The Importance of Power in Photobiomodulation, a Systematic Review and Meta-analysis of High Intensity Laser Therapy

The Importance of Power in Photobiomodulation, a Systematic Review and Meta-analysis of High Intensity Laser Therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The Importance of Power in Photobiomodulation, a Systematic Review and Meta-analysis of High Intensity Laser Therapy William Todd Penberthy, Charles E. Vorwaller This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4813995/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Low-level light therapy (LLLT; ≤0.5 Watts; W) has advanced to the stage of guideline recommended treatment with payer coverage for treating shallow tissue oral mucositis. However, LLLT often fails in trials treating deeper tissue pathologies due to an inability to penetrate and deliver sufficient therapeutic light. By contrast, Class IV high -intensity laser therapy (HILT; 0.5-80W) typically at 100-fold higher powers has proven successful for treating these same deeper tissue pathologies. To evaluate the range of indications responding favorably to Class IV HILT, we searched PubMed, Google Scholar, and Cochrane databases from 2018 to March 2024 using the keywords "laser" AND "photobiomodulation" OR "therapy" AND "high" AND "patients" NOT "surgical", focusing on controlled trials. Effect sizes were determined using Cohen’s d. Fifty-six identified studies (n=1,486 HILT vs n=1,494 controls) reported zero serious adverse events. HILT reduced pain in 100% of the trials focused on the knee (n=10), spine, shoulder/arm, and wounds with large effect sizes (>90%). Positive outcomes were demonstrated for the hand/wrist (n=5), feet, face/jaw, bone osteoporosis, and endometriosis. Improvements in range of motion (94%; n=16), functional outcomes (84%; n=37), quality of life (80%; n=20), knee cartilage thickness, rotator cuff tear size, and nerve conduction were demonstrated. Larger effect sizes occurred in follow-up measurements made after cessation of treatment (n=18) indicating that benefits were sustained and not merely transient. The average (median, range) power used was 9.5W (10.5, 0.5-30) and the average power density was 9.1W/cm 2 (8; 1-30). We conclude that Class IV HILT is an exceptionally safe, effective, and increasingly recognized treatment that is in a promising discovery phase of research for an expanding list of indications with deep-tissue pathologies. The medical and payer communities should include HILT as a viable treatment option for indications showing positive outcomes in the published research. Anesthesiology & Pain Medicine Optics/Lasers photobiomodulation musculoskeletal pain knee arthritis Figures Figure 1 Figure 2 INTRODUCTION Since the inception of photobiomodulation therapy (PBMT) over 50 years ago, PBMT has primarily been used to treat shallow tissue pathologies (< 1cm deep) using low-powered light that is less than 500 mW. Numerous therapeutic successes and countless basic science studies have undeniably demonstrated the advantageous properties and clinical benefits of PBMT for a growing range of shallow tissue pathological indications. However, when attempting to treat deeper tissue pathologies, the lower-powered approaches have consistently failed to yield positive results due to the light's inability to penetrate the deeper pathological tissues. 1,2 Over the past two decades, since the first FDA approval of higher-powered coherent laser therapy in the range of 1–80 watts (W), numerous studies investigating higher powers for the treatment of deep tissue pathologies have demonstrated positive outcomes for the same indications. 3–10 This is commonly referred to as high-intensity laser therapy (HILT). The full range of indications that respond positively to HILT is currently in a discovery phase of research and an area of focus for this meta-analysis. Our meta-analysis is accompanied by our review highlighting pioneering firsts in HILT clinical research, both historical and ongoing. PBMT Discovery, Acceptance, and the General Limitations of LLLT to Treating Shallow Tissue Pathologies Only PBMT was initially discovered in 1967 when increased hair growth was observed in shaved mice irradiated with red light in an attempt to determine its carcinogenic properties, which it did not. 11 Thereafter in the early 1970s, PBMT was then evaluated in clinical settings by Andrew and Adam Mester in patients with recalcitrant non-healing leg ulcers. 12 Treatment with just 10 mW of 630nm wavelength light from a helium neon laser resulted in a remarkable complete recovery in 823 out of 1,018 patients (81.4%), with only 23 patients showing no change. 13 Almost 74% of patients who had qualified as non-healing for an average of 5.1 years were healed, on average, within 5.5 months of therapy. These impressive outcomes highlight the urgency of using PBMT, particularly considering that the 5-year mortality rate for patients with diabetic and ischemic foot ulcers is higher than that of several cancers, including prostate and breast cancer. 14 The steady rise in recognition of PBMT was accelerated exponentially by the development of the "NASA LED" in the NASA Space Medicine laboratory of Professor Harry Whelan in 1998. 15 This innovative technology made PBMT more affordable, accessible, and energy efficient, thereby making it more widely available for at-home therapies. By 2020, for the first time in the history of photobiomodulation therapy medicine, clearly therapeutically beneficial outcomes for the treatment of oral mucositis culminated in acceptance at all levels. This ranges from physician consensus-recommended treatment guidelines to recognition by insurance payers using low powers in the range of 25–150 mW to deliver photobiomodulation therapy. 16,17 However, it is important to note that the efficacy of low-level laser therapy (LLLT; low power) in treating oral mucositis is limited to shallow tissue pathologies of less than 2 cm. Evaluation of low-powered PBMT with powers below 500 mW for the treatment of deeper musculoskeletal pathologies have consistently failed to produce positive outcomes. 18–23 Rigorous analysis revealed that LLLT cannot penetrate tissues beyond 2 cm, which is an insufficient depth for delivering therapeutic light intensities to the deeper tissue pathologies occurring in most musculoskeletal arthropathies. 24–26 High Powered Lasers Confer Benefits to Deep Tissue Pathologies On the other hand, high-intensity laser therapy (HILT; higher power) used in clinical practice can penetrate deeply into tissues to deliver effective levels of photobiomodulation therapy. Research by Morries et al. demonstrated that a 15W laser with a 7 cm 2 spot size can penetrate 3 cm (1.2 inches) of tissue while maintaining an established therapeutically active power density of approximately 50 mW/cm 2 . 24 As a result, the use of an 80W laser enables the delivery of therapeutic doses of PBMT to tissues as deep as 15 cm (6 inches) . 7,27 Multiple independent studies have shown that HILT consistently produces positive outcomes, particularly in the treatment of knee osteoarthritis ( 1 ). This approach has the potential to prevent total knee arthroplasty, ultimately saving approximately $ 29,488 per procedure based on a 2018 cost analysis. 28 The FDA class IV device designation encompasses therapeutic lasers since it continues to be generally defined by powers as low as 500mW even though the class IV designation has historically been used to primarily refer to surgical lasers, which use higher powers (e.g., 100-300W) and longer wavelengths (e.g.,10,600nm CO 2 lasers or 2,940nm Er: YAG lasers) than therapeutic lasers. This Surgical laser light is highly absorbed by water to cause flash-boiling, ablation, or carbonization. By contrast, HILT light is not appreciably absorbed by water due to shorter 800-1064nm wavelengths and lower power settings commonly ranging from 2-30W, which impart nondestructive therapeutic cellular activities in a painless fashion. 2 To make matters even more complicated, a 50W CO 2 surgical laser becomes a therapeutic light when the spot size is defocused to a 10cm 2 . 2 So, spot size matters as the light spot size can ultimately control whether a light is surgical or therapeutic and this also controls the depth of penetration for a therapeutic light source of fixed wavelength and collimation. Finally, the power density (irradiance; W/cm 2 ) is the most informative parameter for a given wavelength as related to these surgical⌠therapeutic modalities and depths of penetration. The FDA only recognized clearance for class IV therapy laser devices as recently as 2002. 29 Several medical associations have recommended high-powered photobiomodulation therapies. In 2021, The American Academy of Orthopedic Surgeons began recommending laser therapy for the treatment of osteoarthritis of the knee joint. 30 The American College of Physicians issued a guideline for treating non-radicular low back pain with PBMT starting in 2017. 31 The American Physical Therapy Association Orthopedic Section began issuing PBMT treatment recommendations for heel pain plantar fasciitis, neck pain, and Achilles tendinitis. 32–34 The World Health Organization now recommends laser therapy and its photobiomodulation benefits for neck pain. 35 The list of recommended treatment indications continues to expand. Photobiomodulation therapy has been established and accepted at all levels for treating shallow tissue pathologies. However, the most commonly used power settings have been limited to lower powers (≤ 500mW; class III), which have generally failed to produce positive outcomes when treating deep tissue pathologies (> 2 cm). By using high-powered (1-80W) laser PBMT, positive outcomes have been repeatedly achieved due to the ability of high-powered lasers to penetrate depths of up to 15 cm. 24,27,36 More medical professionals in numerous fields of study are becoming aware of the possibilities of using higher-powered laser PBMT to reach deeper tissues. The primary objective of this meta-analysis was to assess the sum categorical efficacy of high-powered laser PBMT for any categorical indication as published in controlled clinical trials. This includes considering outcome metrics such as pain reduction, range of motion increases, functionality improvements, quality of life improvements, wound closures, neurophysiological measures, or others. The secondary objective was to perform a summary analysis of the optimal laser parameters (power settings, dosages, and wavelengths) and treatment plans used in the currently limited available controlled trials. Accordingly, a suggested summary table of optimal laser parameters and treatment plans is offered at the end of the results section. METHODS Search for Evidence and Article Selection This study adheres to all PRISMA guidelines and provides the required information accordingly. We conducted a systematic review of the best evidence using Cochrane guidelines. The structured question for this review is displayed in Fig. 1 . We searched the most important and appropriate electronic medical databases, including PubMed, Cochrane Library, and Google Scholar. The search terms used were "laser" and ("photobiomodulation" or "therapy") and "high" and "patients," excluding any articles related to surgery, limited to the years 2018 to March 2024, and focused on clinical trials. Articles that were deemed irrelevant to the research objectives were excluded. After collecting the full texts of articles related to the study's objectives, we reviewed the references of these articles and identified additional relevant references for review Inclusion and Exclusion Criteria The inclusion criteria were as follows: ( 1 ) controlled clinical trial studies, ( 2 ) published between 2018 and November 2023, ( 3 ) use of higher powered lasers with average power settings > 0.5W, ( 4 ) patients with a medical diagnosis, ( 5 ) comparison of higher powered lasers versus LLLT or placebo lasers or a common background, and ( 6 ) the use of outcome measures such as pain, range of motion, quality of life, cartilage thickness, disability indices, bone density, or gait. The exclusion criteria included ( 1 ) fundamental research or studies conducted on animals, ( 2 ) controlled trials involving patients without a medical diagnosis, ( 3 ) review articles, and ( 4 ) articles lacking statistical and clinical data. For publications that only provided information on peak power, frequency, and pulse time, we calculated the average power using the formula 37 : average power = peak power x hertz frequency x pulse duration. Statistical Analysis The significance level was based on reported p scores < 0.05. The statistical method was designed to specifically measure the effect size (ES) attributable to HILT compared to the control group. To evaluate the magnitude of the difference between groups, we determined the effect size of each variable using Cohen's d . 38,39 The standardized mean of group assessments made before and after treatment was divided by the pooled standard deviation. $$\:ES=\frac{M\:time\:zero-M\:follow\:up}{SD\:pooled}$$ The difference in effect sizes between the HILT and control groups was calculated by subtracting the effect size for each group, which served as a metric for determining the relative efficacy specifically attributable to HILT. 9 Difference in effect size = ES 1 – ES 2 Interpretation of the effect sizes was based on the values established by Cohen: small effect ≤ 0.2, medium effect 0.2–0.8, and large effect > 0.8. 38 Confidence intervals for the difference of 2 means was calculated with assistance from the PEDro calculator. 40 Power density (W/cm 2 ) is the most important parameter controlling the depth of penetration at a constant wavelength, collimation, and continuous setting, but the power density parameter is often not described in studies. Spot size matters. A PBMT device can become surgical if the spot size is concentrated and vice versa, a surgical carbon dioxide laser can become therapeutic if it is defocused to a larger size. 2 Since the depth of penetration is a major focus of our meta-analysis, we include a description of the power density throughout our entire report whenever the spot size for the hand piece is described and can be determined in any study. RESULTS QUALITATIVE SUMMARY OF INCLUSIVE STUDIES The meta-analysis included 56 studies that fullfilled the criteria for inclusion. These studies evaluated various outcome measures such as pain, function, quality of life, range of motion, strength, and anatomical structures (Tables 1 and 2 ). Among these studies, two were triple-blinded, 23 were double-blinded, 23 were single-blinded, 3 were not blinded, and one had an undetermined blinding status. Using the standard p < 0.05 as the probability value, significant reductions in pain were found in 43 out of 47 studies. Additionally, 36 out of 39 arthropathies showed statistically significant reductions in pain. Table 1 Summary list of all studies meeting criteria for inclusion in the meta-analysis. Studies are categorized by target anatomies towards consideration of the relative depth of penetration respectively: knee, spine/back, shoulder/arm, face, hand/wrist, foot, wounds, gynecological, bone, and COVID-19. Single, double, or triple blinded are denoted by numbers 1–3. HILT specific outcomes are described with effective pain reduction, range of motion (ROM) increases, quality of life (QoL) increases, or functional gains after HILT treatment denoted as positive (+) or negative (-) when assessed. KNEE Reference Blinding HILT Specific Outcomes ROM >QoL >Function Ahmad 1 Knee Osteoarthritis (Malaysia) 37511894 ; 2023 2 Pain reduced (NPRS scale) Flexion reduced LLLT had clinically insignificant outcomes + + + + Akaltun 2 Knee Osteoarthritis (Turkey) 33074393 2020 2 Pain reduced (VAS & WOMAC) ROM increased Cartilage thickness increased + + + Bettancourt 3 Knee osteoarthritis (Portugal) J.Arthritis ; 2020 1 Pain reduced at EOT and 1mo after cessation + Ekici 4 Knee OA (Turkey) 37743421 ; 2023 2 Pain reduced Cartilage thickness increased ROM increased + + + El-Shamy 5 Hemophilic Arthropathy (Egypt) 27976591 ; 2018 2 Pain reduced Gait performance improved Functional improvements + + + El-Shamy 6 Juvenile Rheumatoid Arthritis Egypt) 30016193 ; 2018 2 Pain reduced Gate improved (GAITRite) + + Mostafa 7 Knee Osteoarthritis (Egypt) 34986012 ; 2022 2 Pain reduced Gate improved (WOMAC) + + Nazari 8 Knee Osteoarthritis (Iran) 30178432 ; 2019 3 Pain reduced Stiffness in knee reduced (WOMAC stiffness) ROM increased + + + Nouri 9 Patellofemoral Pain Syndrome (Iran) 31360367 ; 2019 1 Pain reduced Functionality improved + + Samaan 10 Knee Osteoarthritis (Egypt) 35678062 ; 2022 1 Pain reduced ROM increased Function improved (WOMAC) + + + Siriratna 11 Knee Osteoarthritis (Thailand) 36313402 ; 2022 1 Pain reduced Functional ability was unchanged (WOMAC) + - Taheri 12 Knee osteoarthritis (Iran) MEJRH-134330 ; 2024 1 Pain reduced Functional ability improved (WOMAC) + + + Wibisono 13 Knee Osteoarthritis 2024 U Greater increase in balance in the HILT group than LLLT + SPINE/BACK Reference Blinding HILT Specific Outcomes ROM >QoL >Function Abdelbassett 14 Chronic lower back pain (Saudi Arabia & Egypt) 33178306 ; 2020 2 Pain reduced Disability reduced Lumbar mobility improved ROM increased QoL improved (EroQoL) + + + + Abdelmageed 15 Chronic Discogenic Sciatica (Egypt) link ; 2022 1 Pain reduced Increased walking distance Increased leg ROM Increased spinal neuron activity Potential recovery from conduction block + + Ahi 16 Myofascial pain syndrome (Turkey) 36538189 2022 1 Pain reduced Disability reduced (NDI) ROM increased QoL improved (SF-36) + + + + Chatterjee 17 Peripheral neuropathy, lumbar (India) 31405365; 2019 1 Pain reduced more by HILT + + - Chen 18 Lumbar disc protrusion (China) 28854500 ; 2018 1 Pain reduced Disability reduced (ODI) ROM increased + - Gawaan 19 Myofascial pain syndrome post-neck discectomy (Egypt) The Egyptian Journal of Hospital Medicine (2023) 1 Pain reduced Pressure pain threshold increased Neck ROM increased + + Ince 20 Neck pain (Turkey) 37204965 ; 2024 1 Pain reduced Cervical ROM increased Disability (NDI) reduced QoL (SF-36) increased + + + + Kenareh 21 Chronic neck pain (Iran) 34733743 ; 2021 U Short term pain relief + + Sherif 22 Cervical Radiculopathy (Egypt) Medical Journal of Cairo University ; 2023 U Pain was reduced Electrophysiological measures were unchanged + Venosa 23 Cervical Spondylosis (Italy) 30443883 ; 2019 1 Pain reduced ROM increased Disability (NDI) reduced + + + + Yilmaz 24 Cervical disc herniation (Turkey) 32147037 ; 2020 1 Pain reduced QoL improved ROM increased + + + SHOULDER/ARM Reference Blinding HILT Specific Outcomes ROM >QoL >Function Abdelhakiem 25 Hemiplegic shoulder (Egypt) 38538637; 2024 ? Pain reduced, functional ability improved, and handgrip strength increased + + Aceituno-Gómez 26 Subacromial impingement (Spain) 30672303 ; 2019 2 Pain unchanged Disability (CMS score) unchanged + - Atan 27 Adhesive capsulitis (frozen shoulder (Turkey) 32808147 2021 2 Pain reduced QoL improved Functional ability (SPADI) unchanged + + - Elsodany 28 Rotator Cuff Tendinopathy (Egypt & Saudi Arabia) 30188253 ; 2018 1 Pain reduced ROM increased both at EOT & 3mos post-treatment + + + Karaca 29 Lateral sylitis (Turkey) 36117204 ; 2022 0 Pain reduced Grip strength increased Hand function increased + + Kaydock 30 Lateral epicondylitis (Turkey) 32637921 ; 2020 2 Pain reduced Hand grip strength increased QoL (SF-36) increased Function (QDASH) increased + + + Korkmaz 31 Hemiplegic Shoulder Pain (Turkey) 33829317 ; 2021 2 Pain reduced ROM increased Disability index (SPADI) decreased Motor recovery improved QoL (NHP) improved Functional (FIM) improved Rotator cuff tear size reduced + + + + Ordahan 32 Adhesive capsulitis (Turkey) 37533657 ; 2023 2 Pain reduced Disability index (SPADI) decreased + - + Yilmaz 33 Subacromial Impingement Syndrome (Turkey) 33400012; 2021 2 Pain reduced ROM increased Function (CMS) increased QoL (SF-36) improved Strength increased Daily activity increased + + + + Sen 34 Lateral epicondylitis (Turkey) 38280938 ; 2024 0 Pain reduced Disability improvement + + Zaki 35 Subacromial impingement syndrome(Iran) 34184965 ; 2022 1 Pain reduced Function (SPADI) improved Ultrasound (MSKUS) improvements + + FACE Reference Blinding HILT Specific Outcomes ROM >QoL >Function Abdullatif 36 Bell’s Palsy (Egypt) 2022 1 Increased eyebrow raising Increased smiling ability + + Ekici 37 Myogenic temporomandibular joint disorder (Turkey) 34174507 ; 2021 2 Pain reduced ROM increased in jaw Functional disability reduced Improved QoL + + + Elkallah 38 Chronic sinusitis (Egypt) 32904078 ; 2020 1 Symptomatic improvements (SNOT-22) Nadershah 39 Temporomandibular joint disorder (Saudi Arabia) 31988570 ; 2020 2 Pain reduced + Wu 40 Bell’s Palsy (China) 37738368; 2023 0 Improved facial grades Improved electrophysiology + + + HAND/WRIST Abdel-aal 41 Hand OA in SLE (Egypt) 32638614 ; 2020 2 Pain reduced Swelling reduced Tenderness reduced Grip strength increased + + Cantero-Tellez 42 Thumb OA (Spain & USA) 31807782 ; 2020 3 Pain reduced + Ahi 43 De Quervain’s Tenosynovitis, thumb (Turkey) 36974441 ; 2023 2 Pain reduced Hand grip strength increased QoL (SF-36) increased Function (QDASH) increased + + Ezzati 44 Carpal tunnel syndrome (Iran) 31742366 ; 2020 2 HILT was superior to LLLT: Pain reduced Electrophysiological measures (CMAP & sensory nerve conduction) + + Chongkriengkrai 45 de Quervain’s tenosynovitis (Thailand) 37783935 ; 2023 2 Pain unchanged Hand grip strength unchanged Disability Several AEs - FOOT Reference Blinding HILT Specific Outcomes ROM >QoL >Function Bidoki 46 Plantar fasciitis (Iran) 38584653; 2024 2 30W 980nm 8J/cm 2 + + + Elnagger 47 Hemophilic A ankle arthropathy (Egypt) 31628558 2020 1 Pain reduced Gait improved + + Naruseviciute 48 Plantar fasciitis (Lithuania) 32513018 ; 2020 1 No statistical difference in pain Laser more effective than LLLT in the opinion of participants + Ordahan 49 Plantar fasciitis (Turkey) 29627888 ; 2018 2 Pain reduced (VAS) Function improved QoL improved (Laser all more than LLLT) + + + Yesil 50 Calcaneal spur (Turkey) 31478095 ; 2019 2 Pain unchanged QoL unchanged Function (FAOS) unchanged Improved pedographic measures - - + WOUNDS Lu 51 Chronic Refractory Wounds (China) 34253665 ; 2021 1 Improvement in Bates-Jensen Wound Assessment Tool (BWAT) Improvement in Pressure Ulcer Scale for Healing Thabet 52 Caesarian Healing in diabetic women (Egypt) 29706708 ; 2018 1 Wound appearance