Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.

<p>Abbreviations: RR – risk ratio; CI – confidence interval; HSCT – hematopoietic stem cell transplantation.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 with 95% CIs that do not include 1, suggests that low level laser is better than placebo/no therapy.</p><p>Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.</p

Summary of outcomes of low level laser therapy as compared to placebo/no treatment.

<p>Abbreviations: RR - risk ratio; SMD - standardized mean difference; WMD – weighted mean difference; CI – confidence interval;</p><p>*Maximum anticipated mucositis was week 6±1 in head and neck cancer radiotherapy/chemo-radiotherapy trials and day 10±4 in chemotherapy and hematopoietic stem cell transplantation trials (from date of chemotherapy initiation and stem cell infusion respectively).</p><p>** Severe pain defined as a visual analogue scale score >7.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 and a standardized mean difference or weighted mean difference <0 with 95% CIs that do not include 1 or 0 respectively, suggest that low level laser is better than placebo/no therapy.</p><p>Summary of outcomes of low level laser therapy as compared to placebo/no treatment.</p

Forest plot of overall incidence of severe (grade 3 or 4) mucositis.

<p>Squares to the left of the vertical line indicate that low level laser therapy reduces mucositis. Horizontal lines through the squares represent 95% confidence intervals (CIs). The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI.</p

Flow diagram of trial identification and selection.

<p>Flow diagram of trial identification and selection.</p

Baseline characteristics of studies included in the meta-analysis^*.

<p>Abbreviations: Allo - allogeneic hematopoietic stem cell transplant; Auto-autologous hematopoietic stem cell transplant; Chemo – chemotherapy; EORTC-European Organization for Research and Treatment of Cancer; GaAIAs/AsGaAI – gallium-aluminium-arsenide/arsenate; He-Ne- helium-neon; HSCT – hematopoietic stem cell transplantation; InGaAIP – indium-gallium-aluminium phosphide; LED – light emitting diode; NA – not available; NCI CTC – National Cancer Institute Common Terminology Criteria; OMAS – Oral Mucositis Assessment Scale; OMI - Oral Mucositis Index; Pub – published; Radio- radiotherapy; RTOG – Radiation Therapy Oncology Group; VAS – visual analog scale; WHO – World Health Organization.</p><p>*There were 18 studies reporting 19 separate comparisons between low level light therapy and placebo/no therapy as one study stratified the population by underlying disease diagnosis and HSCT regimen.</p><p>Baseline characteristics of studies included in the meta-analysis^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107418#nt102" target="_blank">*</a>}.</p

Funnel plot “trim and fill” technique assessing publication bias for overall incidence of severe mucositis.

<p>The x-axis represents the risk ratio for the effect of low level laser therapy and the y-axis represents the inverse of the variance of the effect. Estimated number of missing studies on right side = 4.</p