PICO
Patient/Population
Combat soldiers/policemen Anterior knee pain
(n=26)
Intervention
Photobiomodulation (PBM) + Photobiomodulation (PT)
Comparison
PT + Sham PBM
Outcomes
Pain
Functional abilities
Translatability: (3/3) Easy 
Comments: “Addition of Photobiomodelation to Physiotherapy for AKP resulted in earlier reduction in pain and improved functionality, compared with PT alone.”
Limitations: Small sample (n=26); non iqual pt interventions.
Appraisals:
PEDro Scale – (8/10) Concealed allocation: No; Blind therapists: No.(by PEDro – confirmed)
Risk of Bias – (3/4) Allocation concealment: high/nuclear. (by RobotReviewer)
BTB
Intervention – 1
- PBM
Dose
- 1+2 – 660/850 nm LED cluster – 50 mW/cm2, pulsed 2.5 Hz, 1390 mW total, 1 mn per application point (3 J/cm2
- 3 – 810 nm single‐point laser – 200 mW,4.75 W/cm 2, 30 Scs per application point (6 J, 142.5 J/cm2)
- 4 – 5 × 810 nm, cluster – 200 mW, 6 W/cm2, 30 seconds per application point (6 J, 180 J/cm2 per laser diode).
Periodicity
- 4 weeks, biweekly 30‐mn sessions: the first weekly session included PBM/Sham + PT and the second weekly session included only PBM/Sham (total no. of treatments = 8 × PBM/Sham + 4 × PT)
Local/Technic:
1 – 1 application to popliteal and inguinal lymph nodes with the LED cluster to reduce inflammation and stimulate drainage of edema;
2 – 4 applications around the patella, LED cluster, with another 2 applications over the area of maximum pain to reduce inflammation and stimulate repair;
3 – treatment of 3 to 6 muscle trigger points around the knee using the single-point laser;
4 – treatment over the spinous processes and ipsilateral nerve root exits of L2-L5 (innervation of the knee joint) for analgesia using the Laser Cluster.
Intervention – 2
- PT
Dose
- “According to the best clinical judgment of the physiotherapist”
Periodicity
- —
Local/Technic:
- “One or more of the following: stretching and strengthening of relevant muscles, soft tissue manipulation, hot packs, proprioceptive training, dry needling, electrotherapy, and taping (kinesio, rigid).”
Citation:
Gavish, L., Spitzer, E., Friedman, I., Lowe, J., Folk, N., Zarbiv, Y., Gelman, E., Vishnevski, L., Fatale, E., Herman, M., Gofshtein, R., Gam, A., Gertz, S. D., Eisenkraft, A., & Barzilay, Y. (2021). Photobiomodulation as an Adjunctive Treatment to Physiotherapy for Reduction of Anterior Knee Pain in Combat Soldiers: A Prospective, Double-Blind, Randomized, Pragmatic, Sham-Controlled Trial. Lasers in surgery and medicine, 10.1002/lsm.23442. Advance online publication. https://onlinelibrary.wiley.com/doi/10.1002/lsm.23442
Comments by the author Dr. Lilach Gavish, posted with his permission :
“1. This was a double blinded study. The patient and the evaluators (orthopedic team) did not know the group allocation. Triple blinding is not a requirement for a quality study. Initially, I supplied the therapist with special goggles because we used red light as part of the PBM treatment. However, I cannot be sure that they were always used and hence did not write that in the article.
2. Regarding the small sample size, working with the military is very difficult because they move the soldiers to different parts of the country regardless of the study (they have other priorities). So many times we found ourselves with a potential eligible group, but a week later we were informed that they are moving for 2 weeks to somewhere else. Believe me, recruitment was very frustrating.
3. We did not interfere with the clinical judgment of the physiotherapist. Every participant came to our study because they had anterior knee pain. But every patient is different in his/her needs. We did not want to prevent the patient from receiving the best standard care. This also makes the study results more applicable to the real world and that is why we added the word “pragmatic” to the title.”