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The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews
The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer–related lymphedema (BCRL). In addition, an updated and comprehensive...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer London
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8971164/ https://www.ncbi.nlm.nih.gov/pubmed/34779937 http://dx.doi.org/10.1007/s10103-021-03446-3 |
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author | Wang, Yuping Ge, Yonggui Xing, Wenting Liu, Junping Wu, Jiqi Lin, Haijuan Lu, Yaqin |
author_facet | Wang, Yuping Ge, Yonggui Xing, Wenting Liu, Junping Wu, Jiqi Lin, Haijuan Lu, Yaqin |
author_sort | Wang, Yuping |
collection | PubMed |
description | The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer–related lymphedema (BCRL). In addition, an updated and comprehensive systematic review was conducted, which aimed to provide updated evidence about this topic. PubMed, EMBASE, and Cochrane Library databases were systematically searched for systematic reviews and randomized controlled trials (RCTs) investigating the effectiveness and safety of LLLT in patients with BCRL. The methodological quality for each of included systematic reviews or RCTs was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool or Cochrane risk of bias tool, respectively. The updated systematic review separately compared the effectiveness of LLLT to each of active or negative interventions. Data were pooled with random-effects models for each outcome per comparison. The evidence quality of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) or GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) for quantitative studies and qualitative studies, respectively. Seven systematic reviews and ten RCTs met the eligibility criteria. Conflicting results regarding the effectiveness of LLLT were presented by the overview of systematic reviews. The AMSTAR 2 showed that the methodological quality of included systematic reviews was low or critically low quality due to one or more critical weaknesses. The GRADE and GRADE-CERQual showed that the evidence quality was low to very low for most outcomes. The updated systematic review showed that LLLT may offer additional benefits as compared to compression therapies (pneumatic compression or compression bandage), placebo laser, or no treatment for patients with BCRL. However, when compared to other types of active interventions, LLLT did not improve outcomes significantly. None of the treatment-related adverse event was reported. Many trials had a high or unclear risk of bias for two or more items, and our updated systematic review showed low quality of evidence per outcome using GRADE approach. Due to insufficient data and poor quality of evidence, there is uncertain to reach these conclusions that LLLT is superior to another active or negative intervention and is safe. More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed to inform clinical guidelines and routine practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10103-021-03446-3. |
format | Online Article Text |
id | pubmed-8971164 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer London |
record_format | MEDLINE/PubMed |
spelling | pubmed-89711642022-04-07 The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews Wang, Yuping Ge, Yonggui Xing, Wenting Liu, Junping Wu, Jiqi Lin, Haijuan Lu, Yaqin Lasers Med Sci Review Article The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer–related lymphedema (BCRL). In addition, an updated and comprehensive systematic review was conducted, which aimed to provide updated evidence about this topic. PubMed, EMBASE, and Cochrane Library databases were systematically searched for systematic reviews and randomized controlled trials (RCTs) investigating the effectiveness and safety of LLLT in patients with BCRL. The methodological quality for each of included systematic reviews or RCTs was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool or Cochrane risk of bias tool, respectively. The updated systematic review separately compared the effectiveness of LLLT to each of active or negative interventions. Data were pooled with random-effects models for each outcome per comparison. The evidence quality of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) or GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) for quantitative studies and qualitative studies, respectively. Seven systematic reviews and ten RCTs met the eligibility criteria. Conflicting results regarding the effectiveness of LLLT were presented by the overview of systematic reviews. The AMSTAR 2 showed that the methodological quality of included systematic reviews was low or critically low quality due to one or more critical weaknesses. The GRADE and GRADE-CERQual showed that the evidence quality was low to very low for most outcomes. The updated systematic review showed that LLLT may offer additional benefits as compared to compression therapies (pneumatic compression or compression bandage), placebo laser, or no treatment for patients with BCRL. However, when compared to other types of active interventions, LLLT did not improve outcomes significantly. None of the treatment-related adverse event was reported. Many trials had a high or unclear risk of bias for two or more items, and our updated systematic review showed low quality of evidence per outcome using GRADE approach. Due to insufficient data and poor quality of evidence, there is uncertain to reach these conclusions that LLLT is superior to another active or negative intervention and is safe. More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed to inform clinical guidelines and routine practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10103-021-03446-3. Springer London 2021-11-15 2022 /pmc/articles/PMC8971164/ /pubmed/34779937 http://dx.doi.org/10.1007/s10103-021-03446-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Article Wang, Yuping Ge, Yonggui Xing, Wenting Liu, Junping Wu, Jiqi Lin, Haijuan Lu, Yaqin The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title | The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title_full | The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title_fullStr | The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title_full_unstemmed | The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title_short | The effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: An overview and update of systematic reviews |
title_sort | effectiveness and safety of low-level laser therapy on breast cancer–related lymphedema: an overview and update of systematic reviews |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8971164/ https://www.ncbi.nlm.nih.gov/pubmed/34779937 http://dx.doi.org/10.1007/s10103-021-03446-3 |
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