Low-Level Laser Therapy versus Resisted Exercise in Hand Function of Patients with Systemic Sclerosis
Keywords:
Systemic sclerosis, Serum cortisol level, Resisted exercise, Modified rodnan skin score, Low-level laser, Hand grip dynamometerAbstract
Introduction: Systematic sclerosis is connective tissue autoimmune lesion, where nearby 90% suffers` have an apparent hand` functional restrictions. This research designed to estimate the value of low-level laser versus resisted exercise on systemic sclerosis suffers` hand function in line to state the proper management approach for hand function restrictions among systematic sclerosis individuals.
Material and methods: Forty participants suffering from systematic sclerosis affecting their hands` function with scleroderma allocated randomly into equal groups; A received 3 sessions per week of low-level laser, also conventional physical program involved stretch, and active mobility training, where B received resisted exercises, also conventional physical program comprising stretching, as well active range of motion exercises. Skin thickness, serum cortisol level, and Hand Grip strength were evaluated pre-, then post- intervention using a Modified Rodnan skin scoring, Serum cortisol laboratory analysis, and hand-held dynamometer (HHD), also pinch gauge, respectively.
Results: The groups revealed equivalent remarkable modified Rondon skin thickness, and serum cortisol level reduction, plus highly significant increase in hand grip strength (p < 0.001).
Conclusion: Both low-level laser and resisted exercises are equivalent effectively enhance hand grip strength, as well functional capabilities throughout systematic sclerosis management.
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Stocker JK, Cup EHC, Vonk MC, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Bert Staal J, et al. What moves the rheumatologist? Unravelling decision making in the referral of systemic; sclerosis patients to health professionals: A qualitative study. Rheumatol Adv Pract. 2018;2(2):1-7.
Denton CP, Khanna D. Systemic sclerosis. Lancet 2017; 390:1685-99.
Pettersson H, Akerstrom A, Nordin A, Svenungsson E, Alexanderson H, Bostrom C. Selfreported physical capacity and activity in patients with systemic sclerosis and matched controls. Scandinavian journal of rheumatology. 2017;46(6):490-5.
Liem SIE, Meessen J, Wolterbeek R, Ajmone Marsan N, Ninaber MK, Vliet Vlieland TPM, et al. Physical activity in patients with systemic sclerosis. Rheumatology international. 2018;38(3):443-53.
Sandler RD, Matucci-Cerinic M, Hughes M. Musculoskeletal hand involvement in systemic sclerosis. Semin Arthritis Rheum. 2020; 50:329-34.
Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis research & therapy. 2018;20(1):112.
Moore DF, Kramer E, Eltarboulsi R, Steen VD. Increased morbidity and mortality of scleroderma in african americans compared to non-african americans. Arthritis Care Res. 2019;71(9):1154-63.
Bairkdar M, Rossides M, Westerlind H, Hesselstrand R, Arkema EV, Holmqvist M. Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis. Rheumatology (Oxford) 2021;60(7):3121-33.
Mouthon L, Poole JL, Physical and occupational therapy. In: Varga J, Denton C, Wigley F, Kuwana M, Allanore Y, editors. Scleroderma: From pathogenesis to comprehensive management. New York: Springer. 2017.Pp:603-13.
Toci AL, Madison Hyer J, Silver RM, Nietert PJ, Hant FN. Systemic sclerosis and perceptions of quality in primary care. Am J Med Sci. 2016;351(5):447-51.
11.Whyte J, Dijkers MP, Fasoli SE, Ferraro M, Katz LW, Norton S, et al. Recommendations for reporting on rehabilitation interventions. Am J Phys Med Rehabil. 2021;100(1):5-16.
Meyer T, Tilly C. Reporting of patients' characteristics in rehabilitation trials: an analysis of publications of RCTs in major clinical rehabilitation journals. Eur J Phys Rehabil Med. 2020;56(6):829-35.
Amiri M, Kumbhare D. Randomized controlled trials in non-pharmacological rehabilitation research: a scoping review of the reporting of sample size calculation, randomization procedure, and statistical analyses. Eur J Phys Rehabil Med. 2020;56(6):790-8.
