***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The aim of the study was to estimate the influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis . MATERIAL AND METHODS 125 patients were r and omly assigned to 4 groups : • group I received one-wave laser irradiation ( wave length 810 nm , dose 8 J/point ) • group II received two-wave MLS laser irradiation ( power 1100 mW , frequency 2000 Hz , dose 12.4 J/point ) • group III received a similar regimen of two-wave MLS laser irradiation , but at a dose of 6.6 J per point • group IV was a placebo group where laser therapy procedures were simulated without actual irradiation . The effectiveness of the therapy was evaluated by means of Lequesne 's scale , a modified Laitinen question naire and a visual analogue scale ( VAS ) . Statistical analysis utilised non-parametric Wilcoxon 's and Mann-Whitney 's tests . Calculations were carried out with MedCalc v. 11.6.1.0 . RESULTS Statistically significant improvements in knee joint function and pain relief were seen in all groups ( I , II and III ) . When groups I , II and III were compared , the largest improvement was found in group II ( MLS laser , dose 12.4 J/point ) . The degrees of improvement in groups I and III were similar . CONCLUSIONS One-wave laser irradiation at a dose of 8 J per point and two-wave laser irradiation with doses of 12.4 J and 6.6 J per point significantly improved knee joint function and relieved knee pain in patients with osteoarthritis BACKGROUND AND OBJECTIVES A prospect i ve , double-blind , r and omized , and controlled trial was conducted in patients with knee osteoarthritis ( OA ) to evaluate the efficacy of infrared low-power Gallium-Arsenide ( Ga-As ) laser therapy ( LPLT ) and compared two different laser therapy regimes . STUDY DESIGN / MATERIAL S AND METHODS Ninety patients were r and omly assigned to three treatment groups by one of the nontreating authors by drawing 1 of 90 envelopes labeled ' A ' ( Group I : actual LPLT consisted of 5 minutes , 3 J total dose + exercise ; 30 patients ) , ' B ' ( Group II : actual LPLT consisted of 3 minutes , 2 J total dose + exercise ; 30 patients ) , and ' C ' ( Group III : placebo laser group + exercise ; 30 patients ) . All patients received a total of 10 treatments , and exercise therapy program was continued during study ( 14 weeks ) . Subjects , physician , and data analysts were unaware of the code for active or placebo laser until the data analysis was complete . All patients were evaluated with respect to pain , degree of active knee flexion , duration of morning stiffness , painless walking distance and duration , and the Western Ontario and Mc Master Universities Osteoarthritis Index ( WOMAC ) at week 0 , 6 , 10 , and 14 . RESULTS Statistically significant improvements were indicated in respect to all parameters such as pain , function , and quality of life ( QoL ) measures in the post-therapy period compared to pre-therapy in both active laser groups ( P < 0.01 ) . Improvements in all parameters of the Group I and in parameters , such as pain and WOMAC of the Group II , were more statistically significant when compared with placebo laser group ( P < 0.05 ) . CONCLUSIONS Our study demonstrated that applications of LPLT in different dose and duration have not affected results and both therapy regimes were a safe and effective method in treatment of knee OA Objectives : To estimate the effects of low level laser therapy in combination with a programme of exercises on pain , functionality , range of motion , muscular strength and quality of life in patients with osteoarthritis of the knee . Design : A r and omized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups . Setting : Special Rehabilitation Services . Subjects : Forty participants with knee osteoarthritis , 2–4 osteoarthritis degree , aged between 50 and 75 years and both genders . Intervention : Participants were r and omized into one of two groups : the laser group ( low level laser therapy dose of 3 J and exercises ) or placebo group ( placebo laser and exercises ) . Main measures : Pain was assessed using a visual analogue scale ( VAS ) , functionality using the Lequesne question naire , range of motion with a universal goniometer , muscular strength using a dynamometer , and activity using the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) question naire at three time points : ( T1 ) baseline , ( T2 ) after the end of laser therapy ( three weeks ) and ( T3 ) the end of the exercises ( 11 weeks ) . Results : When comparing groups , significant differences in the activity were also found ( P = 0.03 ) . No other significant differences ( P > 0.05 ) were observed in other variables . In intragroup analysis , participants in the laser group had significant improvement , relative to baseline , on pain ( P = 0.001 ) , range of motion ( P = 0.01 ) , functionality ( P = 0.001 ) and activity ( P < 0.001 ) . No significant improvement was seen in the placebo group . Conclusion : Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief , function and activity on patients with osteoarthritis of the knees Objective The aim of this study was to evaluate the effects of an exercise training protocol and low-level laser therapy ( and the association of both treatments ) on musculoskeletal atrophy using an experimental model of knee osteoarthritis ( OA ) . Design Fifty male Wistar rats were r and omly divided into five groups : control group , knee OA control group , OA plus exercise training group , OA plus low-level laser therapy group , and OA plus exercise training associated with low-level laser therapy group . The exercise training and the laser irradiation started 4 wks after the surgery , 3 days per week for 8 wks . The exercise was performed at a speed of 16 m/min , 3 days per week , 50 mins per day , for 8 wks . Laser irradiation was applied at two points of the left knee joint ( medial and lateral ) , for 24 sessions . Results The results showed that both trained groups ( irradiated or not ) presented a significant increase in the muscle cross-sectional area and a decrease in muscle fiber density compared with the knee OA control group . Moreover , both trained and laser-irradiated groups demonstrated decreased muscle-specific ring-finger protein 1 and atrogin-1 immunoexpression . Conclusions These results