improved + GYNECOLOGICAL Thabet 53 Endometriosis (Egypt) 29668354 2018 1 Pain and adhesions reduced Improved QoL + + BONE Alayat 54 Osteoporosis (Saudi Arabia) 29068756 ; 2018 1 Lumbar bone mineral density improved and sustained for 1y Blinding − 0, unblinded: 1, single-blinded; 2, double-blinded; 3, triple blinded; U - unknown. (+) significantly positive outcome, (-) no apparent benefit, NA - not applicable/not measured. Pain measures are all VAS-based unless noted. ROM - range of motion. QoL - quality of life. Table 2 Laser parameters, treatment plan, and study design with follow-up sorted from highest to lowest positive effect size outcomes. Panels are categorized by knee, spine/back, shoulder/arm, face, hand/wrist, foot, wounds, gynecologic, or bone. Table only includes studies for which effect sizes could be calculated from the available data as statistically presented. COVID-19 Reference Blinding HILT Specific Outcomes <Lung indices Mortality >Taste restoration Shabaan 55 COVID-19 Loss of taste (ageusia) 37149582; 2023 2 Complete taste restoration after laser 94% vs 61% + Vetrici 56 COVID-19 pneumoniae (Canada)33776469 33776469; 2021 1 Improved lung function Reduced ICU admissions Rapid recovery Reduced mortality N = 10 + + + KNEE Author Diagnosis Reference Laser Settings Treatment Study Design FU Cohen’s d Effect Size El-Shamy 1 Juvenile Rheumatoid Arthritis (Egypt) 30016193 ; 2018 10.5W 52.5W/cm 2 120–150µs 10-30Hz 750J/knee/session HIRO 3.0 3x/wk 4wk ET ± HILT EOT 4.6 Nazari 2 Knee Osteoarthritis (Iran) 30178432 ; 2019 4W spot size? 30Hz 2100J/session E20780 - laser YAG HT 3x/wk 4wk ET ± HILT EOT 4.0 El-Shamy 3 Hemophilic Arthropathy (Egypt) 27976591 ; 2018 10.5W (52.5W/cm 2 ) 120–150µs 10-30Hz 750J/knee/session HIRO 3.0 3x/wk 12wk ET ± HILT EOT 2.9 Samaan 4 Knee Osteoarthritis (Egypt) 35678062 ; 2022 12W (12W/cm 2 ) 25Hz 300J/analgesic or 3000J/biostimulation BTL6000 2x/wk 2wk ET ± HILT EOT 2.4 Bettancourt 5 Knee osteoarthritis (Portugal) J.Arthritis ; 2020 30W (30W/cm 2 ) Pulsed & Continuous 6J and 80J (BTL industries?) Every other day 14x total 2wks HILT v sham 4wk 1.9 Siriratna 6 Knee Osteoarthritis (Thailand) 36313402 ; 2022 1W (0.5W/cm 2 ) 2000Hz 560J/session Mphi laser device 2-3x/wk 10x total HILT v sham EOT 1.8 Ahmad 7 Knee Osteoarthritis (Malaysia) 37511894 ; 2023 5W 5W/cm 2 190J pulsed & 3000J CW BTL-6000 1x/wk 12wks HILTvLLLT EOT 1.3 Akaltun 8 Knee Osteoarthritis (Turkey) 33074393 2020 12W (12W/cm 2 2) 25Hz 300J/analgesic session & 3000J/biostimulation session BTL6000 5X/wk 2wk ±HILT 6wks 1.1 Taheri 9 Knee osteoarthritis (Iran) MEJRH-134330 ; 2024 2W 500J Lumix CPS 3x/wk 2wk ET ± HILT EOT 1.1 Mostafa 10 Knee Osteoarthritis (Egypt) 34986012 ; 2022 10.5W 52.5W/cm 2 1500mJ/cm 2 /session HIRO 3.0 3x/wk 4wk HILT v Shock Wave Therapy EOT 1.0 Ekici 11 Knee OA (Turkey) 37743421 ; 2023 10W & 5W 10W/cm 2 /Analgesic & 5W/cm 2 /Biostimulatory BTL6000 3x/wk 3wk ET ± HILT EOT 0.4 Wibisono 12 Knee OA (Indonesia) Medico Hospitalia; 2024 10W 2m – analgesic phase 10W 4m – biostimulatory phase 2x/wk 4wk HILT v LLLT 0.3 Spine/Back Reference Laser Settings Treatment Study Design FU Cohen’s d Effect Size Venosa 13 Cervical Spondylosis (Italy) 30443883 ; 2019 10.5W 52.5W/cm 2 120–150µs, 10-30Hz 2050J/session HIRO 3.0 2x/wk 6wks HILT + ET v US + TENS + ET 4wks 3.3 Sherif 14 Cervical Radiculopathy (Egypt) Medical Journal of Cairo University ; 2023 2W & 4W 980nm 4Hz 840J/session LevelLaser EZ1 2x/wk 4wks ET ± HILT EOT 2.3 Ince 15 Neck pain (Turkey) 37204965 ; 2024 10.5W 52.5W/cm 2 120–150µs 10-30Hz 2632J/session HIRO 3.0 5x/wk 4wks ET ± HILT 12wks 1.8 Abdelbassett 16 Chronic lower back pain (Saudi Arabia & Egypt) 33178306 ; 2020 12W 12W/cm 2 1200J/session BTL000 2/wk 12wks HILT v sham EOT 1.5 Gawaan 17 Myofascial pain syndrome post-neck discectomy (Egypt) The Egyptian Journal of Hospital Medicine (2023) 14W ? pulsed 2803J/session Device Omega 3x/wk 4wk ET ± HILT EOT 1.4 Abdelmageed 18 Chronic Discogenic Sciatica (Egypt) link ; 2022 1W/cm2 810nm + 980nm 400J/session 3x/wk 4wks PT ± HILT EOT 1.4 Kenareh 19 Chronic neck pain (Iran) 34733743 ; 2021 10W 3m Then 7W 7m 1/d 2wks 10x total HILT v US 1.4 Chen 20 Lumbar disc protrusion(China) 28854500 ; 2018 12W 12W/cm 2 7500J/session BTL600 5x/wk 2wk ±HILT + Spinal decompression 4wks 1.0 Chatterjee 21 Peripheral neuropathy, lumbar (India) 31405365; 2019 8W 5.3W/cm 2 980nm:810nm at 80%:20% 1920J 3x/wk 4wks 1x/wk 8wks HILT v Sham +standard of care 0.9 Ahi 22 Myofascial pain syndrome (Turkey) 36538189 2022 8W 8W/cm 2 ?J BT6000 2x/wk 4wk ET + PT ± HILT EOT Don’t have raw data, but (+) Yilmaz 23 Cervical disc herniation (Turkey) 32147037 ; 2020 8W 8W/cm 2 1850J/session BTL6000 5x/wk 4wk ET ± HILT EOT 0.3 SHOULDER/ARM Reference Laser Settings Treatment Study Design FU Cohen’s d Effect Size Karaca 24 Lateral epicondylitis (arthropathy) (Turkey) 36117204 ; 2022 4W and 6W 13-20W/cm2 6J/cm 2 analgesic & 12J/cm 2 biostimulation BTL6000 2x/wk 2wks PT + ESWT ± HILT 4wks 5.0 Elsodany 25 Rotator Cuff Tendinopathy (Egypt & Saudi Arabia) 30188253 ; 2018 Power? 10.5W? 2050J per session HIRO 3.0 3x/wk 4wks ET ± HILT EOT 4.7 Abdelhakiem 26 Hemiplegic shoulder pain after stroke 38538637; 2024 3x 8W 75s 100J 6x 12W 30s ITO (LAZR-207) 3x/wk 3wks ET ± HILT 1wk 4.5 Atan 27 Adhesive capsulitis (frozen shoulder; (arthropathy) (Turkey) 32808147; 2021 8, 12, 8W 100J/cm 2 iLux 5x/wk 3wk ET ± HILT 3mos 2 Zaki 28 Subacromial impingement syndrome 34184965 ; 2022 4W 5W/cm 2 2050J/session Zimmer Opton 3x/wk 7 sessions total LLL-KT, HPL-KT, & sham-KT Do not have raw data Ordahan 29 Adhesive capsulitis (Turkey) 37533657 ; 2023 12W 12W/cm 2 10J/cm 2 /analgesic & 100J/cm 2 /biostimulatory BTL6000 5x/wk 3wk HILT ± stretchin + ET v LLLT ± stretchin + ET 3wks 1.6 Korkmaz 30 Hemiplegic Shoulder Pain (arthropathy) (Turkey) 33829317 ; 2021 8W 8W/cm 2 300J/analgesic session & 2500J/biostimulatory session BTL600 3x/wk 3wk PT ± HILT EOT 1.3 Yilmaz 23 Subacromial Impingement Syndrome (arthropathy) (Turkey) 334000012 ; 2021 10.5W 52.5W/cm 2 40Hz 2781J/session HIRO 3.0 5x/wk 3wks ET ± HILT EOT 0.4 Aceituno-Gómez 31 Subacromial impingement (Spain) 30672303 ; 2019 12W pulsed 250J/cm 2 iLux Laser device (Mectronic) 5x/wk 3wk ET ± HILT 3mos 0.3 Kaydock 32 Lateral epicondylitis (arthropathy), (Turkey) 32637921 ; 2020 6W 6W/cm 2 6J/cm 2 /analgesic & 120-150J/cm 2 /biostimulatory BTL6000 3x/wk 3wk HILT v LLLT EOT 0.4 FACE Reference Laser Settings Treatment Study Design FU Cohen’s d Effect Size Ekici 33 Myogenic temporomandibular joint disorder (Turkey) 34174507 ; 2021 10.5W 52.5W/cm 2 120–150µs 10-30Hz 1029J/session HIRO 3.0 1x/wk 15d HILT v sham 4wk 1.5 Wu 34 Bell’s Palsy (China) 37738368; 2023 1W of 808nm + 0.2W of 905nm 3x/wk 72x total ±HILT 1.2 Abdullatif 35 Bell’s Palsy (Egypt) 2022 1,808J/session HIRO 3.0 1x/wk 4wk 2 sides of face EOT - Elkallah 36 Chronic sinusitis (Egypt) 32904078 ; 2020 1W/cm 2 810nm & 980nm 150J/sinus Zimmer Opton Pro 3x/wk 4wk SMT ± HILT EOT - Nadershah 37 Temporomandibular joint disorder (Saudi Arabia) 31988570 ; 2020 7W 2.5W/cm 2 300J/treatment Ezlase 940 device (Biolase Technology, Inc. California, USA) Every other day 10d HILT v sham EOT - HAND/WRIST Abdel-aal 38 Hand OA in SLE (Egypt) 32638614 ; 2020 Power? 2100J/session HIRO 3.0 3x/wk 8wks HILT v sham EOT 1.9 Cantero-Tellez 39 Thumb OA (Spain & USA) 31807782 ; 2020 1.5W 0.3W/cm 2 800 + 970nm 2Hz 50% duty cycle 75J/session K- Laser, Mod. K1200 3x/wk 4wks HILT v sham EOT 1.2 Ahi 40 De Quervain’s Tenosynovitis, thumb (Turkey) 36974441 ; 2023 12W 52.5W/cm 2 10J/cm 2 /analgesic & 120-150J/cm 2 /biostimulatory BTL6000 3x/wk 5wk HILT v sham EOT 1.0 Ezzati 41 Carpal tunnel syndrome (Iran) 31742366 ; 2020 1.6W 808nm 8J or 20J/cm 2 5x/2wks HILT v LLLT EOT 0.4 Chongkriengkrai 42 de Quervain’s tenosynovitis (Thailand) 37783935 ; 2023 8W 8W/cm 2 80J/analgesic & 800J/biostimulatory BTL600 3x/wk 3wk Split + ET + HILT/sham 3wk -0.9 FOOT Reference Laser Settings Treatment Study Design FU Cohen’s d Effect Size Ordahan 43 Plantar fasciitis (Turkey) 29627888 ; 2018 8W and 6W First week: 8W 6J/cm2 Next 2 weeks: 6W 120J/cm2 BTL6000 3x/wk 3wks HILT v LLLT EOT 2.2 Elnagger 44 Hemophilic A ankle arthropathy (Egypt) 31628558 2020 7W 7W/cm 2 3000J BTL600 3x/wk 8x total PT ± HILT EOT 0.7 Naruseviciute 45 Plantar fasciitis (Lithuania) 32513018 ; 2020 10.5W 52.5W/cm 2 120–150µs 10-30Hz 3000J HIRO 3.0 8x/3wk PT ± HILT EOT 0.5 Yesil 46 Calcaneal spur (Turkey) 31478095 ; 2019 10.5W 52.5W/cm 2 120–150µs 10-30Hz 1281J/session HIRO 3.0 5x/wk 3wks ET + HILT/sham 4wks 0.1 WOUNDS Lu 47 Chronic Refractory Wounds; (China) 34253665 ; 2021 8W 8W/cm 2 80J/cm 2 BTL6000 3x/wk 3wk SMT + HILT/sham EOT 4.2 Thabet 48 Caesarian Healing in diabetic women; (Egypt) 29706708 ; 2018 10.5W 52.5W/cm 2 120–150µs 10-40Hz 360-540J HIRO 3.0 S SMT + HILT/sham EOT 0.9 GYNECOLOGICAL Thabet 49 Endometriosis (Egypt) 29668354 2018 10.5W 52.5W/cm 2 120–150µs 10-40Hz 0.1% duty cycle 1300J BTL600 3x/wk 8wk HT ± HILT EOT 2.2 BONE Alayat 50 Osteoporosis (Saudi Arabia) 29068756 ; 2018 10.5W 52.5W/cm 2 120–150µs 10-30Hz 3000J total per session HIRO 3.0 3x/wk 24 wks ET ± HILT EOT 0.5 1064nm wavelengths were used throughout unless noted otherwise under treatment settings. FU-follow-up; ET-exercise therapy; PT-physical therapy; ESWT-extracorporeal shock wave therapy; KT-kinesiology taping; LLL-low level light; HT-hormone therapy; EOT-end of treatment follow-up. SMT-standard medical treatment. Kaydock study was a measure of hand grip strength and Abdel-all was a measure of joint swelling. All other measures were VAS. Most significantly, no serious adverse events (AEs) were observed in 56 controlled trials. Eight non-serious AEs were reported among a total of 1,486 HILT-treated patients. One patient, a light-skinned female with adhesive capsulitis, experienced a photoallergy. 41 Three non-serious AEs were reported in children with hemophilic arthropathies, but no further details were provided. 42 Two other patients reported post-HILT pain, and one experienced post-swelling pain in a study treating patients with de Quervain's tenosynovitis (wrist tendon pain). 43 The greatest cumulative categorically favorable pain reduction response data was observed with treatment of knee pathologies. Pain was reduced in all 12 out of 12 studies that measured pain (Table 2 and Supplementary Table S1 ). Eleven out of 12 studies exhibited a large effect size in pain reductions. A thirteenth study demonstrated improvements in balance in patients with osteoarthritis only after treatment with HILT, but not when treated with LLLT. 44 In a 2020 knees osteoarthritis study, changes in knee cartilage thickness were measured from three different ultrasound aspects at 6 weeks after treatment. 45 High-powered PBMT resulted in a medium to large effect size in changes in cartilage thickness from all three aspects, according to Cohen's criteria for effect size (|d| < 0.2 = small effect; 0.2 < |d| 0.8 = large effect. 38 Only one study measured changes in tendon (supraspinatus) size before and after treatments. 46 In this study, treatment of patients with subacromial impingement syndrome with HILT demonstrated an improvement in supraspinatus tendon thickness compared to LLLT or sham laser treatment. HILT treatment showed significant pain reduction in all 11 spine studies, including non-specific lower back pain, cervical disc herniation, discogenic sciatica, myofascial pain syndrome, cervical radiculopathy, cervical spondylosis, peripheral neuropathy, diabetic neuropathy, and lumbar disc protrusion. In foot indications, 5 out of 6 HILT treatments resulted in statistically significant pain reduction, specifically for plantar fasciitis and ankle arthropathy (Table 1 ). However, no significant pain reduction was observed for calcaneal spur. For shoulder or arm-related conditions, HILT treatment led to significant pain reduction in 11 out of 12 studies measuring pain, including rotator cuff injury, tendinopathy, adhesive capsulitis, subacromial impingement, lateral epicondylitis, and hemiplegic shoulder pain. Negative data was obtained in one study focusing on subacromial impingement and one study focusing on lateral epicondylitis. However, the latter lateral epicondylitis study did show positive outcomes in terms of increased hand grip strength and upper limb function (QDASH). Two studies focused on post-stroke patients with hemiplegic shoulder pain evaluating exercise therapy ± HILT yielded exceptionally large effect size positive outcomes after HILT (ES = 4.5 and 1.3). 47,48 Additionally, HILT not only resulted in significant reduction in shoulder pain but it also decreased rotator cuff tear size. The control group, which did not receive HILT treatment, showed no change in tear size. 48 Healing was confirmed through ultrasound measurements. Cohen effect sizes for both reduction in tear size and pain measures in the HILT group were large, suggesting that proper healing of the tissue contributed to the significantly greater pain reduction Non-musculoskeletal studies with large effect sizes (Cohen's > 0.8), included wound healing (chronic refractory and caesarian section), chronic discogenic sciatica (increased nerve activity and pain reduction), endometriosis (pain reduction), and TMJ (mouth opening size also increased; Tables 1 and 2 ). A positive outcome of lesser effect size was also achieved for osteoporosis with osteopenia. 49 Bone density measures were made 6 months and 1 year after cessation of treatment. In both cases, there was an increase in bone mineral density in the HILT plus exercise group, but no significant change was observed in the exercise therapy only group. In musculoskeletal disorders, restricted range of motion (ROM) and loss of cartilage are common. In 15 out of 16 studies assessing ROM, HILT treatment resulted in statistically significant increases in ROM compared to control groups without HILT (Table 1 ). These studies involved patients with knee osteoarthritis (n = 7), subacromial impingement (n = 2), cervical spondylosis, hemiplegic shoulder pain, neck pain, myofascial pain syndrome post-neck discectomy, rotator cuff tendinopathy, hemophilic arthropathy, and myogenic temporomandibular joint disorder. Quality of life measures attempt to quantify how debilitating various conditions are to patients’ overall well-being and their basic functional life-skills. HILT treatment demonstrably improved the quality of life (QoL) in 16 out of the 20 studies assessing QoL. Positive QoL outcomes were observed after treatment of patients diagnosed with knee osteoarthritis, subacromial impingement syndrome, endometriosis, plantar fasciitis, hemiplegic shoulder pain, neck pain, adhesive capsulitis (frozen shoulder), chronic lower back pain, cervical disc herniation, cervical spondylosis, lateral epicondylitis, and myogenic temporomandibular joint disorder (Table 1 ). Functional outcomes or abilities include measurements of physical functions using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale or the measures of the ability to walk further over 6 minutes as with patients with hemophilic arthropathy. 45,50 HILT increased patient functional abilities in 31 out of 37 studies making functional assessments. Technical Procedural Aspects The most used lasers were the BTL-6000 (n = 20 studies) and the HIRO 3.0 (n = 15). The most commonly used wavelength was 1064nm (n = 42), while 4 studies used 810 + 980nm (Zimmer Opton Pro), 2 used 808 + 905nm, 2 used 980nm, 2x 940nm, and three studies used 808nm + 905nm, 800nm + 970nm, or 940nm (Table 2 ). In 27 out of 29 studies, a biphasic administration method was used to generate positive outcomes. This method involved an initial analgesic mode (lower power) followed by a biostimulatory mode (higher power) in subsequent treatment sessions. The Hilterapia HIRO 3 laser (ASA laser, Arcugnano, Vicenza, Italy) used distinctly different and unique laser settings with both an exceptionally high peak power (3kW) and an exceptionally short pulse (100µs). Studies were primarily conducted in Turkey (n = 16) and Egypt (n = 15), with smaller numbers in Iran (n = 6), Saudi Arabia (n = 4), China (n = 3), and other countries with 2 studies (Thailand, Italy, Spain), or a single study (United States, Lithuania, Thailand, Malaysia, Portugal; Table 2 ). QUANTITATIVE SUMMARY OF HILT EFFECT SIZES Forest plot analysis was used to visually present the comparisons of quantitative effect size outcomes. Figure 2 illustrates the pain (VAS) outcomes of evaluations of HILT, categorized by anatomies that have similar depths of pathology: knees, shoulder/arm, and spine related. Among a total of 9 studies, knee-related pathologies displayed the highest average effect size compared to shoulder/arm (n = 11) and spine-related pathologies (n = 13), with effect sizes of -2.3, -1.85, and − 1.15 respectively. Figure 2 presents both end-of-treatment (EOT) and extended post-cessation of HILT follow-ups for knee-related pathologies. Most importantly, 17 out of 18 studies, which measured outcomes at extended follow-up times ( Supplementary Table S2 ), revealed that the benefits of pain reduction after the cessation of HILT treatment plans were sustained and not temporary. The average large effect size for pain reduction between groups after treatment cessation was 2.2 ± 1.5 for extended follow-up measures, compared to 2.0 ± 1.7 for end of treatment measures. This summary data demonstrates that HILT does not only provide temporary pain relief. Instead, it has biostimulatory properties and can promote tissue regeneration, leading to sustained positive outcomes in the clinic. It addresses the pathology itself and not merely the symptomatic presentation in the repetitive unlimited fashion characteristic of many pain medications. HILT is superior to LLLT in Controlled Trials HILT was found to be superior to LLLT in 7 out of 8 studies, with a statistically significant large effect size (ES) difference compared to LLLT (Table 4 ; average ES = 1.21 ± 0.76). HILT demonstrated superiority over LLLT in the treatment of knee osteoarthritis (5W/cm 2 vs 0.4W and 5W vs 78mW), lateral epicondylitis (8W/cm 2 vs 240mW), adhesive capsulitis (frozen shoulder; 12W/cm 2 vs 240mW), subacromial impingement (5W/cm 2 vs 250W/cm 2 ), plantar fasciitis (7W/cm 2 vs 50mW), and carpal tunnel syndrome (1.6W vs 50mW; power densities are provided as they are more meaningful, when details were provided within studies). One study compared two different HILT parameters (12W/cm 2 vs 0.8W), but did not use LLLT (< 500mW). 51 Both treatments were equally effective in reducing chronic nonspecific lower back pain in this study. Optimal Laser Powers Needed Per Categorical Anatomies to the Best We can Determine Based on Limited Available RCT Evidence To determine optimal power settings to use per respective indications that can be based on the highly limited currently available trial data we used effect size (ES) quantitations to perform the following analysis (Table 2 and summary Table 3 ). We report the power densities used to achieve the best outcomes per categorical diagnosis when the spot size is described in the study reports. Table 3 Optimal laser parameters and treatment plans based on summary analysis of the most positive outcomes from RCTs fulfilling criteria for inclusion in our meta-analysis. Anatomy Power density “Dose” (as Joules or Fluence, J/cm 2 ) Treatment Plan Knee (arthropathies, injuries) 5-30W/cm2 750-3000J Daily treatment regimens for at least 2 weeks Spine/Back (radiculopathies, spondylosis, neck pain, chronic pain, myofascial pain syndrome post-neck discectomy, discogenic sciatica, lumbar disc protrusion) 10-12W/cm2 850-7500J 5x/wk for 2wks or 2x/wk for 4-6wks Shoulder/arm (lateral epicondylitis, rotator cuff tendinopathy, adhesive capsulitis, frozen shoulder, subacromial impingement syndrome) 5-20W/cm2 2000-2500J 2-3x/wk for ≥2wks Wound (Chronic Refractory Wounds) 8-10W/cm2 80J+150J/cm2 or 540J 3x/wk for ≥3wks Hand/wrist (arthropathies, carpal tunnel syndrome, De Quervain’s tenosynovitis) 0.3-12W/cm2 2100J or 150J/cm2 3x/wk for ≥4wks Foot (plantar fasciitis, ankle arthropathy) 8W/cm2 120J/cm2 3x/wk for 3wks Table 4 Summary of HILT vs LLLT studies in this meta-analysis. Laser parameters and outcomes are shown. All studies used the same treatment plans between groups. Pain reduction, functional (including disability indices), and quality of life (QoL) measures are noted. The superior outcome is labelled for each metric. A blank cell denotes that no measurement was made. HILT LLLT Superiority Reference Power or Power Density λ (nm) Dosage Power or Power Density λ (nm) Dosage Pain reduction Function QoL Abdelbassett 51 Chronic lower back pain (Saudi Arabia & Egypt) 33178306 ; 2020 12W 1064 1200J 0.8W 850 1200J Both class IV HILT lasers. Both powers were effective. Ahmad 7 Knee Osteoarthritis (Malaysia) 37511894 ; 2023 5W 1064 400J 0.4W 830 3190J HILT HILT HILT Ezzati 23 Carpal tunnel syndrome (Iran) 31742366 ; 2020 1.6W 808 20J/cm 2 50mW 860 20J/cm2 HILT HILT Nerve conduction & Compound muscle action potential Kaydock 20 Lateral epicondylitis (Turkey) 32637921 ; 2020 8W/cm 2 1064 150J/cm 2 240mW 904 2.4J/cm2 HILT HILT SF-36 & QDASH HILT Naruseviciute 22 Plantar fasciiitis (Lithuania) 32513018 ; 2020 7W 7W/cm 2 1064 3000J 50mW 785 140J Both groups exhibited reduced pain. There was no untreated control. Ordahan 106 Adhesive capsulitis (Turkey) 37533657 ; 2023 12W/cm 2 1064 120J/cm 2 240mW 904 3J/cm 2 HILT Ordahan 21 Plantar fasciiitis (Turkey) 29627888 ; 2018 6W/cm 2 1064 150J/cm 2 240mW 904 0.16W/cm 2 640J/session HILT HILT Heel tenderness HILT Foot and Ankle Outcome Scores Zaki 46 Subacromial impingement syndrome 34184965 ; 2022 4W 5W/cm 2 810 + 980 2050J 200mW 250W/cm 2 810 + 980 2000J HILT HILT It is important to note that the HIRO 3.0 device utilizes extremely short pulses (120–150µs pulses at frequencies of 10-40Hz), with the light being off for most of the time of each second. Additionally, it operates at exceptionally high peak powers (12kW) with a spot size of 0.2cm 2 . Due to these unique characteristics, the HIRO 3.0 treatment method is fundamentally different from other devices that use continuous or 50% off pulsed settings. Therefore, our focus in this discussion is limited to the studies that utilized continuous or pulsed (50% on/off) settings, rather than HIRO 3.0 micro-pulsing (120–150µs, 10-40Hz). Knee – 12W at 12W/cm 2 (52.5W/cm 2 micro-pulsed) Twelve studies all yielded positive calculated effect sizes ranging from 4.6 to 0.4, using power settings ranging from 1W to 14W. The study with the greatest measurably positive effect size involved the treatment of children with juvenile rheumatoid arthritis. 