Discepola MN, Carboni-Jiménez A, Kwakkenbos L, Henry RS, Boruff J, Krishnan A, et al. Effects of non-pharmacological and non-surgical interventions on health outcomes in systemic sclerosis: protocol for a living systematic review. BMJ Open. 2021;11:e047428.
Stöcker JK, Schouffoer AA, Spierings J, et al. Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud’s phenomenon and Digital ulcers in patients with systemic sclerosis. Rheumatology 2022; 61:1476–86.
Mugii N, Hamaguchi Y, Maddali-Bongi S. Clinical significance and usefulness of rehabilitation for systemic sclerosis. 2018;3(1):71-80.
Frade S, Cameron M, Espinosa-Cuervo G, Suarez-Almazor M, Lopez-Olivo MA. Exercise and physical therapy for systemic sclerosis. Cochrane Database Syst Rev. 2022;2022(3):CD0014902.
Sydow E, Arat S, Nijs G, Severi S, Westhovens R, Lenaerts J, et al. An explorative study evaluating feasibility and effectiveness of two different exercise programs in systemic sclerosis associated microstomia. Journal of Scleroderma and Related Disorders. 2018; Conference (Supplement 1):197.
Mitropoulos A, Gumber A, Akil M, Klonizakis M. Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Microvascular research. 2019; 125:103887.
de Oliveira NC, Portes LA, Pettersson H, Alexanderson H, Bostrom C. Aerobic and resistance exercise in systemic sclerosis: State of the art. Musculoskeletal care. 2017;15(4):316-23.
Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. Investigating the effectiveness and feasibility of exercise on microvascular reactivity and quality of life in systemic sclerosis patients: study protocol for a feasibility study. Trials. 2018;19(1):647.
Gokcen N, Badak SO, Sarpel T, Sertdemir Y, Erken E. The efficacy of a home-based, delfadministered hand exercise program for patients with systemic sclerosis: a randomized controlled, evaluator-blind, clinical trial. J Clin Rheumatol. 2022;28: e422-9.
Uras C, Mastroeni S, Tabolli S, et al. A comparison between two educational methods in the rehabilitation of the microstomia in systemic sclerosis: a randomized controlled trial. Clin Rehabil 2019; 33:1747-56.
24.Retameiro ACB, Nerves M, Tavares Alde F, Boaro CDT, Rodriguez DFS, Leal TSda S, Costa RM, Bertolini GRF, Ribeiro LFC. Resistance exercise and low-level laser therapy improves grip strength and morphological aspects in the ankle joint of wistar rats with experimental arthritis. Anat Rec (Hoboken). 2023;306(4):918-632.
Dougherty DH, Kwakkenbos L, Carrier ME, Salazar G, Assassi S, Baron M, et al. The Scleroderma Patient-Centered Intervention Network (SPIN) Cohort: baseline clinical features and comparison to other large scleroderma cohorts. Rheumatology. 2018; 57:1623-31.
Denton CP, Hughes M, Gak N, Vila J, Buch MH, Chakravarty K, et al. BSR and BHPR guideline for the treatment of systemic sclerosis. Rheumatology. 2016; 55:1906-10.
Kwakkenbos L, Østbø N, Carrier ME, Nielson WR, Fedoruk C, Levis B, et al. Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) program. Pilot Feasibility Study. 2022; 8:45.
Nordlund J, Henry RS, Kwakkenbos L, Carrier ME, Levis B, Nielson WR, et al. The Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program: protocol for a two-arm parallel partially nested randomized controlled feasibility trial with progression to full-scale trial. Trials. 2021; 22:856.
Hughes M, Herrick AL. Digital ulcers in systemic sclerosis. Rheumatology (Oxford). 2017; 56:14-25.
Avci P, Gupta A, Sadasivam M, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2013; 32:41–52.
