peak torque reached in maximum voluntary contraction test (MVC), load in 1-repetition maximum test (1-RM) and thigh circumference (perimetry) at larger cross-sectional area (CSA) at baseline, 4 weeks, 8 weeks, and 12 weeks. Volunteers from group treated with phototherapy before and placebo after training sessions showed significant (p < 0.05) changes in MVC and 1-RM tests for both exercises (leg extension and leg press) when compared to other groups. With an apparent lack of side effects and safety due to no thermal damage to the tissue, we conclude that the application of phototherapy yields enhanced strength gains when it is applied before exercise. The application may have additional beneficial value in post-injury rehabilitation where strength improvements are needed.

Using Pre-Exercise Photobiomodulation Therapy Combining Super-Pulsed Lasers and Light-Emitting Diodes to Improve Performance in Progressive Cardiopulmonary Exercise Tests.

CONTEXT: Skeletal muscle fatigue and exercise performance are novel areas of research and clinical application in the photobiomodulation field, and positive outcomes have been reported in several studies; however, the optimal measures have not been fully established. OBJECTIVE: To assess the acute effect of photobiomodulation therapy (PBMT) combining superpulsed lasers (low-level laser therapy) and light-emitting diodes (LEDs) on muscle performance during a progressive cardiopulmonary treadmill exercise test. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty untrained male volunteers (age = 26.0 ± 6.0 years, height = 175.0 ± 10.0 cm, mass = 74.8 ± 10.9 kg). INTERVENTION(S): Participants received PBMT with either combined superpulsed lasers and LED (active PBMT) or placebo at session 1 and the other treatment at session 2. All participants completed a cardiopulmonary test on a treadmill after each treatment. For active PBMT, we performed the irradiation at 17 sites on each lower limb (9 on the quadriceps, 6 on the hamstrings, and 2 on the gastrocnemius muscles), using a cluster with 12 diodes (four 905-nm superpulsed laser diodes with an average power of 0.3125 mW, peak power of 12.5 W for each diode, and frequency of 250 Hz; four 875-nm infrared LED diodes with an average power of 17.5 mW; and four 640-nm red LED diodes with an average power of 15 mW) and delivering a dose of 30 J per site. MAIN OUTCOME MEASURE(S): Distance covered, time until exhaustion, pulmonary ventilation, and dyspnea score. RESULTS: The distance covered (1.96 ± 0.30 versus 1.84 ± 0.40 km, t19 = 2.119, P < .001) and time until exhaustion on the cardiopulmonary test (780.2 ± 91.0 versus 742.1 ± 94.0 seconds, t19 = 3.028, P < .001) was greater after active PBMT than after placebo. Pulmonary ventilation was greater (76.4 ± 21.9 versus 74.3 ± 19.8 L/min, t19 = 0.180, P = .004) and the score for dyspnea was lower (3.0 [interquartile range = 0.5-9.0] versus 4.0 [0.0-9.0], U = 184.000, P < .001) after active PBMT than after placebo. CONCLUSIONS: The combination of lasers and LEDs increased the time, distance, and pulmonary ventilation and decreased the score of dyspnea during a cardiopulmonary test.

The thermal impact of phototherapy with concurrent super-pulsed lasers and red and infrared LEDs on human skin.

From the very first reports describing the method of action of phototherapy, the effects have been considered to be the result of photochemical and photophysical interactions between the absorbed photons and tissue and not related to secondary changes in tissue or skin temperature. However, thermal effects have been recently reported in dark pigmented skin when irradiated with single wavelengths of 810 and 904 nm of low-level laser therapy (LLLT) devices even with doses that do not exceed those recommended by the World Association of Laser Therapy (WALT). The aim of this study was to evaluate the thermal impact during the concurrent use of pulsed red and infrared LEDs and super-pulsed lasers when applied to light, medium, and dark pigmented human skin with doses typically seen in clinical practice. The study evaluated the skin temperature of 42 healthy volunteers (males and females 18 years or older, who presented different pigmentations, stratified according to Von Luschan's chromatic scale) via the use of a thermographic camera. Active irradiation was performed with using the multi-diode phototherapy cluster containing four 905-nm super-pulsed laser diodes (frequency set to 250 Hz), four 875-nm infrared-emitting diodes, and four 640-nm LEDs (manufactured by Multi Radiance Medical™, Solon, OH, USA). Each of the four doses were tested on each subject: placebo, 0 J (60 s); 10 J (76 s); 30 J (228 s); and 50 J (380 s). Data were collected during the last 5 s of each dose of irradiation and continued for 1 min after the end of each irradiation. No significant skin temperature increases were observed among the different skin color groups (p > 0.05), age groups (p > 0.05), or gender groups (p > 0.05). Our results indicate that the concurrent use of super-pulsed lasers and pulsed red and infrared LEDs can be utilized in patients with all types of skin pigmentation without concern over safety or excessive tissue heating. Additionally, the doses and device utilized in present study have demonstrated positive outcomes in prior clinical trials. Therefore, it can be concluded that the effects seen by the concurrent use of multiple wavelengths and light sources were the result of desirable photobiomodulation effect and not related to thermal influence.