50 However, this study needs to be qualified since it is the only study involving children, and children naturally recover at a greater rate than adults. Additionally, this is a unique and distinct rare form of arthropathy that occurs due to recurrent bleeds inherent in hemophilic arthropathy. As a result, the benefits were reduced in follow-up measures. The laser treatment settings were 10.5 W (50W/cm 2 , 120–150µs, 10-30Hz, 750J per knee per session, HIRO 3.0) three times per week for 4 weeks. In contrast, other studies using non-micro-pulsed settings achieved large effect sizes that improved over time, as measured in extended follow-up measures conducted after the cessation of treatment. These studies used 12W or 30W settings at power densities of 12 W/cm 2 or 30W/cm 2 . Spine/Back – 12W at 12W/cm 2 (10.5W at 52.5W/cm 2 micro-pulsed) Eleven studies focused on pathologies of the spine achieved measurably positive outcomes by using power settings ranging from 1W to 14W. The study with the highest effect size (3.3 ES) involved treatments using 10.5W (50W/cm 2 , 1064nm, 120–150µs,10-40Hz, 2050J total, over 30m, HIRO 3.0) for patients with cervical spondylosis. 52 These treatments were administered twice a week for a duration of 6 weeks. Shoulder and arm – 6W at 6W/cm 2 Thirteen studies focused on the shoulder or arm using powers ranging from 4W to 12W. Effect sizes could be calculated for 8 studies. The most impressive quantitative positive outcome (5.0 ES) was achieved when using 6W (1064nm, BTL6000) to treat patients with lateral epicondylitis. 53 Treatment involved an initial 45 seconds of 4W (12W/cm 2 ) to provide analgesia followed by 12 minutes of 6W administration. Only four sessions were conducted over two weeks. The authors did not mention whether the administration was continuous or pulsed. The results of two studies evaluating HILT treatment for de Quervain's tenosynovitis were contrasting and interesting. 43,54 A positive outcome (ES = 1.0) with no adverse events was achieved with a higher power and shorter treatment duration, while a negative outcome occurred with 3 out of 10 subjects experiencing adverse events when using a lower power but for a longer time (10W 100s 250J vs 8W 5min 800J respectively; BTL600 1064nm for both). Face – 10.5W Five studies focused on the face, which included two Bell's Palsy studies, two temporomandibular joint disorder studies, and one study on chronic sinusitis. However, only one of these studies provided enough data to calculate the effect size for pain. 55 The study showed an impressively large effect size (1.5 ES) when the myogenic temporomandibular joint disorder was effectively treated using micropulsed therapy with a power output of 10.5 watts (50W/cm 2 , 120–150µs, 10-30Hz, 1092J/session, HIRO 3.0), administered five times per week for three weeks. Foot − 8W (24W/cm 2 ) Six studies focused on the foot – three on plantar fasciitis, one on ankle arthropathy, one on calcaneal spur, and one on diabetic peripheral neuropathy. 21,22,56–58 These used 7W to 10.5W. These used power settings ranging from 7W to 10.5W. The most positive outcome (2.2 ES) was achieved when using 8W superpulsed (24W/cm 2 ; 1064nm; BTL6000) for just 75 seconds to deliver 150J three times in the first week followed by just 30 second treatments at 6W power to deliver 120 J three time per week for a subsequent 2 weeks. 21 These were exceptionally short treatment sessions. Hand – 1.5W (0.3W/cm 2 ; 800 + 970nm) Five studies focused on the hand and all exhibited measurably positive effect size outcomes, but the power setting was not described for the most impressively positive outcome (1.9 ES) involving treatment of hand osteoarthritis. 59 Thus, we must defer to the second most impressively positive outcome, which was achieved by treating thumb osteoarthritis with 800nm with 970nm at a power of just 1.5W (2Hz, 50% duty cycle). This treatment was applied over an area of 5cm 2 for only 45 seconds per session. 60 The treatment was done three times per week for a period of four weeks. Wound – 10.5W (50W/cm 2 ) Just two controlled studies were conducted on wounds, and both yielded positive outcomes. The effect sizes were 4.2 for cesarian healing and 0.9 for chronic refractory wounds. 61,62 The most impressive treatment regimen (10.5W, 25Hz, 1064nm, HIRO 3.0) consisted of three phases: ( 1 ) fast scanning across the entire wound for 100-150J, ( 2 ) 14 seconds of irradiation focused on 12–14 spots for a total of 160-240J, and ( 3 ) the same as the first phase but at a slower scanning pace. Treatments took 8 minutes and were administered three times per week for 8 weeks. Bone – 10.5W micropulsed (50W/cm 2 ) There was only one study that examined the effects of HILT on bone mineral density in men with osteopenia or osteoporosis. The study demonstrated a medium effect size (0.5 ES), and most importantly, this effect size was maintained even 1 year after the treatment was stopped (0.4 ES). 49 The treatment used in this study involved the administration of micropulsed light with an average power of 10.5W (at 50W/cm 2 , 1064nm, 120–150µs, 10-30Hz, 3000J per session using HIRO 3.0) three times per week for a total of 24 weeks. DISCUSSION The objective of this meta-analysis was to evaluate the full range of indications that can benefit from high-powered laser photobiomodulation therapy. The secondary objective was to determine the optimal laser settings and treatment regimens based on the currently available data from randomized controlled trials (RCTs). Pain levels after high-powered laser therapy (HILT) were the most commonly measured outcome, and all studies focused on the knee, spine, shoulder/arm, and wound showed reductions in pain. Most of these reductions were significant, as indicated by the large effect sizes (Tables 1 and 2 ). Additionally, improvements in range of motion, mobility, quality of life, cartilage growth, rotator cuff tear recovery, and nerve conduction were also demonstrated. Consistent with our project's hypothesis, all 7 out of 8 studies that directly compared HILT to LLLT showed that higher powered lasers had better outcomes. The only exception was one study where both high and low energy PBMT effectively reduced pain in patients with plantar fasciitis and it is possible this was due to referred pain for which the laser was not focused on the appropriate pathogenic anatomy (discussed below in limitations section; Table 3 ). Three of these HILT superior studies focused on the shoulder and arm, while the other individual studies focused on the knee, foot, and hand. In a previous double-blind RCT for patients with myofascial pain, LLLT treatment did not reduce pain, whereas a similar study using HILT showed a significant reduction in pain. 63,64 Furthermore, LLLT treatment did not provide any benefits for temporomandibular joint dysfunction (TMJD), while a controlled study using HILT showed that the higher powered approach was especially effective in reducing pain. In summary, based on our meta-analysis spanning the past six years, high-powered laser PBMT consistently produces superior outcomes. Our findings are in agreement with all prior meta-analyses. 65–69 Overwhelmingly positive outcomes (96%) were observed after comprehensive evaluation of HILT treatment specifically targeting pain (July 2020 to August 2022; n = 31 RCTs). 69 When treating knee osteoarthritis, HILT + ET outperformed LLLT + ET (≤ December 2019; n = 10 RCTs). 7 An analysis focused on knee osteoarthritis concluded that HILT effectively alleviates pain (≤ September 2022; n = 9 CTs). 70 Likewise, an analysis of HILT treatment for neck pain concluded that it effectively reduces pain and improves cervical ROM (≤ March 2022; n = 9 RCTs). 68 Another analysis comparing HILT to other physical therapy modalities for knee osteoarthritis found that HILT is superior in terms of pain reduction and functional improvement (≤ March 2022; n = 10 RCTs). In line with our observations, an extensive meta-analysis of musculoskeletal outcomes (≤ September 2022; n = 42 RCTs) found large (> 0.8) effect sizes in pain reduction and improved function after HILT treatment. 65 Overall, it is evident that HILT holds significant potential for transforming the treatment of various musculoskeletal pains, stiffness, and loss of function. However, there are current limitations to implementation including a general lack of physician awareness of the wide-ranging therapeutic utility of HILT and restricted patient access. Study Limitations Our study had several limitations. Firstly, other than one study focused on knee arthropathy that used 30 watts 71 , the highest-powered laser was only 15 watts for subacromial impingement. 72 However, there are photobiomodulation therapy lasers in regular clinical practice that use powers as high as 80 watts that have yet to be evaluated in a controlled setting. We could not find any RCTs describing the evaluation of average powers above 30W. Secondly, most of our studies were limited to the 1064nm wavelength without consideration of higher powers using other wavelengths. Most basic PBMT biomedical research has in fact used wavelengths between 650 (red) to 830nm range. This is significant because 810-830nm light is not absorbed by water, thus making this the lowest heat-generating wavelength, 73 which enables more tolerable deeper penetrating PBMT at the highest power density settings. Additional limitations include variable study designs, variable follow-up times, failure to report spot size, and small sample sizes. Another limitation potentially affecting outcomes is the possibility that the laser was not directed towards the source of pathogenesis. For instance, foot pain associated with plantar fasciitis may initially manifest as referred pain originating from tightness in the hips. It is well-known that stretching and strengthening the hips can be beneficial in reducing foot pain. 74,75 Therefore, it is possible that more positive outcomes for plantar fasciitis could be achieved if the laser was directed at the hip. This may increase range of motion and influence the nerves responsible for sending pain signals through the sacrum. Similarly, for other conditions involving referred pain in the extremities, focusing the laser on the spinal cord or central nervous system (CNS) may lead to more positive benefits. This is because all pain signals ultimately pass through these anatomical routes since all pain signals ultimate go through these anatomical routes. High-powered Laser PBMT Therapeutic Index is Superior to Standard Pain Management Pharmaceuticals (NSAIDs and opioids) Out of the 1,456 patients treated with HILT in all studies within this meta-analysis, there was not a single serious adverse event reported from our meta-analysis. This safety profile is vastly superior to the pharmacotherapeutics that are commonly used to treat chronic pain conditions. Even more, HILT clearly has the potential to correct the cause of the pain by stimulating tissue regeneration with healing, while pain-relieving pharmacotherapies are generally not designed to address the cause, rather only to address the symptomology. Opioid side effects commonly involve analgesic tolerance, addiction, constipation, nausea, and respiratory depression that can result in death. 76 In fact, opiate-related overdoses have been among the fastest rising causes of death in America, rising to epidemic proportions over the past 3 decades from 1988 until 2018. 77,78 By 2028, the estimates are that more Americans will have died in the 21st century of drug overdoses than those who died in all of America’s wars over its entire history. Additionally, a 2022 report released by the U.S. Commission on Combating Synthetic Opioid Trafficking estimates that drug overdoses now cost the U.S. approximately $ 1 trillion every year. 79 Finally, on Feb. 10, 2022, the CDC issued new guidelines for prescribing opioids that advises doctors to limit new opioid prescriptions and discuss alternative therapies with patients. 80 By comparison, no serious adverse events have ever been reported let alone deaths, when using high-powered PBMT. High-powered laser PBMT should be considered as an approach that may enable the transition from chronic medication to a tolerable or potentially even painless health status. When the 100% efficacy observed for studies focused on knees, shoulders/arms, and spine is combined with this level of safety, the combined therapeutic index (toxicity: efficacy) of high-powered PBMT is truly remarkable next to pharmaceutical approaches. Most significantly, these high-powered laser PBMT RCTs are now proven to provide sustained benefits in bio-stimulation of tissue healing with regeneration, unlike pharmaceuticals commonly used to address musculoskeletal disorders, including the chronic use of corticosteroids and NSAIDs, both of which are well-known to disrupt the removal of damaged tissue and the collective wound healing process. 81,82 High-powered PBMT is now poised to take a new position as an effective, non-invasive, and drug-free, alternative therapy treatment for pain relief, inflammation reduction, and accelerated healing. Optimal Treatment for Stimulating Cartilage /Tendon Growth in the Knee with Osteoarthritis Knee osteoarthritis (KOA) commonly involves the loss of supporting cartilage with knee replacement surgery often being the usual recourse. One 2020 HILT study in this meta-analysis demonstrated a statistically significant increase in knee cartilage thickness after HILT treatment compared to baseline, indicating that high-intensity laser therapy can stimulate cartilage regeneration. 45,80 Comparing it with a 2017 study that failed to demonstrate increased cartilage suggests that a daily regular treatment regimen is the best approach to increasing the chance for sustained recovery with both sustained reductions in pain and true increases in cartilage growth. Similar powers (12W in positive outcome; 10.5W in negative), wavelengths (both 1064nm), and pulse settings (10Hz in positive outcome and 30Hz in negative) settings were used in both 2020 studies. However a more regular treatment regimen was used in the more successful approach – 5 days per week for 2 weeks compared to just 2 days per week for 6 weeks. 83 A more positive pain reduction outcome was observed with time (ES EOT =0.4 becomes 1.1 by 6 weeks; VAS), correlating with the statistically significant increases in femoral cartilage thickness (ES MedialCartilage =0.7 becomes 1.1 by 6 weeks). In the study by Ekici and Ordahan, no significant change in cartilage thickness was observed when performing treatments at just 5W/cm 2 biostimulatory power settings 3x/wk for patients with knee osteoarthritis. 84 Still, the HILT effectively reduced pain in a statistically significant fashion for these patients and this reduction in pain was sustained and apparent at measures made at 3 months post-cessation of treatment. All told, the summary results support that it is best to perform at least daily ≥ 10W/cm 2 treatment regimens to increase the chance of stimulating cartilage growth with sustained outcomes. Most impressively, the sizes of partial tear rotator cuff tears (PTRCT) were significantly decreased with a large effect after treating patients with hemiplegic shoulder pain using HILT compared to controls in a study performed by Korkmaz et al., which utilized 8W/cm 2 administered 3x/wk for 3wks (ES PTRCT =0.9). 48 These results clearly indicate that the high-powered laser can stimulate tendon growth. Another study demonstrated that HILT treatment (5W/cm 2 ) effectively reduced inflammation of supraspinatus tendons in patients with subacromial impingement syndrome. 46 Based on the summary data, knee arthropathies and injuries would appear poised to be the next indication most likely to be recognized in consensus guidelines and paid for by insurance companies. This indication has the greatest current cumulative data with consistently positive outcomes. Not only does knee arthropathy clearly respond favorably to high-powered laser PBMT as concluded from this meta-analysis, but The American Academy of Orthopedic Surgeons (AAOS) now recommends laser therapy in its latest recommendations for the non-arthroplasty treatment of osteoarthritis of the knee joint to “improve pain and function. 30 Investigators point out that patients should expect to experience improvements in pain and function with the treatment and significantly, there have been no reports of serious side effects from laser treatment for pain control. 85 A 2022 meta-analysis focused on laser PBMT for treating KOA reached the same conclusion that summary data indicates high-powered laser PBMT works for relieving pain and stiffness in KOA, especially when combined together with exercise therapy and using higher powers. 7 CONCLUSION Our meta-analysis data supports that high-powered laser photobiomodulation therapy is a consistently effective and exceptionally safe treatment approach for reducing pain and stimulating sustained recovery for a wide range of indications that generally involve musculoskeletal joint-related pathologies, nerve-associated pathologies, wounds, and endometriosis. More controlled trials are needed to further establish consensus guideline treatment recommendations and gain recognition by payers for knee arthropathies and an expanding variety of indications. Declarations Competing Interests WTP was supported by compensation from Aspen Laser, LLC. CEV is the CEO of Aspen Laser and has issued and pending patents. Supplementary Materials Supplementary file contains Table S1 and S2. Funding Information WTP was supported by compensation from Aspen Laser, LLC. Author’s Contributions CEV and WTP conceived and contributed to the study design. WTP performed analysis. Both authors contributed to, reviewed, and approved the article. Acknowledgements We thank and gratefully acknowledge Anthony Murawski and Thomas A. Hertel, MSPT for critical reading, critique, and analysis of the manuscript. References Photobiomodulation (PBM) research - a comprehensive database. 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Lasers Surg Med 48:343–349 Wang X et al (2017) Up-regulation of cerebral cytochrome-c-oxidase and hemodynamics by transcranial infrared laser stimulation: A broadband near-infrared spectroscopy study. J Cereb Blood Flow Metab 37:3789–3802 Wang X, Wanniarachchi H, Wu A, Gonzalez-Lima F, Liu H (2021) Transcranial photobiomodulation and thermal stimulation induce distinct topographies of EEG alpha and beta power changes in healthy humans. Sci Rep 11:18917 Additional Declarations The authors declare potential competing interests as follows: Both authors were supported by Aspen Lasers, LLC. CEV is the CEO of Aspen Laser and has issued and pending patents. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4813995","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":332586985,"identity":"f93e711e-4c23-4d93-b2aa-abdfd53d2322","order_by":0,"name":"William Todd Penberthy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYLACxgYGBn4QI6GAGOVsUC2SDSAtBqRoMTgA4hGjxeB+78HHhTts8o3Pr0788MCAQZ5f7AABLcf4ko1nnkmz3Hbj7WYJoMMMZ85OwK/F7BiPmTRv22EDsxtnN4C0JBjcJqzF/Ddv238D4xlnN/8gVosZM2/bAQMD/t5txNlifywvWZr3TLKBxA3ebRYJBhKE/SLZfPbgZ94ddgb8/Wc33/xRYSPPL01ACwMDD5SWAKuUIKQcWQv/AWJUj4JRMApGwUgEAJ77Qw/nkIG6AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-1048-1816","institution":"CME Scribe, LLC","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"William","middleName":"Todd","lastName":"Penberthy","suffix":""},{"id":332586986,"identity":"a7fdcacd-c0d0-426e-8706-8686bd384de0","order_by":1,"name":"Charles E. Vorwaller","email":"","orcid":"","institution":"Aspen Lasers, LLC","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Charles","middleName":"E.","lastName":"Vorwaller","suffix":""}],"badges":[],"createdAt":"2024-07-27 16:55:21","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4813995/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4813995/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61811047,"identity":"f596bd46-b3e5-4b10-b9a5-f02f3deb066d","added_by":"auto","created_at":"2024-08-05 20:23:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51784,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart indicating the screening and searching process.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4813995/v1/bad5b3ee73e015c63c25455a.png"},{"id":61809439,"identity":"6dabade4-5096-46ae-88b3-445466d0410b","added_by":"auto","created_at":"2024-08-05 20:15:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":348596,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plots of HILT-dependent effect sizes (ES) on pain VAS along with 95% confidence intervals for patients with specific diagnosis categorically involving knee (A), shoulder/arm (B), or spine/back (C). \u003c/strong\u003eEnd of treatment (EOT) and extended follow-ups are shown in knee studies. Bold type indicates purely ±HILT ES, while other studies compare HILT to alternative treatment protocols as noted (ET, exercise therapy; CPT, conventional physical therapy; OA, osteoarthritis; US, ultrasound). The average ES per anatomical category is indicated by the diamond at the bottom based on the average of EOT outcome measures, not extended follow-up times. Dashed lines separate studies for the knee to show EOT outcomes at extended follow-ups within studies. US, ultrasound.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4813995/v1/3982c03eabff17ff25d0e095.png"},{"id":61811788,"identity":"fdd0a40f-ee44-4b1b-b4c6-2b4becb7a927","added_by":"auto","created_at":"2024-08-05 20:31:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2568687,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4813995/v1/db2f9511-b663-4149-90df-2c31385898a7.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: Both authors were supported by Aspen Lasers, LLC. CEV is the CEO of Aspen Laser and has issued and pending patents.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe Importance of Power in Photobiomodulation, a Systematic Review and Meta-analysis of High Intensity Laser Therapy\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSince the inception of photobiomodulation therapy (PBMT) over 50 years ago, PBMT has primarily been used to treat shallow tissue pathologies (\u0026lt; 1cm deep) using low-powered light that is less than 500 mW. Numerous therapeutic successes and countless basic science studies have undeniably demonstrated the advantageous properties and clinical benefits of PBMT for a growing range of shallow tissue pathological indications. However, when attempting to treat deeper tissue pathologies, the lower-powered approaches have consistently failed to yield positive results due to the light's inability to penetrate the deeper pathological tissues.