To the Editor: The EBM in Action article on laser treatment by Del Mar et al1 raises my anxiety about the reliability of evidence-based medicine (EBM) in general and, at the very least, the authors' assessment of the question they set out to answer. One is seldom, if ever, in a position to understand the breadth and depth of an issue unless it is the subject of particular study. Most of us can not challenge statements made in such articles without an intimate knowledge of the literature. As laser therapy is the topic of my PhD thesis, I am in a unique position to have much of the literature on the subject at my fingertips.
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- Castle Hill Medical Centre, Castle Hill, NSW.
- 1. Del Mar CB, Glasziou PP, Spinks AB, Sanders SL. Is laser treatment effective and safe for musculoskeletal pain? Med J Aust 2001; 175: 169.
- 2. Gam AN, Thorsen H, Lonnberg F. The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain 1993; 52: 63-66.
- 3. Bjordal JM, Greve G. What may alter the conclusion of reviews? Phys Ther Rev 1998; 3: 121-132.
- 4. Beckerman H, de Bie RA, Bouter L, et al. The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther 1992; 72: 483-491.
- 5. Gross AR, Aker PD, Goldsmith CH, Peloso P. Physical medicine modalities for mechanical neck disorders (Cochrane Review). In: The Cochrane Library, 1, 2000. Oxford: Update Software.
- 6. Basford JR, Sheffield CG, Harmsen WS. Laser therapy: a randomised, controlled trial of the effects of low-intensity Nd: YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil 1999; 80: 647-652.
- 7. Soriano F, Rios R. Gallium arsenide laser treatment of chronic low back pain: a prospective, randomized and double blind study. Laser Ther 1998; 10: 175-180.
- 8. Ely JW, Osheroff JA, Ebell MH, et al. Analysis of questions asked by family doctors regarding patient care. BMJ 1999; 319: 358-361.
- 9. Del Mar CB, Silagy CA, Glasziou PP, et al. Feasibility of an evidence-based literature search service for general practitioners. Med J Aust 2001; 175: 134-137.
- 10. Craig JA, Barron J, Walsh DM, Baxter GD. Lack of effect of combined low intensity laser therapy/phototherapy (CLILT) on delayed onset muscle soreness in humans. Lasers Surg Med 1999; 24: 223-230.
- 11. Basford JR, Sheffield CG, Cieslak KR. Laser therapy: a randomized, controlled trial of the effects of low intensity Nd: YAG laser irradiation on lateral epicondylitis. Arch Phys Med Rehabil 2000; 81: 1504-1510.
- 12. Bouter LM. Insufficient scientific evidence for efficacy of widely used electrotherapy, laser therapy, and ultrasound treatment in physiotherapy. Ned Tijdschr Geneeskd 2000; 144: 502-505.
- 13. Cochrane AL. Effectiveness and efficiency. Random reflections on health services. London: Nuffield Provincial Hospitals Trust, 1972. (Reprinted in 1989 in association with theBMJ.).