suggest that exercise training and low-level laser therapy were effective in preventing musculoskeletal alterations related to atrophy caused by the degenerative process induced by knee OA Background Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment , cartilage , and other structures necessary to joint stability . There is a need to investigate therapeutic re sources that combine different wavelengths as well as different light sources ( low-level laser therapy and light-emitting diode therapy ) in the same apparatus for the treatment of osteoarthritis . The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise  program for individuals with osteoarthritis of the knee . Methods / Design A double-blind , controlled , r and omized clinical trial will be conducted involving patients with osteoarthritis of the knee . Evaluations will be performed using functional question naires before and after the treatment protocol s , in a reserved room with only the evaluator and participant present , and no time constraints placed on the answers or evaluations . The following functional tests will also be performed : stabilometry ( balance assessment ) , dynamometry ( muscle strength of gluteus medius and quadriceps ) , algometry ( pain threshold ) , fleximeter ( range of motion ) , timed up- and -go test ( functional mobility ) , and the functional reach test . The participants will then be allocated to three groups through a r and omization process using opaque envelopes : exercise program , exercise program + phototherapy , or exercise program + placebo phototherapy , all of which will last for eight weeks . Discussion The purpose of this r and omized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee . The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee . Data will be published after the study is completed . Trial registration The protocol for this study has been su bmi tted to Clinical Trials , registration number NCT02102347 , on 29 March 2014 IMPORTANCE There is debate about benefits of acupuncture for  knee pain . OBJECTIVE To determine the efficacy of laser and needle acupuncture for  chronic knee pain . DESIGN , SETTING , AND PARTICIPANTS Zelen- design clinical trial ( r and omization occurred before informed consent ) , in Victoria , Australia ( February 2010-December 2012 ) . Community volunteers ( 282 patients aged ≥50 years with chronic knee pain ) were treated by family physician acupuncturists . INTERVENTIONS No acupuncture ( control group , n = 71 ) and needle ( n = 70 ) , laser ( n = 71 ) , and sham laser ( n = 70 ) acupuncture . Treatments were delivered for 12 weeks . Participants and acupuncturists were blinded to laser and sham laser acupuncture . Control participants were unaware of the trial . MAIN OUTCOMES AND MEASURES Primary outcomes were average knee pain ( numeric rating scale , 0 [ no pain ] to 10 [ worst pain possible ] ; minimal clinical ly important difference [ MCID ] , 1.8 units ) and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , 0 [ no difficulty ] to 68 [ extreme difficulty ] ; MCID , 6 units ) at 12 weeks . Secondary outcomes included other pain and function measures , quality of life , global change , and 1-year follow-up . Analyses were by intention-to-treat using multiple imputation for missing outcome data . RESULTS At 12 weeks and 1 year , 26 ( 9 % ) and 50 ( 18 % ) participants were lost to follow-up , respectively . Analyses showed neither needle nor laser acupuncture  significantly improved pain ( mean difference ; -0.4 units ; 95 % CI , -1.2 to 0.4 , and -0.1 ; 95 % CI , -0.9 to 0.7 , respectively ) or function ( -1.7 ; 95 % CI , -6.1 to 2.6 , and 0.5 ; 95 % CI , -3.4 to 4.4 , respectively ) compared with sham at 12 weeks . Compared with control , needle and laser acupuncture result ed in modest improvements in pain ( -1.1 ; 95 % CI , -1.8 to -0.4 , and -0.8 ; 95 % CI , -1.5 to -0.1 , respectively ) at 12 weeks , but not at 1 year . Needle acupuncture result ed in modest improvement in function compared with control at 12 weeks ( -3.9 ; 95 % CI , -7.7 to -0.2 ) but was not significantly different from sham ( -1.7 ; 95 % CI , -6.1 to 2.6 ) and was not maintained at 1 year . There were no differences for most secondary outcomes and no serious adverse events . CONCLUSIONS AND RELEVANCE In patients older than 50 years with moderate or severe chronic knee pain , neither laser nor needle acupuncture conferred benefit over sham for pain or function . Our findings do not support acupuncture for these patients . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12609001001280 Inflammation of synovial membrane and degeneration of articular cartilage in osteoarthritis ( OA ) lead to major changes in joint space width ( JSW ) and biochemical components such as collagen-II telopeptide ( CTX-II ) and matrix metallo protineases ( MMP-3 , 8 , and 13 ) . Low-level laser therapy ( LLLT ) is thought to have an analgesic effect as well as biomodulatory effect on microcirculation and cartilage regeneration in animal studies . The objective of this study was to examine the analgesic and biochemical effect of LLLT in patients with knee osteoarthritis . Subjects ( n = 34 ) who fulfilled the selection criteria were r and omly divided into active group ( n = 17 ) and  placebo group . Subjects in active group were irradiated laser with the frequency of 3 days per week for 4 weeks with the specific parameters on 8 different points on the joint at 1.5 J per point for 60 s for 8 points for a total dose of 12 J in a skin contact method . The placebo group was treated with the same probe with minimum emission of energy . Visual analog scale for pain intensity , joint space width , collagen-II telopeptide , and matrix metallo protinease-3 , 8 , and 13 was measured before treatment and at 4 and 8 weeks following treatment . Data are analyzed with mean values and st and ard deviation with p < 0.05 . Baseline values of all outcome measures show insignificant difference ( p > 0.05 ) in both groups which shows homogeneity . After 4- and 8-week treatment , active laser group shows more significant difference ( p 
    Output:
    
Disability was also statistically significantly reduced by LLLT .
LLLT reduces pain and disability in KOA at 4 - 8 J with 785 - 860 nm wavelength and at 1 - 3 J with 904 nm wavelength per treatment spot .