\u003csup\u003e1,2\u003c/sup\u003e Over the past two decades, since the first FDA approval of higher-powered coherent laser therapy in the range of 1–80 watts (W), numerous studies investigating higher powers for the treatment of deep tissue pathologies have demonstrated positive outcomes for the same indications.\u003csup\u003e3–10\u003c/sup\u003e This is commonly referred to as high-intensity laser therapy (HILT). The full range of indications that respond positively to HILT is currently in a discovery phase of research and an area of focus for this meta-analysis. Our meta-analysis is accompanied by our review highlighting pioneering firsts in HILT clinical research, both historical and ongoing.\u003c/p\u003e\n\u003ch3\u003ePBMT Discovery, Acceptance, and the General Limitations of LLLT to Treating Shallow Tissue Pathologies Only\u003c/h3\u003e\n\u003cp\u003ePBMT was initially discovered in 1967 when increased hair growth was observed in shaved mice irradiated with red light in an attempt to determine its carcinogenic properties, which it did not.\u003csup\u003e11\u003c/sup\u003e Thereafter in the early 1970s, PBMT was then evaluated in clinical settings by Andrew and Adam Mester in patients with recalcitrant non-healing leg ulcers.\u003csup\u003e12\u003c/sup\u003e Treatment with just 10 mW of 630nm wavelength light from a helium neon laser resulted in a remarkable complete recovery in 823 out of 1,018 patients (81.4%), with only 23 patients showing no change.\u003csup\u003e13\u003c/sup\u003e Almost 74% of patients who had qualified as non-healing for an average of 5.1 years were healed, on average, within 5.5 months of therapy. These impressive outcomes highlight the urgency of using PBMT, particularly considering that the 5-year mortality rate for patients with diabetic and ischemic foot ulcers is higher than that of several cancers, including prostate and breast cancer.\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe steady rise in recognition of PBMT was accelerated exponentially by the development of the \"NASA LED\" in the NASA Space Medicine laboratory of Professor Harry Whelan in 1998.\u003csup\u003e15\u003c/sup\u003e This innovative technology made PBMT more affordable, accessible, and energy efficient, thereby making it more widely available for at-home therapies.\u003c/p\u003e \u003cp\u003e By 2020, for the first time in the history of photobiomodulation therapy medicine, clearly therapeutically beneficial outcomes for the treatment of oral mucositis culminated in acceptance at all levels. This ranges from physician consensus-recommended treatment guidelines to recognition by insurance payers using low powers in the range of 25–150 mW to deliver photobiomodulation therapy.\u003csup\u003e16,17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, it is important to note that the efficacy of low-level laser therapy (LLLT; low power) in treating oral mucositis is limited to shallow tissue pathologies of less than 2 cm. Evaluation of low-powered PBMT with powers below 500 mW for the treatment of \u003cem\u003edeeper\u003c/em\u003e musculoskeletal pathologies have consistently failed to produce positive outcomes.\u003csup\u003e18–23\u003c/sup\u003e Rigorous analysis revealed that LLLT cannot penetrate tissues beyond 2 cm, which is an insufficient depth for delivering therapeutic light intensities to the \u003cem\u003edeeper\u003c/em\u003e tissue pathologies occurring in most musculoskeletal arthropathies.\u003csup\u003e24–26\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eHigh Powered Lasers Confer Benefits to Deep Tissue Pathologies\u003c/h2\u003e \u003cp\u003eOn the other hand, high-intensity laser therapy (HILT; higher power) used in clinical practice can penetrate deeply into tissues to deliver effective levels of photobiomodulation therapy. Research by Morries et al. demonstrated that a 15W laser with a 7 cm\u003csup\u003e2\u003c/sup\u003e spot size can penetrate 3 cm (1.2 inches) of tissue while maintaining an established therapeutically active power density of approximately 50 mW/cm\u003csup\u003e2\u003c/sup\u003e.\u003csup\u003e24\u003c/sup\u003e As a result, the use of an 80W laser enables the delivery of therapeutic doses of PBMT to tissues as deep as 15 cm (6 inches) .\u003csup\u003e7,27\u003c/sup\u003e Multiple independent studies have shown that HILT consistently produces positive outcomes, particularly in the treatment of knee osteoarthritis (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This approach has the potential to prevent total knee arthroplasty, ultimately saving approximately \u003cspan\u003e$\u003c/span\u003e29,488 per procedure based on a 2018 cost analysis.\u003csup\u003e28\u003c/sup\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe FDA class IV device designation encompasses \u003cem\u003etherapeutic\u003c/em\u003e lasers since it continues to be generally defined by powers as low as 500mW even though the class IV designation has historically been used to \u003cem\u003eprimarily\u003c/em\u003e refer to \u003cem\u003esurgical\u003c/em\u003e lasers, which use \u003cem\u003ehigher\u003c/em\u003e powers (e.g., 100-300W) and \u003cem\u003elonger\u003c/em\u003e wavelengths (e.g.,10,600nm CO\u003csub\u003e2\u003c/sub\u003e lasers or 2,940nm Er: YAG lasers) than \u003cem\u003etherapeutic\u003c/em\u003e lasers. This \u003cem\u003eSurgical\u003c/em\u003e laser light is highly absorbed by water to cause flash-boiling, ablation, or carbonization. By contrast, HILT light is not appreciably absorbed by water due to shorter 800-1064nm wavelengths and lower power settings commonly ranging from 2-30W, which impart nondestructive \u003cem\u003etherapeutic\u003c/em\u003e cellular activities in a painless fashion.\u003csup\u003e2\u003c/sup\u003e To make matters even more complicated, a 50W CO\u003csub\u003e2\u003c/sub\u003e \u003cem\u003esurgical\u003c/em\u003e laser becomes a \u003cem\u003etherapeutic\u003c/em\u003e light when the spot size is defocused to a 10cm\u003csup\u003e2\u003c/sup\u003e.\u003csup\u003e2\u003c/sup\u003e So, spot size matters as the light spot size can ultimately control whether a light is \u003cem\u003esurgical\u003c/em\u003e or \u003cem\u003etherapeutic\u003c/em\u003e and this also controls the depth of penetration for a therapeutic light source of fixed wavelength and collimation. Finally, the power density (irradiance; W/cm\u003csup\u003e2\u003c/sup\u003e) is the most informative parameter for a given wavelength as related to these surgical⌠therapeutic modalities and depths of penetration.\u003c/p\u003e \u003cp\u003eThe FDA only recognized clearance for class IV \u003cem\u003etherapy\u003c/em\u003e laser devices as recently as 2002.\u003csup\u003e29\u003c/sup\u003e Several medical associations have recommended high-powered photobiomodulation therapies. In 2021, The American Academy of Orthopedic Surgeons began recommending laser therapy for the treatment of osteoarthritis of the knee joint.\u003csup\u003e30\u003c/sup\u003e The American College of Physicians issued a guideline for treating non-radicular low back pain with PBMT starting in 2017.\u003csup\u003e31\u003c/sup\u003e The American Physical Therapy Association Orthopedic Section began issuing PBMT treatment recommendations for heel pain plantar fasciitis, neck pain, and Achilles tendinitis.\u003csup\u003e32–34\u003c/sup\u003e The World Health Organization now recommends laser therapy and its photobiomodulation benefits for neck pain.\u003csup\u003e35\u003c/sup\u003e The list of recommended treatment indications continues to expand.\u003c/p\u003e \u003cp\u003ePhotobiomodulation therapy has been established and accepted at all levels for treating shallow tissue pathologies. However, the most commonly used power settings have been limited to lower powers (≤ 500mW; class III), which have generally failed to produce positive outcomes when treating deep tissue pathologies (\u0026gt; 2 cm). By using high-powered (1-80W) laser PBMT, positive outcomes have been repeatedly achieved due to the ability of high-powered lasers to penetrate depths of up to 15 cm.\u003csup\u003e24,27,36\u003c/sup\u003e More medical professionals in numerous fields of study are becoming aware of the possibilities of using higher-powered laser PBMT to reach deeper tissues.\u003c/p\u003e \u003cp\u003eThe primary objective of this meta-analysis was to assess the sum categorical efficacy of high-powered laser PBMT for any categorical indication as published in \u003cem\u003econtrolled\u003c/em\u003e clinical trials. This includes considering outcome metrics such as pain reduction, range of motion increases, functionality improvements, quality of life improvements, wound closures, neurophysiological measures, or others. The secondary objective was to perform a summary analysis of the optimal laser parameters (power settings, dosages, and wavelengths) and treatment plans used in the currently limited available controlled trials. Accordingly, a suggested summary table of optimal laser parameters and treatment plans is offered at the end of the \u003cspan refid=\"Sec9\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n "},{"header":"METHODS","content":"\u003ch2\u003eSearch for Evidence and Article Selection\u003c/h2\u003e\n\u003cp\u003eThis study adheres to all PRISMA guidelines and provides the required information accordingly. We conducted a systematic review of the best evidence using Cochrane guidelines. The structured question for this review is displayed in \u003cstrong\u003eFig.\u0026nbsp;1\u003c/strong\u003e. We searched the most important and appropriate electronic medical databases, including PubMed, Cochrane Library, and Google Scholar. The search terms used were \"laser\" and (\"photobiomodulation\" or \"therapy\") and \"high\" and \"patients,\" excluding any articles related to surgery, limited to the years 2018 to March 2024, and focused on clinical trials. Articles that were deemed irrelevant to the research objectives were excluded. After collecting the full texts of articles related to the study's objectives, we reviewed the references of these articles and identified additional relevant references for review\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) controlled clinical trial studies, (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) published between 2018 and November 2023, (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) use of higher powered lasers with average power settings\u0026thinsp;\u0026gt;\u0026thinsp;0.5W, (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) patients with a medical diagnosis, (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e) comparison of higher powered lasers versus LLLT or placebo lasers or a common background, and (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e) the use of outcome measures such as pain, range of motion, quality of life, cartilage thickness, disability indices, bone density, or gait. The exclusion criteria included (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) fundamental research or studies conducted on animals, (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) controlled trials involving patients without a medical diagnosis, (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) review articles, and (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) articles lacking statistical and clinical data. For publications that only provided information on peak power, frequency, and pulse time, we calculated the average power using the formula\u003csup\u003e37\u003c/sup\u003e: average power\u0026thinsp;=\u0026thinsp;peak power x hertz frequency x pulse duration.\u003c/p\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eThe significance level was based on reported p scores\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The statistical method was designed to specifically measure the effect size (ES) attributable to HILT compared to the control group. To evaluate the magnitude of the difference between groups, we determined the effect size of each variable using Cohen's \u003cem\u003ed\u003c/em\u003e.\u003csup\u003e38,39\u003c/sup\u003e The standardized mean of group assessments made before and after treatment was divided by the pooled standard deviation.\u003c/p\u003e\n\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n\u003cdiv id=\"FileID_Equa\" class=\"mathdisplay\"\u003e$$\\:ES=\\frac{M\\:time\\:zero-M\\:follow\\:up}{SD\\:pooled}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe difference in effect sizes between the HILT and control groups was calculated by subtracting the effect size for each group, which served as a metric for determining the relative efficacy specifically attributable to HILT.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDifference in effect size\u0026thinsp;=\u0026thinsp;ES\u003csub\u003e1\u003c/sub\u003e \u0026ndash; ES\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n\u003cp\u003eInterpretation of the effect sizes was based on the values established by Cohen: small effect\u0026thinsp;\u0026le;\u0026thinsp;0.2, medium effect 0.2\u0026ndash;0.8, and large effect\u0026thinsp;\u0026gt;\u0026thinsp;0.8.\u003csup\u003e38\u003c/sup\u003e Confidence intervals for the difference of 2 means was calculated with assistance from the PEDro calculator.\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePower density (W/cm\u003csup\u003e2\u003c/sup\u003e) is the most important parameter controlling the depth of penetration at a constant wavelength, collimation, and continuous setting, but the power density parameter is often \u003cem\u003enot\u003c/em\u003e described in studies. Spot size matters. A PBMT device can become \u003cem\u003esurgical\u003c/em\u003e if the spot size is concentrated and vice versa, a \u003cem\u003esurgical\u003c/em\u003e carbon dioxide laser can become \u003cem\u003etherapeutic\u003c/em\u003e if it is defocused to a larger size.\u003csup\u003e2\u003c/sup\u003e Since the depth of penetration is a major focus of our meta-analysis, we include a description of the power density throughout our entire report whenever the spot size for the hand piece is described and can be determined in any study.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eQUALITATIVE SUMMARY OF INCLUSIVE STUDIES\u003c/h2\u003e\n \u003cp\u003eThe meta-analysis included 56 studies that fullfilled the criteria for inclusion. These studies evaluated various outcome measures such as pain, function, quality of life, range of motion, strength, and anatomical structures (Tables \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Among these studies, two were triple-blinded, 23 were double-blinded, 23 were single-blinded, 3 were not blinded, and one had an undetermined blinding status. Using the standard \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as the probability value, significant reductions in pain were found in 43 out of 47 studies. Additionally, 36 out of 39 arthropathies showed statistically significant reductions in pain.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eSummary list of all studies meeting criteria for inclusion in the meta-analysis.\u003c/strong\u003e Studies are categorized by target anatomies towards consideration of the relative depth of penetration respectively: knee, spine/back, shoulder/arm, face, hand/wrist, foot, wounds, gynecological, bone, and COVID-19. Single, double, or triple blinded are denoted by numbers 1\u0026ndash;3. HILT specific outcomes are described with effective pain reduction, range of motion (ROM) increases, quality of life (QoL) increases, or functional gains after HILT treatment denoted as positive (+) or negative (-) when assessed.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eKNEE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;ROM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;QoL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Function\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAhmad\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Malaysia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37511894\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced (NPRS scale)\u003c/p\u003e\n \u003cp\u003eFlexion reduced\u003c/p\u003e\n \u003cp\u003eLLLT had clinically insignificant outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkaltun\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e33074393\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003e(VAS \u0026amp; WOMAC)\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eCartilage thickness increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBettancourt\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Portugal)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eJ.Arthritis\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced at EOT and 1mo after cessation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEkici\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee OA\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37743421\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eCartilage thickness increased\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEl-Shamy\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemophilic Arthropathy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e27976591\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eGait performance improved\u003c/p\u003e\n \u003cp\u003eFunctional improvements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEl-Shamy\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eJuvenile Rheumatoid Arthritis\u003c/p\u003e\n \u003cp\u003eEgypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30016193\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eGate improved\u003c/p\u003e\n \u003cp\u003e(GAITRite)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMostafa\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34986012\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eGate improved\u003c/p\u003e\n \u003cp\u003e(WOMAC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNazari\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30178432\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eStiffness in knee reduced\u003c/p\u003e\n \u003cp\u003e(WOMAC stiffness)\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNouri\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePatellofemoral Pain Syndrome\u003c/p\u003e\n \u003cp\u003e(Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31360367\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eFunctionality improved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSamaan\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Egypt) \u003cspan class=\"Underline\"\u003e35678062\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eFunction improved\u0026nbsp;(WOMAC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSiriratna\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Thailand)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36313402\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eFunctional ability was unchanged\u003c/p\u003e\n \u003cp\u003e(WOMAC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTaheri\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee osteoarthritis (Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eMEJRH-134330\u003c/span\u003e; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eFunctional ability improved\u003c/p\u003e\n \u003cp\u003e(WOMAC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWibisono\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreater increase in balance in the HILT group than LLLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eSPINE/BACK\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;ROM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;QoL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Function\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelbassett\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic lower back pain (Saudi Arabia \u0026amp; Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e33178306\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eDisability reduced\u003c/p\u003e\n \u003cp\u003eLumbar mobility improved\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eQoL improved (EroQoL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelmageed\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic Discogenic Sciatica (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003elink\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eIncreased walking distance\u003c/p\u003e\n \u003cp\u003eIncreased leg ROM\u003c/p\u003e\n \u003cp\u003eIncreased spinal neuron activity\u003c/p\u003e\n \u003cp\u003ePotential recovery from conduction block\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAhi\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyofascial pain syndrome (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36538189\u003c/span\u003e 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eDisability reduced (NDI)\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eQoL improved (SF-36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChatterjee\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePeripheral neuropathy, lumbar (India)\u003c/p\u003e\n \u003cp\u003e31405365; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced more by HILT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChen\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLumbar disc protrusion (China)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e28854500\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eDisability reduced (ODI)\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGawaan\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyofascial pain syndrome post-neck discectomy (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eThe Egyptian Journal of Hospital Medicine\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e(2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003ePressure pain threshold increased\u003c/p\u003e\n \u003cp\u003eNeck ROM increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInce\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eNeck pain\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37204965\u003c/span\u003e ; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eCervical ROM increased\u003c/p\u003e\n \u003cp\u003eDisability (NDI) reduced\u003c/p\u003e\n \u003cp\u003eQoL (SF-36) increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKenareh\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic neck pain\u003c/p\u003e\n \u003cp\u003e(Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34733743\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShort term pain relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSherif\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical Radiculopathy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eMedical Journal of Cairo University\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain was reduced\u003c/p\u003e\n \u003cp\u003eElectrophysiological measures were unchanged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVenosa\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical Spondylosis (Italy)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30443883\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eDisability (NDI) reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYilmaz\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical disc herniation (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32147037\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eQoL improved\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eSHOULDER/ARM\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;ROM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;QoL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Function\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelhakiem\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemiplegic shoulder (Egypt)\u003c/p\u003e\n \u003cp\u003e38538637; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced, functional ability improved, and handgrip strength increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAceituno-G\u0026oacute;mez\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial impingement (Spain)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30672303\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain unchanged\u003c/p\u003e\n \u003cp\u003eDisability (CMS score) unchanged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtan\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdhesive capsulitis (frozen shoulder (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32808147\u003c/span\u003e 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eQoL improved\u003c/p\u003e\n \u003cp\u003eFunctional ability (SPADI) unchanged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElsodany\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eRotator Cuff Tendinopathy\u003c/p\u003e\n \u003cp\u003e(Egypt \u0026amp; Saudi Arabia) \u003cspan class=\"Underline\"\u003e30188253\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eboth at EOT \u0026amp; 3mos post-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaraca\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral sylitis\u0026nbsp; (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36117204\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eGrip strength increased\u003c/p\u003e\n \u003cp\u003eHand function increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaydock\u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral epicondylitis\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32637921\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eHand grip strength increased\u003c/p\u003e\n \u003cp\u003eQoL (SF-36) increased\u003c/p\u003e\n \u003cp\u003eFunction (QDASH) increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKorkmaz\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemiplegic Shoulder Pain (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e33829317\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eDisability index (SPADI) decreased\u003c/p\u003e\n \u003cp\u003eMotor recovery improved\u003c/p\u003e\n \u003cp\u003eQoL (NHP) improved\u003c/p\u003e\n \u003cp\u003eFunctional (FIM) improved\u003c/p\u003e\n \u003cp\u003eRotator cuff tear size reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e32\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdhesive capsulitis\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37533657\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eDisability index (SPADI) decreased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYilmaz\u003csup\u003e33\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial Impingement Syndrome\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e33400012; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased\u003c/p\u003e\n \u003cp\u003eFunction (CMS) increased\u003c/p\u003e\n \u003cp\u003eQoL (SF-36) improved\u003c/p\u003e\n \u003cp\u003eStrength increased\u003c/p\u003e\n \u003cp\u003eDaily activity increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSen\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral epicondylitis (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e38280938\u003c/span\u003e; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eDisability improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZaki\u003csup\u003e35\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial impingement syndrome(Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34184965\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eFunction (SPADI) improved\u003c/p\u003e\n \u003cp\u003eUltrasound (MSKUS) improvements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eFACE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;ROM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;QoL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Function\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdullatif\u003csup\u003e36\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBell\u0026rsquo;s Palsy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncreased eyebrow raising\u003c/p\u003e\n \u003cp\u003eIncreased smiling ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEkici\u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyogenic temporomandibular joint disorder\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34174507\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eROM increased in jaw\u003c/p\u003e\n \u003cp\u003eFunctional disability reduced\u003c/p\u003e\n \u003cp\u003eImproved QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElkallah\u003csup\u003e38\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic sinusitis\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32904078\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSymptomatic improvements (SNOT-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNadershah\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eTemporomandibular joint disorder\u003c/p\u003e\n \u003cp\u003e(Saudi Arabia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31988570\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWu\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBell\u0026rsquo;s Palsy\u003c/p\u003e\n \u003cp\u003e(China)\u003c/p\u003e\n \u003cp\u003e37738368; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImproved facial grades\u003c/p\u003e\n \u003cp\u003eImproved electrophysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAND/WRIST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdel-aal\u003csup\u003e41\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHand OA in SLE\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32638614\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eSwelling reduced\u003c/p\u003e\n \u003cp\u003eTenderness reduced\u003c/p\u003e\n \u003cp\u003eGrip strength increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCantero-Tellez\u003csup\u003e42\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThumb OA\u003c/p\u003e\n \u003cp\u003e(Spain \u0026amp; USA)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31807782\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAhi\u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eDe Quervain\u0026rsquo;s Tenosynovitis, thumb (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36974441\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eHand grip strength increased\u003c/p\u003e\n \u003cp\u003eQoL (SF-36) increased\u003c/p\u003e\n \u003cp\u003eFunction (QDASH) increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEzzati\u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCarpal tunnel syndrome (Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31742366\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT was superior to LLLT:\u003c/p\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eElectrophysiological measures\u003c/p\u003e\n \u003cp\u003e(CMAP \u0026amp; sensory nerve conduction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChongkriengkrai\u003csup\u003e45\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ede Quervain\u0026rsquo;s tenosynovitis\u003c/p\u003e\n \u003cp\u003e(Thailand)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37783935\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain unchanged\u003c/p\u003e\n \u003cp\u003eHand grip strength unchanged\u003c/p\u003e\n \u003cp\u003eDisability\u003c/p\u003e\n \u003cp\u003eSeveral AEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eFOOT\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;ROM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;QoL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Function\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBidoki\u003csup\u003e46\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciitis\u003c/p\u003e\n \u003cp\u003e(Iran)\u003c/p\u003e\n \u003cp\u003e38584653; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30W 980nm\u003c/p\u003e\n \u003cp\u003e8J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElnagger\u003csup\u003e47\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemophilic A ankle arthropathy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31628558\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced\u003c/p\u003e\n \u003cp\u003eGait improved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNaruseviciute\u003csup\u003e48\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciitis (Lithuania)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32513018\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo statistical difference in pain\u003c/p\u003e\n \u003cp\u003eLaser more effective than LLLT in the opinion of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e49\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciitis\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29627888\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain reduced (VAS)\u003c/p\u003e\n \u003cp\u003eFunction improved\u003c/p\u003e\n \u003cp\u003eQoL improved\u003c/p\u003e\n \u003cp\u003e(Laser all more than LLLT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYesil\u003csup\u003e50\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCalcaneal spur\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31478095\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain unchanged\u003c/p\u003e\n \u003cp\u003eQoL unchanged\u003c/p\u003e\n \u003cp\u003eFunction (FAOS) unchanged\u003c/p\u003e\n \u003cp\u003eImproved pedographic measures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWOUNDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLu\u003csup\u003e51\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic Refractory Wounds\u003c/p\u003e\n \u003cp\u003e(China)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34253665\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprovement in Bates-Jensen Wound Assessment Tool (BWAT)\u003c/p\u003e\n \u003cp\u003eImprovement in Pressure Ulcer Scale for Healing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThabet\u003csup\u003e52\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCaesarian Healing in diabetic women\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29706708\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound appearance improved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGYNECOLOGICAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThabet\u003csup\u003e53\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eEndometriosis\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29668354\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain and adhesions reduced\u003c/p\u003e\n \u003cp\u003eImproved QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBONE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlayat\u003csup\u003e54\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eOsteoporosis\u003c/p\u003e\n \u003cp\u003e(Saudi Arabia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29068756\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLumbar bone mineral density improved and sustained for 1y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eBlinding \u0026minus;\u0026thinsp;0, unblinded: 1, single-blinded; 2, double-blinded; 3, triple blinded; U - unknown. (+) significantly positive outcome, (-) no apparent benefit, NA - not applicable/not measured. Pain measures are all VAS-based unless noted. ROM - range of motion. QoL - quality of life.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaser parameters, treatment plan, and study design with follow-up sorted from highest to lowest positive effect size outcomes.\u003c/strong\u003e Panels are categorized by knee, spine/back, shoulder/arm, face, hand/wrist, foot, wounds, gynecologic, or bone. Table only includes studies for which effect sizes could be calculated from the available data as statistically presented.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eCOVID-19\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHILT Specific Outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Lung indices\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;ICU admission\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Mortality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;Taste restoration\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShabaan\u003csup\u003e55\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCOVID-19 Loss of taste (ageusia)\u003c/p\u003e\n \u003cp\u003e37149582; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplete taste restoration after laser\u003c/p\u003e\n \u003cp\u003e94% vs 61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVetrici\u003csup\u003e56\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCOVID-19 pneumoniae\u003c/p\u003e\n \u003cp\u003e(Canada)33776469\u003c/p\u003e\n \u003cp\u003e33776469; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImproved lung function\u003c/p\u003e\n \u003cp\u003eReduced ICU admissions\u003c/p\u003e\n \u003cp\u003eRapid recovery\u003c/p\u003e\n \u003cp\u003eReduced mortality\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabf\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eKNEE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLaser\u003c/p\u003e\n \u003cp\u003eSettings\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy Design\u003c/p\u003e\n \u003cp\u003eFU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEl-Shamy\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eJuvenile Rheumatoid Arthritis (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30016193\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W 52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e750J/knee/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNazari\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Iran) \u003cspan class=\"Underline\"\u003e30178432\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4W spot size?\u0026nbsp;30Hz\u003c/p\u003e\n \u003cp\u003e2100J/session\u003c/p\u003e\n \u003cp\u003eE20780 - laser YAG HT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEl-Shamy\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemophilic Arthropathy\u003c/p\u003e\n \u003cp\u003e(Egypt) \u003cspan class=\"Underline\"\u003e27976591\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W (52.5W/cm\u003csup\u003e2\u003c/sup\u003e) 120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e750J/knee/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e12wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSamaan\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Egypt) \u003cspan class=\"Underline\"\u003e35678062\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12W (12W/cm\u003csup\u003e2\u003c/sup\u003e) 25Hz\u003c/p\u003e\n \u003cp\u003e300J/analgesic or 3000J/biostimulation BTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e2wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBettancourt\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Portugal)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eJ.Arthritis\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30W (30W/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003ePulsed \u0026amp; Continuous\u003c/p\u003e\n \u003cp\u003e6J and 80J\u003c/p\u003e\n \u003cp\u003e(BTL industries?)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvery other day\u003c/p\u003e\n \u003cp\u003e14x total\u003c/p\u003e\n \u003cp\u003e2wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSiriratna\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Thailand)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36313402\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1W (0.5W/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003e2000Hz\u003c/p\u003e\n \u003cp\u003e560J/session\u003c/p\u003e\n \u003cp\u003eMphi laser device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2-3x/wk\u003c/p\u003e\n \u003cp\u003e10x total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAhmad\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Malaysia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37511894\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5W\u003c/p\u003e\n \u003cp\u003e5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e190J pulsed \u0026amp; 3000J CW\u003c/p\u003e\n \u003cp\u003eBTL-6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1x/wk\u003c/p\u003e\n \u003cp\u003e12wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILTvLLLT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkaltun\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Turkey) \u003cspan class=\"Underline\"\u003e33074393\u003c/span\u003e 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12W (12W/cm\u003csup\u003e2\u003c/sup\u003e2) 25Hz\u003c/p\u003e\n \u003cp\u003e300J/analgesic session \u0026amp; 3000J/biostimulation session\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5X/wk\u003c/p\u003e\n \u003cp\u003e2wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026plusmn;HILT\u003c/p\u003e\n \u003cp\u003e6wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTaheri\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Iran) \u003cspan class=\"Underline\"\u003eMEJRH-134330\u003c/span\u003e; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2W\u003c/p\u003e\n \u003cp\u003e500J\u003c/p\u003e\n \u003cp\u003eLumix CPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e2wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMostafa\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34986012\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e1500mJ/cm\u003csup\u003e2\u003c/sup\u003e/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v Shock Wave Therapy\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEkici\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee OA\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37743421\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10W \u0026amp; 5W\u003c/p\u003e\n \u003cp\u003e10W/cm\u003csup\u003e2\u003c/sup\u003e/Analgesic \u0026amp; 5W/cm\u003csup\u003e2\u003c/sup\u003e/Biostimulatory\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWibisono\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee OA (Indonesia)\u003c/p\u003e\n \u003cp\u003eMedico Hospitalia; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10W 2m \u0026ndash; analgesic phase\u003c/p\u003e\n \u003cp\u003e10W 4m \u0026ndash; biostimulatory phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v LLLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabg\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eSpine/Back\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLaser\u003c/p\u003e\n \u003cp\u003eSettings\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy Design\u003c/p\u003e\n \u003cp\u003eFU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVenosa\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical Spondylosis (Italy)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30443883\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s, 10-30Hz\u003c/p\u003e\n \u003cp\u003e2050J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e6wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT\u0026thinsp;+\u0026thinsp;ET v US\u0026thinsp;+\u0026thinsp;TENS\u0026thinsp;+\u0026thinsp;ET\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSherif\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical Radiculopathy (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eMedical Journal of Cairo University\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2W \u0026amp; 4W\u003c/p\u003e\n \u003cp\u003e980nm 4Hz\u003c/p\u003e\n \u003cp\u003e840J/session\u003c/p\u003e\n \u003cp\u003eLevelLaser EZ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInce\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eNeck pain (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37204965\u003c/span\u003e ; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e2632J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003e12wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelbassett\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic lower back pain (Saudi Arabia \u0026amp; Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e33178306\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003cp\u003e12W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e1200J/session\u003c/p\u003e\n \u003cp\u003eBTL000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/wk\u003c/p\u003e\n \u003cp\u003e12wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGawaan\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyofascial pain syndrome post-neck discectomy (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003eThe Egyptian Journal of Hospital Medicine\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e(2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14W\u003c/p\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003cp\u003epulsed\u003c/p\u003e\n \u003cp\u003e2803J/session\u003c/p\u003e\n \u003cp\u003eDevice Omega\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelmageed\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic Discogenic Sciatica (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003elink\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1W/cm2\u003c/p\u003e\n \u003cp\u003e810nm\u0026thinsp;+\u0026thinsp;980nm\u003c/p\u003e\n \u003cp\u003e400J/session\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKenareh\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic neck pain (Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34733743\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10W 3m\u003c/p\u003e\n \u003cp\u003eThen 7W 7m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/d 2wks\u003c/p\u003e\n \u003cp\u003e10x total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v US\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChen\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLumbar disc protrusion(China)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e28854500\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003cp\u003e12W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e7500J/session\u003c/p\u003e\n \u003cp\u003eBTL600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e2wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026plusmn;HILT\u0026thinsp;+\u0026thinsp;Spinal decompression\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChatterjee\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePeripheral neuropathy, lumbar (India)\u003c/p\u003e\n \u003cp\u003e31405365; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W 5.3W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e980nm:810nm at 80%:20%\u003c/p\u003e\n \u003cp\u003e1920J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk 4wks\u003c/p\u003e\n \u003cp\u003e1x/wk 8wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v Sham\u003c/p\u003e\n \u003cp\u003e+standard of care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAhi\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyofascial pain syndrome (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36538189\u003c/span\u003e 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W\u003c/p\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e?J\u003c/p\u003e\n \u003cp\u003eBT6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;+\u0026thinsp;PT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t have raw data, but (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYilmaz\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCervical disc herniation (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32147037\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W\u003c/p\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e1850J/session\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabh\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSHOULDER/ARM\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eLaser\u003c/p\u003e\n \u003cp\u003eSettings\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy Design\u003c/p\u003e\n \u003cp\u003eFU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaraca\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral epicondylitis\u003c/p\u003e\n \u003cp\u003e(arthropathy) (Turkey)\u003cspan class=\"Underline\"\u003e36117204\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e4W and 6W\u003c/p\u003e\n \u003cp\u003e13-20W/cm2\u003c/p\u003e\n \u003cp\u003e6J/cm\u003csup\u003e2\u003c/sup\u003e analgesic \u0026amp; 12J/cm\u003csup\u003e2\u003c/sup\u003e biostimulation\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2x/wk\u003c/p\u003e\n \u003cp\u003e2wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT\u0026thinsp;+\u0026thinsp;ESWT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElsodany\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eRotator Cuff Tendinopathy (Egypt \u0026amp; Saudi Arabia) \u003cspan class=\"Underline\"\u003e30188253\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePower? 10.5W?\u003c/p\u003e\n \u003cp\u003e2050J per session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdelhakiem\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemiplegic shoulder pain after stroke\u003c/p\u003e\n \u003cp\u003e38538637; 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e3x 8W 75s 100J\u003c/p\u003e\n \u003cp\u003e6x 12W 30s\u003c/p\u003e\n \u003cp\u003eITO (LAZR-207)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003e1wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtan\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdhesive capsulitis (frozen shoulder; (arthropathy) (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32808147;\u003c/span\u003e 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e8, 12, 8W\u003c/p\u003e\n \u003cp\u003e100J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eiLux\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003e3mos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZaki\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial impingement syndrome\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34184965\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e4W\u003c/p\u003e\n \u003cp\u003e5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e2050J/session\u003c/p\u003e\n \u003cp\u003eZimmer Opton\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e7 sessions total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLLL-KT, HPL-KT, \u0026amp; sham-KT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo not have raw data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdhesive capsulitis\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37533657\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003cp\u003e12W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e10J/cm\u003csup\u003e2\u003c/sup\u003e/analgesic \u0026amp; 100J/cm\u003csup\u003e2\u003c/sup\u003e/biostimulatory\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT\u0026thinsp;\u0026plusmn;\u0026thinsp;stretchin\u0026thinsp;+\u0026thinsp;ET\u003c/p\u003e\n \u003cp\u003ev LLLT\u0026thinsp;\u0026plusmn;\u0026thinsp;stretchin\u0026thinsp;+\u0026thinsp;ET\u003c/p\u003e\n \u003cp\u003e3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKorkmaz\u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemiplegic Shoulder Pain\u003c/p\u003e\n \u003cp\u003e(arthropathy) (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e33829317\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e8W\u003c/p\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e300J/analgesic session \u0026amp; 2500J/biostimulatory session\u003c/p\u003e\n \u003cp\u003eBTL600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYilmaz\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial Impingement Syndrome\u003c/p\u003e\n \u003cp\u003e(arthropathy) (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e334000012\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e40Hz\u003c/p\u003e\n \u003cp\u003e2781J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAceituno-G\u0026oacute;mez\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial impingement (Spain)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e30672303\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003cp\u003epulsed\u003c/p\u003e\n \u003cp\u003e250J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eiLux Laser device\u003c/p\u003e\n \u003cp\u003e(Mectronic)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003e3mos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaydock\u003csup\u003e32\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral epicondylitis\u003c/p\u003e\n \u003cp\u003e(arthropathy), (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32637921\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e6W\u003c/p\u003e\n \u003cp\u003e6W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e6J/cm\u003csup\u003e2\u003c/sup\u003e/analgesic \u0026amp; 120-150J/cm\u003csup\u003e2\u003c/sup\u003e/biostimulatory\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v LLLT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFACE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaser\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSettings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCohen\u0026rsquo;s\u003c/strong\u003e \u003cstrong\u003ed\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEkici\u003csup\u003e33\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMyogenic temporomandibular joint disorder\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34174507\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e1029J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1x/wk\u003c/p\u003e\n \u003cp\u003e15d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eWu\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBell\u0026rsquo;s Palsy (China)\u003c/p\u003e\n \u003cp\u003e37738368; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1W of 808nm\u0026thinsp;+\u0026thinsp;0.2W of 905nm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e72x total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026plusmn;HILT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAbdullatif\u003csup\u003e35\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBell\u0026rsquo;s Palsy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u0026nbsp;2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,808J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 sides of face\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eElkallah\u003csup\u003e36\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic sinusitis\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32904078\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e810nm \u0026amp; 980nm\u003c/p\u003e\n \u003cp\u003e150J/sinus\u003c/p\u003e\n \u003cp\u003eZimmer Opton Pro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNadershah\u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eTemporomandibular joint disorder\u003c/p\u003e\n \u003cp\u003e(Saudi Arabia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31988570\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7W\u003c/p\u003e\n \u003cp\u003e2.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e300J/treatment\u003c/p\u003e\n \u003cp\u003eEzlase 940 device\u003c/p\u003e\n \u003cp\u003e(Biolase Technology, Inc. California, USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvery other day\u003c/p\u003e\n \u003cp\u003e10d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAND/WRIST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAbdel-aal\u003csup\u003e38\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHand OA in SLE\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32638614\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePower?\u003c/p\u003e\n \u003cp\u003e2100J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e8wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eCantero-Tellez\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThumb OA\u003c/p\u003e\n \u003cp\u003e(Spain \u0026amp; USA)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31807782\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5W\u003c/p\u003e\n \u003cp\u003e0.3W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e800\u0026thinsp;+\u0026thinsp;970nm\u003c/p\u003e\n \u003cp\u003e2Hz 50% duty cycle\u003c/p\u003e\n \u003cp\u003e75J/session\u003c/p\u003e\n \u003cp\u003eK- Laser, Mod. K1200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAhi\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eDe Quervain\u0026rsquo;s Tenosynovitis, thumb\u003c/p\u003e\n \u003cp\u003e(Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e36974441\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e10J/cm\u003csup\u003e2\u003c/sup\u003e/analgesic \u0026amp; 120-150J/cm\u003csup\u003e2\u003c/sup\u003e/biostimulatory\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e5wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEzzati\u003csup\u003e41\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCarpal tunnel syndrome\u003c/p\u003e\n \u003cp\u003e(Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31742366\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6W\u003c/p\u003e\n \u003cp\u003e808nm\u003c/p\u003e\n \u003cp\u003e8J or 20J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/2wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v LLLT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eChongkriengkrai\u003csup\u003e42\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ede Quervain\u0026rsquo;s tenosynovitis\u003c/p\u003e\n \u003cp\u003e(Thailand)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e37783935\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W\u003c/p\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e80J/analgesic \u0026amp; 800J/biostimulatory\u003c/p\u003e\n \u003cp\u003eBTL600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSplit\u0026thinsp;+\u0026thinsp;ET\u0026thinsp;+\u0026thinsp;HILT/sham\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabi\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eFOOT\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLaser\u003c/p\u003e\n \u003cp\u003eSettings\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy Design\u003c/p\u003e\n \u003cp\u003eFU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciitis (Turkey)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29627888\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W and 6W\u003c/p\u003e\n \u003cp\u003eFirst week: 8W 6J/cm2\u003c/p\u003e\n \u003cp\u003eNext 2 weeks: 6W 120J/cm2\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHILT v LLLT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElnagger\u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHemophilic A ankle arthropathy\u003c/p\u003e\n \u003cp\u003e(Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31628558\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7W\u003c/p\u003e\n \u003cp\u003e7W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e3000J\u003c/p\u003e\n \u003cp\u003eBTL600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e8x total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNaruseviciute\u003csup\u003e45\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciitis (Lithuania)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e32513018\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e3000J\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8x/3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYesil\u003csup\u003e46\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCalcaneal spur\u003c/p\u003e\n \u003cp\u003e(Turkey) \u003cspan class=\"Underline\"\u003e31478095\u003c/span\u003e; 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e1281J/session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5x/wk\u003c/p\u003e\n \u003cp\u003e3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;+\u0026thinsp;HILT/sham\u003c/p\u003e\n \u003cp\u003e4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWOUNDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLu\u003csup\u003e47\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic Refractory Wounds; (China)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34253665\u003c/span\u003e; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8W\u003c/p\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e80J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBTL6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e3wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMT\u0026thinsp;+\u0026thinsp;HILT/sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThabet\u003csup\u003e48\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCaesarian Healing in diabetic women; (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29706708\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-40Hz\u003c/p\u003e\n \u003cp\u003e360-540J\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMT\u0026thinsp;+\u0026thinsp;HILT/sham\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGYNECOLOGICAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThabet\u003csup\u003e49\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eEndometriosis (Egypt)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29668354\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-40Hz 0.1% duty cycle\u003c/p\u003e\n \u003cp\u003e1300J\u003c/p\u003e\n \u003cp\u003eBTL600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e8wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHT\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBONE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlayat\u003csup\u003e50\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eOsteoporosis (Saudi Arabia)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e29068756\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5W\u003c/p\u003e\n \u003cp\u003e52.5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e120\u0026ndash;150\u0026micro;s 10-30Hz\u003c/p\u003e\n \u003cp\u003e3000J total per session\u003c/p\u003e\n \u003cp\u003eHIRO 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3x/wk\u003c/p\u003e\n \u003cp\u003e24 wks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eET\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e1064nm wavelengths were used throughout unless noted otherwise under treatment settings. FU-follow-up; ET-exercise therapy; PT-physical therapy; ESWT-extracorporeal shock wave therapy; KT-kinesiology taping; LLL-low level light; HT-hormone therapy; EOT-end of treatment follow-up. SMT-standard medical treatment. Kaydock study was a measure of hand grip strength and Abdel-all was a measure of joint swelling. All other measures were VAS.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eMost significantly, no serious adverse events (AEs) were observed in 56 controlled trials. Eight non-serious AEs were reported among a total of 1,486 HILT-treated patients. One patient, a light-skinned female with adhesive capsulitis, experienced a photoallergy.\u003csup\u003e41\u003c/sup\u003e Three non-serious AEs were reported in children with hemophilic arthropathies, but no further details were provided.\u003csup\u003e42\u003c/sup\u003e Two other patients reported post-HILT pain, and one experienced post-swelling pain in a study treating patients with de Quervain\u0026apos;s tenosynovitis (wrist tendon pain).\u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThe greatest cumulative categorically favorable pain reduction response data was observed with treatment of knee pathologies. Pain was reduced in \u003cem\u003eall\u003c/em\u003e 12 out of 12 studies that measured pain (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cstrong\u003eSupplementary Table S1\u003c/strong\u003e). Eleven out of 12 studies exhibited a large effect size in pain reductions. A thirteenth study demonstrated improvements in balance in patients with osteoarthritis only after treatment with HILT, but not when treated with LLLT.\u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eIn a 2020 knees osteoarthritis study, changes in knee cartilage thickness were measured from three different ultrasound aspects at 6 weeks after treatment.\u003csup\u003e45\u003c/sup\u003e High-powered PBMT resulted in a medium to large effect size in changes in cartilage thickness from all three aspects, according to Cohen\u0026apos;s criteria for effect size (|d| \u0026lt; 0.2\u0026thinsp;=\u0026thinsp;small effect; 0.2 \u0026lt; |d| \u0026lt; 0.8\u0026thinsp;=\u0026thinsp;medium effect; |d| \u0026gt; 0.8\u0026thinsp;=\u0026thinsp;large effect.\u003csup\u003e38\u003c/sup\u003e Only one study measured changes in tendon (supraspinatus) size before and after treatments.\u003csup\u003e46\u003c/sup\u003e In this study, treatment of patients with subacromial impingement syndrome with HILT demonstrated an improvement in supraspinatus tendon thickness compared to LLLT or sham laser treatment.\u003c/p\u003e\n \u003cp\u003eHILT treatment showed significant pain reduction in \u003cem\u003eall\u003c/em\u003e 11 spine studies, including non-specific lower back pain, cervical disc herniation, discogenic sciatica, myofascial pain syndrome, cervical radiculopathy, cervical spondylosis, peripheral neuropathy, diabetic neuropathy, and lumbar disc protrusion. In foot indications, 5 out of 6 HILT treatments resulted in statistically significant pain reduction, specifically for plantar fasciitis and ankle arthropathy (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). However, no significant pain reduction was observed for calcaneal spur.\u003c/p\u003e\n \u003cp\u003eFor shoulder or arm-related conditions, HILT treatment led to significant pain reduction in 11 out of 12 studies measuring pain, including rotator cuff injury, tendinopathy, adhesive capsulitis, subacromial impingement, lateral epicondylitis, and hemiplegic shoulder pain. Negative data was obtained in one study focusing on subacromial impingement and one study focusing on lateral epicondylitis. However, the latter lateral epicondylitis study did show positive outcomes in terms of increased hand grip strength and upper limb function (QDASH).\u003c/p\u003e\n \u003cp\u003eTwo studies focused on post-stroke patients with hemiplegic shoulder pain evaluating exercise therapy\u0026thinsp;\u0026plusmn;\u0026thinsp;HILT yielded exceptionally large effect size positive outcomes after HILT (ES\u0026thinsp;=\u0026thinsp;4.5 and 1.3).\u003csup\u003e47,48\u003c/sup\u003e Additionally, HILT not only resulted in significant reduction in shoulder pain but it also decreased rotator cuff tear size. The control group, which did not receive HILT treatment, showed no change in tear size.\u003csup\u003e48\u003c/sup\u003e Healing was confirmed through ultrasound measurements. Cohen effect sizes for both reduction in tear size and pain measures in the HILT group were large, suggesting that proper healing of the tissue contributed to the significantly greater pain reduction\u003c/p\u003e\n \u003cp\u003eNon-musculoskeletal studies with large effect sizes (Cohen\u0026apos;s\u0026thinsp;\u0026gt;\u0026thinsp;0.8), included wound healing (chronic refractory and caesarian section), chronic discogenic sciatica (increased nerve activity and pain reduction), endometriosis (pain reduction), and TMJ (mouth opening size also increased; Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). A positive outcome of lesser effect size was also achieved for osteoporosis with osteopenia.