Khanna D, Furst DE, Clements PJ, Allanore Y, Baron M, Czirjak L, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. Journal of Scleroderma and Related Disorders 2017;2(1):11-8.
Hopewell S, Boutron I, Moher D. CONSORT and its extensions for reporting clinical trials. Principles and practice of clinical trials. 2020: 1-5.
Almallah MM, Hajeer MY and Almahdi WH et al., (2020): Assessment of a single versus double application of low-level laser therapy in pain reduction following orthodontic elastomeric separation: a randomized controlled trial. Dent Med Probl; 57(1):45-52.
Allanore Y, Simms R, Distler O. Systemic sclerosis. Nat Rev Dis Primers. 1:15002.
Azadholi B, Baker RY. Laer applications in surgery. Ann Transl Med. 4(23):452.
Bennell KL, Dobson F, Hinman RS. Exercise in osteoarthritis: Moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93-117.
Boniface G, Gandhi V, Norris M. A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis. Rheumatology. 10.1093/rheumatology/keaa150.
Cassalia F, Federico S, Danese A, Franceschin L, Amato S, Gratteri F, Battilotti C, Caroppo F, Zappia E, Bennardo L, Fortina AB, Nistico SP. Advances in the management of localized scleroderma: A systematic review of laser therapy and injectable filler approaches. J Pers Med. 2024; 14(8):872-881.
Guo Q, Cen J, He M, Huang D, Tang Z, Xiong H. Fractional erbium: yttrium aluminum garnet laser in the treatment of morphea mouse model. J Cosmet Dermatol. 2023; 22:3282-3290.
De Oliveira AB, Sardella JC, Bufalino A, Miotto LN, Ferrisse TM, Brighenti FL. Low-level laser therapy for xerostomia control in a patient with scleroderma: Clinical case report. Pathol Oral Radiol. 2020;129(1): e107-111.
Spinella A, de Pinto M, Galluzzo C, Testoni S, Macripo P, Lumetti F, Parenti L, Megnani L, Sandri G, Bajocchi G, Starnoni M, De Santis G, Salvarani C, Giuggioli D. Photobiomodulation therapy: A new light in the treatment of systemic sclerosis skin ulcers. Rheumatol Ther. 2022; 9:891905.
Hughes M, Moore T, Manning J, Wilkinson J, Samraj P, Dinsdale G, Roberrts C, Rhodes LE, Herrick AL, Murray A. A feasibility study of a novel low-level light therapy for digital ulcers in systemic sclerosis. J Dermatol Treat. 2018;30(3):251-257.
Liem SIE, Vliet Vlieland TPM, Schoones JW, De Vries-Bouwstra JK. The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review. Rheumatology Advances in Practice 2019;3(2): rkz044.
Comstedt LR, Svensson A, Hesselstrand R, Lehti L, Rubin AT. Effects of intense pulsed light in microstomia in patients with systemic sclerosis: A pilot study. J Cosm LASER Ther. 2016;19(3):143-148.
Retameiro ACB, Neves M, Tavares AL, Boaro CT, Rodriguez DFS, Leal TSS, Costa RM, Bertolini GRF, Ribeiro LFC. Resistance exercise and low-level laser therapy improves grip strength and morphological aspects in the ankle joint of wistar rats with experimental arthritis. Anat Rec (Hpboken). 2023;306(4):918-932.
Alexanderson H, Bergegard J, Bjornadal L, Nordin A. Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study. BMC Res Notes. 2014:7:86.
Horvath J, Balint Z, Szep E, Deiszinger A, Minier T, Farkas N, Torok E, Horvathne Papp E, Komjati D, Mando Z, Czirjak L, Varju C. Efficacy of intensive hand physical therapy in patients with systemic sclerosis. Experi Rheumatol. 2017;35(s106):159-166.
Kwakkenbos L, Carrier M-E, Welling J, Levis B, Levis AW, Sauve M…Luc Mouthon on behalf of the SPIN Investigators. Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the scleroderma patient-centered intervention Network hand exercise program (SPIN-HAND) trial. Trials. 2022; 23:994-1002.
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