Low-level laser therapy for the treatment of osteoarthritis in the dog

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI--COLUMBIA AT REQUEST OF AUTHOR.] In veterinary medicine there is increasing interest in the use of low-level laser therapy (LLLT) for the treatment of pain in dogs with OA. Recently, a study found that 28% of US veterinarians referred patients to rehabilitation facilities for laser therapy. However, despite the common and established use of LLLT in veterinary medicine, there is a paucity of evidence supporting its efficacy in dogs with OA pain.2 Therefore, the goal of these studies was: 1) to investigate the use and economic impact of LLLT in veterinary practices within the State of Missouri for the treatment of OA; 2) to evaluate the efficacy of LLLT for the treatment of OA in clinical patients and provide the initial data for future clinical trials. The first study utilized a qualitative survey that was electronically distributed to practicing veterinarians in the state of Missouri. Its purpose was to evaluate the frequency of use and economic impact of low-level laser therapy (LLLT) for the treatment of osteoarthritis (OA) in dogs in Missouri. The survey response rate was 10% (89/867). Approximately half (43%) of respondents had LLLT units, of which all used LLLT for OA treatment in dogs. In respondents without LLLT units, 20% referred patients for LLLT OA treatment. Training was most often obtained in-house by a representative of the LLLT unit manufacturer (76%). Treatment dose was largely unknown and chosen by predetermined settings on the LLLT unit (65%). In the majority of patients (84%), no treatment site preparation was performed. An average of four patients with OA were treated per week with an average cost per treated joint of $28 (range: $15-45). This study provides insight into the current clinical use and estimated annual economic impact ($6.2 million per year) of treating a single OA joint in dogs with LLLT by Missouri veterinarians. The frequency with which LLLT is used in the treatment of OA combined with the variation in training and treatment protocols supports the need for further research regarding the application and efficacy of LLLT in dogs with OA. The second study evaluated the use of LLLT for the treatment of naturally occurring osteoarthritis in dogs'--utilizing both objective and subjective outcome measures. Patients were enrolled and randomly assigned to one of two treatment groups: 1) LLLT and 2) sham. Objective outcome measures were obtained from force plate analysis [(peak vertical force (PVF), vertical impulse (VI), craniocaudal braking force (Fy-braking), craniocaudal propulsion force (Fypropulsion), craniocaudal braking impulse (Iy-braking), and craniocaudal propulsion impulse (Iy-propulsion)] and kinematic evaluation (joint range-of-motion) and subjective outcome measures were obtained with the use of the Canine Brief Pain Index (CBPI). All outcome measures were obtained at a baseline evaluation and prior to treatments. Normality testing was performed with the D'Agostino-Pearson omnibus test and all data comparisons were performed with statistical software (GraphPad Prism version 6.00, GraphPad Software, San Diego California). All hypothesis tests were 2-sided and the significance level set at [alpha] = 0.05. No differences were found between the LLLT and sham treated groups for all variables. This study provided the initial data required for future clinical trial design.