\u003csup\u003e49\u003c/sup\u003e Bone density measures were made 6 months and 1 year after cessation of treatment. In both cases, there was an increase in bone mineral density in the HILT plus exercise group, but no significant change was observed in the exercise therapy only group.\u003c/p\u003e\n \u003cp\u003eIn musculoskeletal disorders, restricted range of motion (ROM) and loss of cartilage are common. In 15 out of 16 studies assessing ROM, HILT treatment resulted in statistically significant increases in ROM compared to control groups without HILT (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). These studies involved patients with knee osteoarthritis (n\u0026thinsp;=\u0026thinsp;7), subacromial impingement (n\u0026thinsp;=\u0026thinsp;2), cervical spondylosis, hemiplegic shoulder pain, neck pain, myofascial pain syndrome post-neck discectomy, rotator cuff tendinopathy, hemophilic arthropathy, and myogenic temporomandibular joint disorder.\u003c/p\u003e\n \u003cp\u003eQuality of life measures attempt to quantify how debilitating various conditions are to patients\u0026rsquo; overall well-being and their basic functional life-skills. HILT treatment demonstrably improved the quality of life (QoL) in 16 out of the 20 studies assessing QoL. Positive QoL outcomes were observed after treatment of patients diagnosed with knee osteoarthritis, subacromial impingement syndrome, endometriosis, plantar fasciitis, hemiplegic shoulder pain, neck pain, adhesive capsulitis (frozen shoulder), chronic lower back pain, cervical disc herniation, cervical spondylosis, lateral epicondylitis, and myogenic temporomandibular joint disorder (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Functional outcomes or abilities include measurements of physical functions using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale or the measures of the ability to walk further over 6 minutes as with patients with hemophilic arthropathy.\u003csup\u003e45,50\u003c/sup\u003e HILT increased patient functional abilities in 31 out of 37 studies making functional assessments.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eTechnical Procedural Aspects\u003c/h2\u003e\n \u003cp\u003eThe most used lasers were the BTL-6000 (n\u0026thinsp;=\u0026thinsp;20 studies) and the HIRO 3.0 (n\u0026thinsp;=\u0026thinsp;15). The most commonly used wavelength was 1064nm (n\u0026thinsp;=\u0026thinsp;42), while 4 studies used 810\u0026thinsp;+\u0026thinsp;980nm (Zimmer Opton Pro), 2 used 808\u0026thinsp;+\u0026thinsp;905nm, 2 used 980nm, 2x 940nm, and three studies used 808nm\u0026thinsp;+\u0026thinsp;905nm, 800nm\u0026thinsp;+\u0026thinsp;970nm, or 940nm (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In 27 out of 29 studies, a biphasic administration method was used to generate positive outcomes. This method involved an initial analgesic mode (lower power) followed by a biostimulatory mode (higher power) in subsequent treatment sessions. The Hilterapia HIRO 3 laser (ASA laser, Arcugnano, Vicenza, Italy) used distinctly different and unique laser settings with both an exceptionally high peak power (3kW) and an exceptionally short pulse (100\u0026micro;s). Studies were primarily conducted in Turkey (n\u0026thinsp;=\u0026thinsp;16) and Egypt (n\u0026thinsp;=\u0026thinsp;15), with smaller numbers in Iran (n\u0026thinsp;=\u0026thinsp;6), Saudi Arabia (n\u0026thinsp;=\u0026thinsp;4), China (n\u0026thinsp;=\u0026thinsp;3), and other countries with 2 studies (Thailand, Italy, Spain), or a single study (United States, Lithuania, Thailand, Malaysia, Portugal; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eQUANTITATIVE SUMMARY OF HILT EFFECT SIZES\u003c/h2\u003e\n \u003cp\u003eForest plot analysis was used to visually present the comparisons of quantitative effect size outcomes. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the pain (VAS) outcomes of evaluations of HILT, categorized by anatomies that have similar depths of pathology: knees, shoulder/arm, and spine related. Among a total of 9 studies, knee-related pathologies displayed the highest average effect size compared to shoulder/arm (n\u0026thinsp;=\u0026thinsp;11) and spine-related pathologies (n\u0026thinsp;=\u0026thinsp;13), with effect sizes of -2.3, -1.85, and \u0026minus;\u0026thinsp;1.15 respectively. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents both end-of-treatment (EOT) and extended post-cessation of HILT follow-ups for knee-related pathologies.\u003c/p\u003e\n \u003cp\u003eMost importantly, 17 out of 18 studies, which measured outcomes at extended follow-up times (\u003cstrong\u003eSupplementary Table S2\u003c/strong\u003e), revealed that the benefits of pain reduction after the cessation of HILT treatment plans were sustained and not temporary. The average large effect size for pain reduction between groups after treatment cessation was 2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 for extended follow-up measures, compared to 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 for end of treatment measures. This summary data demonstrates that HILT does not only provide temporary pain relief. Instead, it has biostimulatory properties and can promote tissue regeneration, leading to sustained positive outcomes in the clinic. It addresses the pathology itself and not merely the symptomatic presentation in the repetitive unlimited fashion characteristic of many pain medications.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eHILT is superior to LLLT in Controlled Trials\u003c/h2\u003e\n \u003cp\u003eHILT was found to be superior to LLLT in 7 out of 8 studies, with a statistically significant \u003cem\u003elarge\u003c/em\u003e effect size (ES) difference compared to LLLT (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e; average ES\u0026thinsp;=\u0026thinsp;1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76). HILT demonstrated superiority over LLLT in the treatment of knee osteoarthritis (5W/cm\u003csup\u003e2\u003c/sup\u003e vs 0.4W and 5W vs 78mW), lateral epicondylitis (8W/cm\u003csup\u003e2\u003c/sup\u003e vs 240mW), adhesive capsulitis (frozen shoulder; 12W/cm\u003csup\u003e2\u003c/sup\u003e vs 240mW), subacromial impingement (5W/cm\u003csup\u003e2\u003c/sup\u003e vs 250W/cm\u003csup\u003e2\u003c/sup\u003e), plantar fasciitis (7W/cm\u003csup\u003e2\u003c/sup\u003e vs 50mW), and carpal tunnel syndrome (1.6W vs 50mW; power densities are provided as they are more meaningful, when details were provided within studies). One study compared two different HILT parameters (12W/cm\u003csup\u003e2\u003c/sup\u003e vs 0.8W), but did not use LLLT (\u0026lt;\u0026thinsp;500mW).\u003csup\u003e51\u003c/sup\u003e Both treatments were equally effective in reducing chronic nonspecific lower back pain in this study.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eOptimal Laser Powers Needed Per Categorical Anatomies to the Best We can Determine Based on Limited Available RCT Evidence\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eTo determine optimal power settings to use per respective indications that can be based on the \u003cem\u003ehighly limited\u003c/em\u003e currently available trial data we used effect size (ES) quantitations to perform the following analysis (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cstrong\u003eand summary\u003c/strong\u003e Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). We report the power densities used to achieve the best outcomes per categorical diagnosis when the spot size is described in the study reports.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eOptimal laser parameters and treatment plans based on summary analysis of the most positive outcomes from RCTs fulfilling criteria for inclusion in our meta-analysis.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnatomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e\u003cstrong\u003ePower density\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ldquo;Dose\u0026rdquo;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(as Joules or Fluence, J/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Plan\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(arthropathies, injuries)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e5-30W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e750-3000J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003eDaily treatment regimens for at least 2 weeks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpine/Back\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(radiculopathies, spondylosis, neck pain, chronic pain, myofascial pain syndrome post-neck discectomy, discogenic sciatica, lumbar disc protrusion)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e10-12W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e850-7500J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e5x/wk for 2wks or 2x/wk for 4-6wks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulder/arm\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(lateral epicondylitis, rotator cuff tendinopathy, adhesive capsulitis, frozen shoulder, subacromial impingement syndrome)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e5-20W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e2000-2500J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e2-3x/wk for \u0026ge;2wks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Chronic\u0026nbsp;Refractory Wounds)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e8-10W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e80J+150J/cm2 or 540J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e3x/wk for \u0026ge;3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eHand/wrist\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(arthropathies, carpal tunnel syndrome, De Quervain\u0026rsquo;s tenosynovitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e0.3-12W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e2100J or 150J/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e3x/wk for \u0026ge;4wks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"248\"\u003e\n \u003cp\u003e\u003cstrong\u003eFoot\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(plantar fasciitis, ankle arthropathy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"100\"\u003e\n \u003cp\u003e8W/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e120J/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"114\"\u003e\n \u003cp\u003e3x/wk for 3wks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eSummary of HILT vs LLLT studies in this meta-analysis.\u003c/strong\u003e Laser parameters and outcomes are shown. All studies used the same treatment plans between groups. Pain reduction, functional (including disability indices), and quality of life (QoL) measures are noted. The superior outcome is labelled for each metric. A blank cell denotes that no measurement was made.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003cth style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth style=\"height: 35px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eHILT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 35px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eLLLT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 35px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSuperiority\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 97px;\"\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003ePower\u003c/p\u003e\n \u003cp\u003eor\u003c/p\u003e\n \u003cp\u003ePower Density\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026lambda;\u003c/p\u003e\n \u003cp\u003e(nm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003eDosage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003ePower\u003c/p\u003e\n \u003cp\u003eor\u003c/p\u003e\n \u003cp\u003ePower Density\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026lambda;\u003c/p\u003e\n \u003cp\u003e(nm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003eDosage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003cp\u003ereduction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003eFunction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 97px;\" align=\"left\"\u003e\n \u003cp\u003eQoL\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr style=\"height: 99px;\"\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003eAbdelbassett\u003csup\u003e51\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eChronic lower back pain\u003c/p\u003e\n \u003cp\u003e(Saudi Arabia \u0026amp; Egypt) \u003cspan class=\"Underline\"\u003e33178306\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e12W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e1200J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e0.8W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" align=\"left\"\u003e\n \u003cp\u003e1200J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 99px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eBoth class IV HILT lasers.\u003c/p\u003e\n \u003cp\u003eBoth powers were effective.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 86px;\"\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003eAhmad\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKnee Osteoarthritis\u003c/p\u003e\n \u003cp\u003e(Malaysia) \u003cspan class=\"Underline\"\u003e37511894\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e5W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e400J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e0.4W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e3190J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 121px;\"\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003eEzzati\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCarpal tunnel syndrome (Iran)\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e31742366\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e1.6W\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e20J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e50mW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e20J/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNerve conduction\u003c/p\u003e\n \u003cp\u003e\u0026amp;\u003c/p\u003e\n \u003cp\u003eCompound muscle action potential\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 121px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 108px;\"\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003eKaydock\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLateral epicondylitis\u003c/p\u003e\n \u003cp\u003e(Turkey) \u003cspan class=\"Underline\"\u003e32637921\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e8W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e150J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e240mW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e2.4J/cm2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSF-36\u003c/p\u003e\n \u003cp\u003e\u0026amp;\u003c/p\u003e\n \u003cp\u003eQDASH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 108px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 86px;\"\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003eNaruseviciute\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciiitis\u003c/p\u003e\n \u003cp\u003e(Lithuania) \u003cspan class=\"Underline\"\u003e32513018\u003c/span\u003e; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e7W\u003c/p\u003e\n \u003cp\u003e7W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e3000J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e50mW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e140J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eBoth groups exhibited reduced pain.\u003c/p\u003e\n \u003cp\u003eThere was no untreated control.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 86px;\"\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e106\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdhesive capsulitis\u003c/p\u003e\n \u003cp\u003e(Turkey) \u003cspan class=\"Underline\"\u003e37533657\u003c/span\u003e; 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e12W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e120J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e240mW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e3J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 86px;\"\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003eOrdahan\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePlantar fasciiitis\u003c/p\u003e\n \u003cp\u003e(Turkey) \u003cspan class=\"Underline\"\u003e29627888\u003c/span\u003e; 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e6W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e1064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e150J/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e240mW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e0.16W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e640J/session\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHeel tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFoot and Ankle Outcome Scores\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 86px;\"\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003eZaki\u003csup\u003e46\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSubacromial impingement syndrome\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"Underline\"\u003e34184965\u003c/span\u003e; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e4W\u003c/p\u003e\n \u003cp\u003e5W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003cp\u003e+\u0026thinsp;980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e2050J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e200mW\u003c/p\u003e\n \u003cp\u003e250W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003cp\u003e+\u0026thinsp;980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e2000J\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHILT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 86px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003eIt is important to note that the HIRO 3.0 device utilizes extremely short pulses (120\u0026ndash;150\u0026micro;s pulses at frequencies of 10-40Hz), with the light being off for most of the time of each second. Additionally, it operates at exceptionally high peak powers (12kW) with a spot size of 0.2cm\u003csup\u003e2\u003c/sup\u003e. Due to these unique characteristics, the HIRO 3.0 treatment method is fundamentally different from other devices that use continuous or 50% off pulsed settings. Therefore, our focus in this discussion is limited to the studies that utilized continuous or pulsed (50% on/off) settings, rather than HIRO 3.0 micro-pulsing (120\u0026ndash;150\u0026micro;s, 10-40Hz).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eKnee \u0026ndash; 12W at 12W/cm\u003csup\u003e2\u003c/sup\u003e (52.5W/cm\u003csup\u003e2\u003c/sup\u003e micro-pulsed)\u003c/h2\u003e\n \u003cp\u003eTwelve studies all yielded positive calculated effect sizes ranging from 4.6 to 0.4, using power settings ranging from 1W to 14W. The study with the greatest measurably positive effect size involved the treatment of children with juvenile rheumatoid arthritis.\u003csup\u003e50\u003c/sup\u003e However, this study needs to be qualified since it is the only study involving children, and children naturally recover at a greater rate than adults. Additionally, this is a unique and distinct rare form of arthropathy that occurs due to recurrent bleeds inherent in hemophilic arthropathy. As a result, the benefits were reduced in follow-up measures. The laser treatment settings were 10.5 W (50W/cm\u003csup\u003e2\u003c/sup\u003e, 120\u0026ndash;150\u0026micro;s, 10-30Hz, 750J per knee per session, HIRO 3.0) three times per week for 4 weeks. In contrast, other studies using non-micro-pulsed settings achieved large effect sizes that improved over time, as measured in extended follow-up measures conducted after the cessation of treatment. These studies used 12W or 30W settings at power densities of 12 W/cm\u003csup\u003e2\u003c/sup\u003e or 30W/cm\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eSpine/Back \u0026ndash; 12W at 12W/cm\u003csup\u003e2\u003c/sup\u003e (10.5W at 52.5W/cm\u003csup\u003e2\u003c/sup\u003e micro-pulsed)\u003c/h2\u003e\n \u003cp\u003eEleven studies focused on pathologies of the spine achieved measurably positive outcomes by using power settings ranging from 1W to 14W. The study with the highest effect size (3.3 ES) involved treatments using 10.5W (50W/cm\u003csup\u003e2\u003c/sup\u003e, 1064nm, 120\u0026ndash;150\u0026micro;s,10-40Hz, 2050J total, over 30m, HIRO 3.0) for patients with cervical spondylosis.\u003csup\u003e52\u003c/sup\u003e These treatments were administered twice a week for a duration of 6 weeks.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eShoulder and arm \u0026ndash; 6W at 6W/cm\u003csup\u003e2\u003c/sup\u003e\u003c/h2\u003e\n \u003cp\u003eThirteen studies focused on the shoulder or arm using powers ranging from 4W to 12W. Effect sizes could be calculated for 8 studies. The most impressive quantitative positive outcome (5.0 ES) was achieved when using 6W (1064nm, BTL6000) to treat patients with lateral epicondylitis.\u003csup\u003e53\u003c/sup\u003e Treatment involved an initial 45 seconds of 4W (12W/cm\u003csup\u003e2\u003c/sup\u003e) to provide analgesia followed by 12 minutes of 6W administration. Only four sessions were conducted over two weeks. The authors did not mention whether the administration was continuous or pulsed. The results of two studies evaluating HILT treatment for de Quervain\u0026apos;s tenosynovitis were contrasting and interesting.\u003csup\u003e43,54\u003c/sup\u003e A positive outcome (ES\u0026thinsp;=\u0026thinsp;1.0) with no adverse events was achieved with a higher power and shorter treatment duration, while a negative outcome occurred with 3 out of 10 subjects experiencing adverse events when using a lower power but for a longer time (10W 100s 250J vs 8W 5min 800J respectively; BTL600 1064nm for both).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eFace \u0026ndash; 10.5W\u003c/h2\u003e\n \u003cp\u003eFive studies focused on the face, which included two Bell\u0026apos;s Palsy studies, two temporomandibular joint disorder studies, and one study on chronic sinusitis. However, only one of these studies provided enough data to calculate the effect size for pain.\u003csup\u003e55\u003c/sup\u003e The study showed an impressively large effect size (1.5 ES) when the myogenic temporomandibular joint disorder was effectively treated using micropulsed therapy with a power output of 10.5 watts (50W/cm\u003csup\u003e2\u003c/sup\u003e, 120\u0026ndash;150\u0026micro;s, 10-30Hz, 1092J/session, HIRO 3.0), administered five times per week for three weeks.