Chronic Shoulder Pain Treatment: High Intensity Laser or Ultrasound
Condition: Shoulder Pain Chronic
MeSH terms: Shoulder Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      The investigators aimed to evaluate the short-term efficacy of High Intensity LASER Therapy
      (HILT) and Ultrasound (US) treatment in chronic shoulder pain. It's a prospective,
      randomized, controlled, single blind study.141 patients were randomized into two groups, as
      HILT (n=71) and US (n=70) groups. HILT or US treatment was applied to the patients in
      addition to 14 sessions of Hotpack (Hp) + Balneotherapy + Exercise treatment. Pre-treatment
      (Pre-T), Post-treatment 1st day (Post-T1st day) and Post-T findings for the 30th day (Post-T
      30th day) were recorded using the visual analog scale (VAS) and shoulder pain and disability
      index (SPADI) scoring.
    

Detailed description: 
      Chronic shoulder pain, which negatively affects the quality of life due to pain and loss of
      functions, is the third most common painful condition of the musculoskeletal system[1] The
      aim of the study was to determine more effective conventional physical treatment method (HILT
      or US) for pain and daily activities of patients with chronic shoulder pain which was
      difficult to treat, and had unfavorable effects on patient life quality. This prospective,
      randomized, controlled, single blind study was conducted at the Physical Treatment and
      Rehabilitation Training and Research Hospital and ethics board approval was obtained.A total
      of 210 patients, who presented to the hospital with chronic shoulder pain, were evaluated for
      inclusion in the study. Patients to be included in the study were divided into two groups by
      the investigating physician, using simple randomization, and their treatment was organized.
      Forms detailing the patients' (demographics, VAS scores and SPADI) were completed by another
      investigating physician who was blind to the type of treatment the patients would receive.
      The same investigating physician completed Post-treatment 1st day (Post-T1st day) and Post-T
      findings for the 30th day (Post-T 30th day) forms and recorded the data. Patients who were
      randomly divided into two groups received treatment for two weeks (14 days) are shown below:

        -  Group 1: Hotpack (HP)+ Balneotherapy+ Exercise + HILT

        -  Group 2: Hotpack (HP)+ Balneotherapy+ Exercise + US

      Patients in both groups received HP to the affected shoulder region for 20 minutes and
      balneotherapy, in mineral water pool at 38-400C for 20 minutes, for seven consecutive days.
      ROM exercises and Codman exercises, in a level not to increase the severity of the pain of
      the patient, were given and stretching and strengthening exercises were taught to the
      patients.The patients performed these exercises daily in two sets with five repeats in each
      set.

      HILT was performed using a BTL-6000 High Intensity Laser, 12 W(watt), 1064 nm device was a
      hot laser with Nd: YAG LASER source. BTL 4710 US device was applied at 3 MHz frequency, and
      1.5watt/cm2 intensity over 25 cm2 surface area. Headpiece area of the device was 5 cm2, and
      the application was performed as the head of device was positioned at 90º (perpendicular) at
      full contact for 5 minutes by using gel, and performing continuous circular motions. Patients
      were evaluated using VAS and SPADI in pre-treatment (Pre-T), Post-T1st day and Post-T 30th
      day.
    

Intervention name(s): Hıgh İntensity Laser (HILT); Ultrasound; Hotpack; Transcutaneous electrical nerve stimulation; Therapeutic exercises; Balneotherapy
Intervention type(s): Device; Device; Device; Device; Other; Other
Intervention description(s): HILT was performed using a BTL-6000 High Intensity Laser, 12 W(watt), 1064 nm device was a hot laser with Nd: YAG LASER source. In HILT group, the investigators applied the device on the shoulder area in two phases: phase I - analgesia, and phase II - biostimulation.; BTL 4710 US device was applied at 3 MHz frequency, and 1.5watt/cm2 intensity over 25 cm2 surface area. Headpiece area of the device was 5 cm2, and the application was performed as the head of device was positioned at 90º (perpendicular) at full contact for 5 minutes by using gel, and performing continuous circular motions.; All patients had the same physical therapy (PT) protocol including hot pack (HP) for 20 min/session,; All patients had the same physical therapy (PT) protocol includingTENS (Fizyotens 4000, Fizyomed Medical Devices Ltd,Turkey) (50-100 Hz) for 20 min/session,; All patients had the same physical therapy (PT) protocol including therapeutic exercises for shoulder muscles; All patients had the same physical therapy (PT) protocol including balneotherapy in 38-40 °C thermomineralized water for 20 minutes.
Other intervention name(s): TENS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: High Intensity Laser; Ultrasound; Chronic Shoulder Pain