SLR - July 2021 - Brian A. Loring
Reference: Li S, Wang C, Wang B, Liu L, Tang L, Liu D, Yang G, Zhang L. Efficacy of Low-Level Light Therapy for Treatment of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Res Clin Pract. 2018 Sep;143:215-224. doi: 10.1016/j.diabres.2018.07.014. Epub 2018 Jul 23. PMID: 30009935.Level of Evidence: Level 1
Scientific Literature Review
Reviewed By: Brian A. Loring, DPM
Residency Program: Geisinger Community Medical Center – Scranton, PA
Podiatric Relevance: In this article, the authors perform a meta-analysis of randomized controlled trials utilizing low-level light therapy (LLLT) to evaluate the effectiveness in the treatment of diabetic foot ulcerations. Clinicians may be interested to learn about the efficacy of this modality for consideration of employing it in their podiatric practice.
Methods: Databases were searched for randomized controlled trials using search terms focused on generating articles where laser or low light therapy was used in the treatment of diabetic foot wounds. Ultimately, six studies were included in the publication for quantitative synthesis. Reduction of ulcer area, complete healing rate, time of ulcer closure, and granulation tissue formation were the main outcome measures in evaluating low-level light therapy against controls.
Results: A meta-analysis of six articles were used to demonstrate that low-level light (laser) therapy encourages wound healing in a statistically significant manner. This treatment modality was also shown to increase microvascular performance, however macrovascular perfusion was not impacted.
Of note, reduction of ulcer area was found to be 89 percent in LLLT treatment groups compared to 54 percent in control groups. One study included found a three-fold size reduction compared to control groups. Complete healing rate compared to control was found to have a combined odds ratio of 6.72. Median time of ulcer closure was found to be 7.14 weeks in one study compared with 11.5 in a control group. Another study found a median ulcer closure time of 11 weeks versus 14 weeks in the control group. Granulation tissue formation was found to be statistically greater with LLLT compared to control.
Interestingly, LLLT was also shown to decrease pain levels with one study demonstrating an average reduction of VAS score of 9 points in the LLLT group compared to 4.8 in the control group.
Conclusions: Low-level light therapy has had proven effectiveness in its ability to accelerate wound healing, increase granulation tissue formation, and reduce pain levels. No studies reported adverse events or side effects from treatment with this modality. Unfortunately, the research included in the meta-analysis included only Wagner grade one and two wounds.
In this reviewer’s opinion, LLLT may be of great interest to the podiatric clinicians due to its potential to quicken the treatment of diabetic foot ulcers and increase patient satisfaction. CPT codes are available for billing this treatment (including CPT S8948: Low-level laser treatment 15 min). With relatively low upfront cost and operational fees, a low-level light therapy device is an attractive treatment modality for the management of diabetic foot ulcerations.