Phototherapy with combination of super-pulsed laser and light-emitting diodes is beneficial in improvement of muscular performance (strength and muscular endurance), dyspnea, and fatigue sensation in patients with chronic obstructive pulmonary disease.

Phototherapy is an electrophysical intervention being considered for the retardation of peripheral muscular fatigue usually observed in chronic obstructive pulmonary disease (COPD). The objective of this study was to evaluate the acute effects of combination of super-pulsed laser and light-emitting diodes phototherapy on isokinetic performance in patients with COPD. Thirteen patients performed muscular endurance tests in an isokinetic dynamometer. The maximum voluntary isometric contraction (MVIC), peak torque (PT), and total work (TW) of the non-dominant lower limb were measured in two visits. The application of phototherapy or placebo (PL) was conducted randomly in six locations of femoral quadriceps muscle by using a cluster of 12 diodes (4 of 905 nm super-pulsed lasers, 0.3125 mW each; 4 of 875 nm LEDs, 17.5 mW each; and 4 of 640 nm LEDs, 15 mW each, manufactured by Multi Radiance Medical™). We found statistically significant increases for PT (174.7 ± 35.7 N · m vs. 155.8 ± 23.3 N · m, p = 0.003) and TW after application of phototherapy when compared to placebo (778.0 ± 221.1 J vs. 696.3 ± 146.8 J, p = 0.005). Significant differences were also found for MVIC (104.8 ± 26.0 N · m vs. 87.2 ± 24.0 N · m, p = 0.000), sensation of dyspnea (1 [0-4] vs. 3 [0-6], p = 0.003), and fatigue in the lower limbs (2 [0-5] vs. 5 [0.5-9], p = 0.002) in favor of phototherapy. We conclude that the combination of super-pulsed lasers and LEDs administered to the femoral quadriceps muscle of patients with COPD increased the PT by 20.2% and the TW by 12%. Phototherapy with a combination of super-pulsed lasers and LEDs prior to exercise also led to decreased sensation of dyspnea and fatigue in the lower limbs in patients with COPD.

Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis.

Recent studies have explored if phototherapy with low-level laser therapy (LLLT) or narrow-band light-emitting diode therapy (LEDT) can modulate activity-induced skeletal muscle fatigue or subsequently protect against muscle injury. We performed a systematic review with meta-analysis to investigate the effects of phototherapy applied before, during and after exercises. A literature search was performed in Pubmed/Medline database for randomized controlled trials (RCTs) published from 2000 through 2012. Trial quality was assessed with the ten-item PEDro scale. Main outcome measures were selected as: number of repetitions and time until exhaustion for muscle performance, and creatine kinase (CK) activity to evaluate risk for exercise-induced muscle damage. The literature search resulted in 16 RCTs, and three articles were excluded due to poor quality assessment scores. From 13 RCTs with acceptable methodological quality (≥6 of 10 items), 12 RCTs irradiated phototherapy before exercise, and 10 RCTs reported significant improvement for the main outcome measures related to performance. The time until exhaustion increased significantly compared to placebo by 4.12 s (95% CI 1.21-7.02, p < 0.005) and the number of repetitions increased by 5.47 (95% CI 2.35-8.59, p < 0.0006) after phototherapy. Heterogeneity in trial design and results precluded meta-analyses for biochemical markers, but a quantitative analysis showed positive results in 13 out of 16 comparisons. The most significant and consistent results were found with red or infrared wavelengths and phototherapy application before exercises, power outputs between 50 and 200 mW and doses of 5 and 6 J per point (spot). We conclude that phototherapy (with lasers and LEDs) improves muscular performance and accelerate recovery mainly when applied before exercise.