Comparison of effectiveness of high intensity laser therapy against combined physical therapy (hotpack-tens-ultrasound) in patients with subacromial impingement syndrome (SIS)

ABSTRACT Comparison Of Effectiveness Of High Intensity Laser Therapy Against Combined Physical Therapy (Hotpack-TENS-Ultrasound) In Patients With Subacromial Ġmpingement Syndrome (SIS) Objective: The aim of this study was to compare high intensity laser therapy against combined physical therapy (hotpack-tens-ultrasound) modalities in patients with subacromial impingement syndrome (SIS) in terms of pain, functionality and effects on quality of life. Methods: 94 patients who referred to İnönü University Medical Faculty Hospital, Physical Medicine And Rehabilitation Policlinic and were diagnosed as SIS were randomly divided into two groups. Participants were advised not to take any medical treatment until the end of the study. 46 patients were selected for the first group. 7 patients were excluded from the study because they were taking medical treatment and 3 patients were excluded from the study because they didn‟t attend to the treatment sessions regularly. 48 patients were selected for the first group. 9 patients were excluded from the study because they were taking medical treatment and 3 patients were excluded from the study because they didn‟t attend to the treatment sessions regularly. Study was completed with 36 patients in each group. First group was subjected to a total of 9 sessions of therapy which comprised high intensity laser therapy for 3 days a week (every other day) for 3 weeks. Second group was subjected to subjected to a total of 15 sessions of therapy which comprised combined physical therapy (hotpack-tens-ultrasound) 5 days a week for 3 weeks. Both groups were subjected actively to a total of 15 sessions of codman pendulum exercises, range of motion exercises, exercises that strengthen muscles around the shoulder and stretching exercises accompanied by a physiotherapist 5 days a week for 3 weeks. Patients were evaluated before treatment, right after treatment and a month after treatment using Visual Analog Scale, Constant scoring system, Shoulder pain and disability index and SF-36 quality of life questionnaire. Results: Both groups showed statistically significant changes after treatment in all parameters. Laser therapy was found to be more effective than combined therapy according to Visual Analog Scale. When both groups were evaluated with Visual Analog Scale 4 weeks later, laser therapy showed similar effects to combined therapy. Shoulder pain and disability index scores showed that laser therapy was more effective than combined therapy in terms of statistically significant improvement and CONSTANT scores showed that both therapies were similar in efficiency. SF-36 sub-parameters showed that both therapies were similar in efficiency both right after treatment and 4 weeks after treatment. Conclusion: High intensity laser therapy modality is as effective as other conventional therapies in the treatment of subacromial impingement syndrome. High intensity laser therapy is shown to be more effective in the acute phase especially on pain scores. Keywords: Subacromial Impingement Syndrome, High Intensity Laser Therapy, Tens, Ultrasound