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eFoot \u0026minus;\u0026thinsp;8W (24W/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/h2\u003e\n \u003cp\u003eSix studies focused on the foot \u0026ndash; three on plantar fasciitis, one on ankle arthropathy, one on calcaneal spur, and one on diabetic peripheral neuropathy.\u003csup\u003e21,22,56\u0026ndash;58\u003c/sup\u003e These used 7W to 10.5W. These used power settings ranging from 7W to 10.5W. The most positive outcome (2.2 ES) was achieved when using 8W superpulsed (24W/cm\u003csup\u003e2\u003c/sup\u003e; 1064nm; BTL6000) for just 75 seconds to deliver 150J three times in the first week followed by just 30 second treatments at 6W power to deliver 120 J three time per week for a subsequent 2 weeks.\u003csup\u003e21\u003c/sup\u003e These were exceptionally short treatment sessions.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eHand \u0026ndash; 1.5W (0.3W/cm\u003csup\u003e2\u003c/sup\u003e; 800\u0026thinsp;+\u0026thinsp;970nm)\u003c/h2\u003e\n \u003cp\u003eFive studies focused on the hand and all exhibited measurably positive effect size outcomes, but the power setting was not described for the most impressively positive outcome (1.9 ES) involving treatment of hand osteoarthritis.\u003csup\u003e59\u003c/sup\u003e Thus, we must defer to the second most impressively positive outcome, which was achieved by treating thumb osteoarthritis with 800nm with 970nm at a power of just 1.5W (2Hz, 50% duty cycle). This treatment was applied over an area of 5cm\u003csup\u003e2\u003c/sup\u003e for only 45 seconds per session.\u003csup\u003e60\u003c/sup\u003e The treatment was done three times per week for a period of four weeks.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eWound \u0026ndash; 10.5W (50W/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/h2\u003e\n \u003cp\u003eJust two controlled studies were conducted on wounds, and both yielded positive outcomes. The effect sizes were 4.2 for cesarian healing and 0.9 for chronic refractory wounds.\u003csup\u003e61,62\u003c/sup\u003e The most impressive treatment regimen (10.5W, 25Hz, 1064nm, HIRO 3.0) consisted of three phases: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) fast scanning across the entire wound for 100-150J, (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) 14 seconds of irradiation focused on 12\u0026ndash;14 spots for a total of 160-240J, and (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) the same as the first phase but at a slower scanning pace. Treatments took 8 minutes and were administered three times per week for 8 weeks.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003eBone \u0026ndash; 10.5W micropulsed (50W/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/h2\u003e\n \u003cp\u003eThere was only one study that examined the effects of HILT on bone mineral density in men with osteopenia or osteoporosis. The study demonstrated a medium effect size (0.5 ES), and most importantly, this effect size was maintained even 1 year after the treatment was stopped (0.4 ES).\u003csup\u003e49\u003c/sup\u003e The treatment used in this study involved the administration of micropulsed light with an average power of 10.5W (at 50W/cm\u003csup\u003e2\u003c/sup\u003e, 1064nm, 120\u0026ndash;150\u0026micro;s, 10-30Hz, 3000J per session using HIRO 3.0) three times per week for a total of 24 weeks.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe objective of this meta-analysis was to evaluate the full range of indications that can benefit from high-powered laser photobiomodulation therapy. The secondary objective was to determine the optimal laser settings and treatment regimens based on the currently available data from randomized controlled trials (RCTs). Pain levels after high-powered laser therapy (HILT) were the most commonly measured outcome, and all studies focused on the knee, spine, shoulder/arm, and wound showed reductions in pain. Most of these reductions were significant, as indicated by the large effect sizes (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, improvements in range of motion, mobility, quality of life, cartilage growth, rotator cuff tear recovery, and nerve conduction were also demonstrated.\u003c/p\u003e \u003cp\u003eConsistent with our project's hypothesis, all 7 out of 8 studies that directly compared HILT to LLLT showed that higher powered lasers had better outcomes. The only exception was one study where both high and low energy PBMT effectively reduced pain in patients with plantar fasciitis and it is possible this was due to referred pain for which the laser was not focused on the appropriate pathogenic anatomy (discussed below in limitations section; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Three of these HILT superior studies focused on the shoulder and arm, while the other individual studies focused on the knee, foot, and hand. In a previous double-blind RCT for patients with myofascial pain, LLLT treatment did not reduce pain, whereas a similar study using HILT showed a significant reduction in pain.\u003csup\u003e63,64\u003c/sup\u003e Furthermore, LLLT treatment did not provide any benefits for temporomandibular joint dysfunction (TMJD), while a controlled study using HILT showed that the higher powered approach was especially effective in reducing pain. In summary, based on our meta-analysis spanning the past six years, high-powered laser PBMT consistently produces superior outcomes.\u003c/p\u003e \u003cp\u003eOur findings are in agreement with \u003cem\u003eall\u003c/em\u003e prior meta-analyses.\u003csup\u003e65\u0026ndash;69\u003c/sup\u003e Overwhelmingly positive outcomes (96%) were observed after comprehensive evaluation of HILT treatment specifically targeting pain (July 2020 to August 2022; n\u0026thinsp;=\u0026thinsp;31 RCTs).\u003csup\u003e69\u003c/sup\u003e When treating knee osteoarthritis, HILT\u0026thinsp;+\u0026thinsp;ET outperformed LLLT\u0026thinsp;+\u0026thinsp;ET (\u0026le;\u0026thinsp;December 2019; n\u0026thinsp;=\u0026thinsp;10 RCTs).\u003csup\u003e7\u003c/sup\u003e An analysis focused on knee osteoarthritis concluded that HILT effectively alleviates pain (\u0026le;\u0026thinsp;September 2022; n\u0026thinsp;=\u0026thinsp;9 CTs).\u003csup\u003e70\u003c/sup\u003e Likewise, an analysis of HILT treatment for neck pain concluded that it effectively reduces pain and improves cervical ROM (\u0026le;\u0026thinsp;March 2022; n\u0026thinsp;=\u0026thinsp;9 RCTs).\u003csup\u003e68\u003c/sup\u003e Another analysis comparing HILT to other physical therapy modalities for knee osteoarthritis found that HILT is superior in terms of pain reduction and functional improvement (\u0026le;\u0026thinsp;March 2022; n\u0026thinsp;=\u0026thinsp;10 RCTs). In line with our observations, an extensive meta-analysis of musculoskeletal outcomes (\u0026le;\u0026thinsp;September 2022; n\u0026thinsp;=\u0026thinsp;42 RCTs) found large (\u0026gt;\u0026thinsp;0.8) effect sizes in pain reduction and improved function after HILT treatment.\u003csup\u003e65\u003c/sup\u003e Overall, it is evident that HILT holds significant potential for transforming the treatment of various musculoskeletal pains, stiffness, and loss of function. However, there are current limitations to implementation including a general lack of physician awareness of the wide-ranging therapeutic utility of HILT and restricted patient access.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eOur study had several limitations. Firstly, other than one study focused on knee arthropathy that used 30 watts\u003csup\u003e71\u003c/sup\u003e, the highest-powered laser was only 15 watts for subacromial impingement.\u003csup\u003e72\u003c/sup\u003e However, there are photobiomodulation therapy lasers in regular clinical practice that use powers as high as 80 watts that have yet to be evaluated in a controlled setting. We could not find any RCTs describing the evaluation of average powers above 30W. Secondly, most of our studies were limited to the 1064nm wavelength without consideration of higher powers using other wavelengths. Most basic PBMT biomedical research has in fact used wavelengths between 650 (red) to 830nm range. This is significant because 810-830nm light is not absorbed by water, thus making this the lowest heat-generating wavelength,\u003csup\u003e73\u003c/sup\u003e which enables more tolerable deeper penetrating PBMT at the highest power density settings. Additional limitations include variable study designs, variable follow-up times, failure to report spot size, and small sample sizes.\u003c/p\u003e \u003cp\u003eAnother limitation potentially affecting outcomes is the possibility that the laser was not directed towards the source of pathogenesis. For instance, foot pain associated with plantar fasciitis may initially manifest as referred pain originating from tightness in the hips. It is well-known that stretching and strengthening the hips can be beneficial in reducing foot pain.\u003csup\u003e74,75\u003c/sup\u003e Therefore, it is possible that more positive outcomes for plantar fasciitis could be achieved if the laser was directed at the hip. This may increase range of motion and influence the nerves responsible for sending pain signals through the sacrum. Similarly, for other conditions involving referred pain in the extremities, focusing the laser on the spinal cord or central nervous system (CNS) may lead to more positive benefits. This is because all pain signals ultimately pass through these anatomical routes since all pain signals ultimate go through these anatomical routes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eHigh-powered Laser PBMT Therapeutic Index is Superior to Standard Pain Management Pharmaceuticals (NSAIDs and opioids)\u003c/h2\u003e \u003cp\u003eOut of the 1,456 patients treated with HILT in all studies within this meta-analysis, there was not a single \u003cem\u003eserious\u003c/em\u003e adverse event reported from our meta-analysis. This safety profile is vastly superior to the pharmacotherapeutics that are commonly used to treat chronic pain conditions. Even more, HILT clearly has the potential to correct the cause of the pain by stimulating tissue regeneration with healing, while pain-relieving pharmacotherapies are generally not designed to address the cause, rather only to address the symptomology. Opioid side effects commonly involve analgesic tolerance, addiction, constipation, nausea, and respiratory depression that can result in death.\u003csup\u003e76\u003c/sup\u003e In fact, opiate-related overdoses have been among the fastest rising causes of death in America, rising to epidemic proportions over the past 3 decades from 1988 until 2018.\u003csup\u003e77,78\u003c/sup\u003e By 2028, the estimates are that more Americans will have died in the 21st century of drug overdoses than those who died in all of America\u0026rsquo;s wars over its entire history. Additionally, a 2022 report released by the U.S. Commission on Combating Synthetic Opioid Trafficking estimates that drug overdoses now cost the U.S. approximately \u003cspan\u003e$\u003c/span\u003e1 trillion every year.\u003csup\u003e79\u003c/sup\u003e Finally, on Feb. 10, 2022, the CDC issued new guidelines for prescribing opioids that advises doctors to limit new opioid prescriptions and discuss alternative therapies with patients.\u003csup\u003e80\u003c/sup\u003e By comparison, no serious adverse events have ever been reported let alone deaths, when using high-powered PBMT. High-powered laser PBMT should be considered as an approach that may enable the transition from chronic medication to a tolerable or potentially even painless health status.\u003c/p\u003e \u003cp\u003eWhen the 100% efficacy observed for studies focused on knees, shoulders/arms, and spine is combined with this level of safety, the combined therapeutic index (toxicity: efficacy) of high-powered PBMT is truly remarkable next to pharmaceutical approaches. Most significantly, these high-powered laser PBMT RCTs are now proven to provide sustained benefits in bio-stimulation of tissue healing with regeneration, unlike pharmaceuticals commonly used to address musculoskeletal disorders, including the chronic use of corticosteroids and NSAIDs, both of which are well-known to disrupt the removal of damaged tissue and the collective wound healing process.\u003csup\u003e81,82\u003c/sup\u003e High-powered PBMT is now poised to take a new position as an effective, non-invasive, and drug-free, alternative therapy treatment for pain relief, inflammation reduction, and accelerated healing.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eOptimal Treatment for Stimulating Cartilage /Tendon Growth in the Knee with Osteoarthritis\u003c/h2\u003e \u003cp\u003eKnee osteoarthritis (KOA) commonly involves the loss of supporting cartilage with knee replacement surgery often being the usual recourse. One 2020 HILT study in this meta-analysis demonstrated a statistically significant increase in knee cartilage thickness after HILT treatment compared to baseline, indicating that high-intensity laser therapy can stimulate cartilage regeneration.\u003csup\u003e45,80\u003c/sup\u003e Comparing it with a 2017 study that failed to demonstrate increased cartilage suggests that a \u003cem\u003edaily regular\u003c/em\u003e treatment regimen is the best approach to increasing the chance for sustained recovery with both sustained reductions in pain and true increases in cartilage growth. Similar powers (12W in positive outcome; 10.5W in negative), wavelengths (both 1064nm), and pulse settings (10Hz in positive outcome and 30Hz in negative) settings were used in both 2020 studies. However a more regular treatment regimen was used in the more successful approach \u0026ndash; 5 days per week for 2 weeks compared to just 2 days per week for 6 weeks.\u003csup\u003e83\u003c/sup\u003e A more positive pain reduction outcome was observed with time (ES\u003csub\u003eEOT\u003c/sub\u003e=0.4 becomes 1.1 by 6 weeks; VAS), correlating with the statistically significant increases in femoral cartilage thickness (ES\u003csub\u003eMedialCartilage\u003c/sub\u003e=0.7 becomes 1.1 by 6 weeks). In the study by Ekici and Ordahan, no significant change in cartilage thickness was observed when performing treatments at just 5W/cm\u003csup\u003e2\u003c/sup\u003e biostimulatory power settings 3x/wk for patients with knee osteoarthritis.\u003csup\u003e84\u003c/sup\u003e Still, the HILT effectively reduced pain in a statistically significant fashion for these patients and this reduction in pain was sustained and apparent at measures made at 3 months post-cessation of treatment. All told, the summary results support that it is best to perform at least \u003cem\u003edaily\u0026thinsp;\u0026ge;\u0026thinsp;10W/cm\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e treatment regimens to increase the chance of stimulating cartilage growth with sustained outcomes.\u003c/p\u003e \u003cp\u003eMost impressively, the sizes of partial tear rotator cuff tears (PTRCT) were significantly decreased with a large effect after treating patients with hemiplegic shoulder pain using HILT compared to controls in a study performed by Korkmaz et al., which utilized 8W/cm\u003csup\u003e2\u003c/sup\u003e administered 3x/wk for 3wks (ES\u003csub\u003ePTRCT\u003c/sub\u003e=0.9).\u003csup\u003e48\u003c/sup\u003e These results clearly indicate that the high-powered laser can stimulate tendon growth. Another study demonstrated that HILT treatment (5W/cm\u003csup\u003e2\u003c/sup\u003e) effectively reduced inflammation of supraspinatus tendons in patients with subacromial impingement syndrome.\u003csup\u003e46\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Based on the summary data, knee arthropathies and injuries would appear poised to be the next indication most likely to be recognized in consensus guidelines and paid for by insurance companies. This indication has the greatest current cumulative data with consistently positive outcomes. Not only does knee arthropathy clearly respond favorably to high-powered laser PBMT as concluded from this meta-analysis, but The American Academy of Orthopedic Surgeons (AAOS) now recommends laser therapy in its latest recommendations for the non-arthroplasty treatment of osteoarthritis of the knee joint to \u0026ldquo;improve pain and function.\u003csup\u003e30\u003c/sup\u003e Investigators point out that patients should expect to experience improvements in pain and function with the treatment and significantly, there have been no reports of serious side effects from laser treatment for pain control.\u003csup\u003e85\u003c/sup\u003e A 2022 meta-analysis focused on laser PBMT for treating KOA reached the same conclusion that summary data indicates high-powered laser PBMT works for relieving pain and stiffness in KOA, especially when combined together with exercise therapy and using higher powers.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur meta-analysis data supports that high-powered laser photobiomodulation therapy is a consistently effective and exceptionally safe treatment approach for reducing pain and stimulating sustained recovery for a wide range of indications that generally involve musculoskeletal joint-related pathologies, nerve-associated pathologies, wounds, and endometriosis. More controlled trials are needed to further establish consensus guideline treatment recommendations and gain recognition by payers for knee arthropathies and an expanding variety of indications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eWTP was supported by compensation from Aspen Laser, LLC. CEV is the CEO of Aspen Laser and has issued and pending patents.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eSupplementary Materials\u003c/h2\u003e \u003cp\u003eSupplementary file contains Table S1 and S2.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eWTP was supported by compensation from Aspen Laser, LLC.\u003c/p\u003e\u003ch2\u003eAuthor\u0026rsquo;s Contributions\u003c/h2\u003e \u003cp\u003eCEV and WTP conceived and contributed to the study design. WTP performed analysis. Both authors contributed to, reviewed, and approved the article.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe thank and gratefully acknowledge Anthony Murawski and Thomas A. Hertel, MSPT for critical reading, critique, and analysis of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePhotobiomodulation (PBM) research - a comprehensive database. \u003cem\u003eGoogle Docs\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://docs.google.com/spreadsheets/d/1ZKl5Me4XwPj4YgJCBes3VSCJjiVO4XI0tIR0rbMBj08/edit?usp=embed_facebook\u003c/span\u003e\u003cspan address=\"https://docs.google.com/spreadsheets/d/1ZKl5Me4XwPj4YgJCBes3VSCJjiVO4XI0tIR0rbMBj08/edit?usp=embed_facebook\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalderhead RG (2017) Photobiological Basics of Photomedicine: A Work of Art Still in Progress. 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Sci Rep 11:18917\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"CME Scribe, LLC","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"photobiomodulation, musculoskeletal, pain, knee, arthritis","lastPublishedDoi":"10.21203/rs.3.rs-4813995/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4813995/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eLow-level light therapy (LLLT; ≤0.5 Watts; W) has advanced to the stage of guideline recommended treatment with payer coverage for treating \u003cem\u003eshallow\u003c/em\u003e tissue oral mucositis. However, LLLT often fails in trials treating \u003cem\u003edeeper\u003c/em\u003e tissue pathologies due to an inability to penetrate and deliver sufficient therapeutic light. By contrast, Class IV \u003cem\u003ehigh\u003c/em\u003e-intensity laser therapy (HILT; 0.5-80W) typically at 100-fold higher powers has proven successful for treating these \u003cem\u003esame\u003c/em\u003e \u003cem\u003edeeper\u003c/em\u003e tissue pathologies. To evaluate the range of indications responding favorably to\u0026nbsp;Class IV HILT, we searched PubMed, Google Scholar, and Cochrane databases from 2018 to March 2024 using the keywords \"laser\" AND \"photobiomodulation\" OR \"therapy\" AND \"high\" AND \"patients\" NOT \"surgical\", focusing on controlled trials. Effect sizes were determined using Cohen’s\u0026nbsp;d. Fifty-six identified studies (n=1,486 HILT vs n=1,494 controls) reported zero serious adverse events. HILT reduced pain in 100% of the trials focused on the knee (n=10), spine, shoulder/arm, and wounds with large effect sizes (\u0026gt;90%). Positive outcomes were demonstrated for the hand/wrist (n=5), feet, face/jaw, bone osteoporosis, and endometriosis. Improvements in range of motion (94%; n=16), functional outcomes (84%; n=37), quality of life (80%; n=20), knee cartilage thickness, rotator cuff tear size, and nerve conduction were demonstrated. Larger effect sizes occurred in follow-up measurements made after cessation of treatment (n=18) indicating that benefits were sustained and not merely transient. The average (median, range) power used was 9.5W (10.5, 0.5-30) and the average power density was 9.1W/cm\u003csup\u003e2\u003c/sup\u003e (8; 1-30). We conclude that Class IV HILT is an exceptionally safe, effective, and increasingly recognized treatment that is in a promising\u0026nbsp;discovery\u0026nbsp;phase of research for an expanding list of indications\u0026nbsp;with\u0026nbsp;deep-tissue pathologies.\u0026nbsp;The medical and payer communities should include HILT as a viable treatment option for indications showing positive outcomes in the published research.\u003c/p\u003e","manuscriptTitle":"The Importance of Power in Photobiomodulation, a Systematic Review and Meta-analysis of High Intensity Laser Therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-05 20:15:19","doi":"10.21203/rs.3.rs-4813995/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73755770-7e09-4fba-88ba-610a5f260a29","owner":[],"postedDate":"August 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35216090,"name":"Anesthesiology \u0026 Pain Medicine"},{"id":35216091,"name":"Optics/Lasers"}],"tags":[],"updatedAt":"2024-08-05T20:15:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-05 20:15:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4813995","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4813995","identity":"rs-4813995","version":["v1"]},"buildId":"re_ckhLnmML6MCF96OHNJ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}