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Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials had a B level of evidence. The main outcomes that were measured were balance, fatigue, disability index, health-related quality of life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion. Whole-body vibration could be an adequate treatment for fibromyalgia as a main therapy or added to a physical exercise programme as it could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated with caution because the paucity of trials and the marked differences between existing trials in terms of protocol, intervention, and measurement tools hampered the comparison of the trials.
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Review Article
Effects of Whole-Body Vibration Therapy in Patients with
Fibromyalgia: A Systematic Literature Review
Daniel Collado-Mateo,1Jose C. Adsuar,1Pedro R. Olivares,1,2 Borja del Pozo-Cruz,1,3
Jose A. Parraca,1,4 Jesus del Pozo-Cruz,1,5 and Narcis Gusi1
1Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
2Universidad Aut´
onoma de Chile, 3460000 Talca, Chile
3Department of Sport and Exercise Science, e University of Auckland, Auckland 1142, New Zealand
4Faculty of Sport and Physical Education, University of ´
Evora, 7005-399 ´
Evora, Portugal
5Department of Physical Education and Sport, University of Seville, 41013 Seville, Spain
Correspondence should be addressed to Narcis Gusi; ngusi@unex.es
Received  February ; Revised  March ; Accepted  April 
Academic Editor: Li-Wei Chou
Copyright ©  Daniel Collado-Mateo et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Objective. To review the literature on the eects of whole-body vibration therapy in patients with bromyalgia. Design.Systematic
literature review. Patients. Patients with bromyalgia. Methods. An electronic search of the literature in four medical databases was
performed to identify studies on whole-body vibration therapy that were published up to the th of January . Results.Eight
articles satised the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials
had a B level of evidence. e main outcomes that were measured were balance, fatigue, disability index, health-related quality of
life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion.Whole-
body vibration could be an adequate treatment for bromyalgia as a main therapy or added to a physical exercise programme as it
could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated
with caution because the paucity of trials and the marked dierences between existing trials in terms of protocol, intervention, and
measurement tools hampered the comparison of the trials.
1. Introduction
Fibromyalgia (FM) is a chronic disorder of unknown aetiol-
ogy. It is characterised by widespread noninammatory pain
and tenderness that persists for at least  months and by an
acute response in at least  of  specied tender points when
these points are digitally palpated with a pressure of  kg/cm2
[]. FM is associated with several symptoms, including
fatigue, disrupted sleep, impaired cognition, poor physical
tness, headaches, arthritis, muscle spasm, tingling, and bal-
ance problems [,]. ese symptoms reduce the health-
related quality of life (HRQoL) of people with FM [].
In European populations (Spain, Portugal, France, Ger-
many, and Italy), the estimated overall prevalence of FM
is between .% and .% []. Consequently, this disorder
imposes a signicant economic burden due to healthcare
costs and the inability of the patients to work []. In fact, FM
accounts for –% of all new patient contacts in primary
care settings [].
Several therapies have been used to treat the symptoms
associated with FM, including pharmacological and non-
pharmacological therapies. ere is strong evidence show-
ing that both pharmacological and nonpharmacological
approachescanbeeective[]. Nonpharmacological thera-
pies include physical therapies such as yoga, tai chi, walking,
and whole-body vibration (WBV) []. WBV is a physical
therapythatwasshowntoimprovemusclestrength[], bo dy
balance [], gait mobility [], cardiorespiratory tness [],
bone-density [], and pain [] in healthy and various clin-
ical populations.
WBV can be delivered by two types of exercise platform.
One is a sinusoidal vibration device that induces reciprocal
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2015, Article ID 719082, 11 pages
http://dx.doi.org/10.1155/2015/719082
Evidence-Based Complementary and Alternative Medicine
vertical displacements on the le and right sides of a fulcrum
and generates higher lateral acceleration than vertical accel-
eration. e second is a vertical vibration device that induces
up-and-down oscillations over a vertical axis and produces
high strain in the vertical axis []. e intensity of vibration
is determined by three parameters [], namely, amplitude,
frequency, and oscillation acceleration.
Some studies suggested that WBV therapy may improve
balance, pain, and fatigue. e mechanisms behind these
eectsarenotclearbutmayrelatetothefollowing.
() WBV elevates heart rate and oxygen uptake, which
could translate to improved cardiorespiratory tness
over the long term [].
() WBV may inuence the neuromuscular system and
improve reex responses, especially in patients who
have altered reex generation. is may be related to
the ability of vibration to (a) stimulate subcutaneous
proprioceptors, (b) activate muscle spindles, thereby
causing muscle contraction, and (c) stimulate Golgi
tendon organs, thereby improving tonic and antago-
nist vibration reexes []. WBV may also promote
adaptation of human cutaneous sensors in the sole of
the foot [].
() WBV may reduce the perception of pain because
vibration aects the aerent discharge of fast adapting
mechanoreceptors and muscle spindles [].
Potential harmful eects of vibration exposure have been
found in industrial workers, and vibration is recognised as an
industrial hazard. Prolonged exposures can induce vascular
and neurological injuries, and legal limits have been set in
numerous countries []. erefore, any training protocol has
to maximize the potential benets while reducing the poten-
tial adverse side eects. To our knowledge, WBV-related
adverse eects have not been reported in any studies that
focusedonFM.
To our knowledge, there is one review that examined
the eect of WBV therapy on FM-associated symptoms [].
However, this review only examined three articles, all of
which were published between  and . Another ve
articles on WBV therapy in FM have been published ever
since. e aim of the present review was to provide an up-
to-date analysis of the research on the eect of WBV on
FM-associated symptoms, including poor balance, fatigue,
pain, and poor HRQoL. e ultimate objective was to provide
future directions in clinical practice.
2. Materials and Methods
Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) methodology was employed to carry out
this systematic review [].
2.1. Electronic Database Searches and Article Selection Strategy.
To locate the articles reported in this systematic review,
four well-known electronic databases were selected, and a
list of terms and compounded terms was prepared. ese
activities were supervised by medical library science experts
Potential studies identied
(i) Clearly not meeting inclusion
Articles analysed in more
Not a randomised controlled
Articles selected and
(n=68)
Excluded (n=57)
criteria (n = 33)
(ii) Duplicated (n=24)
detailed (n=11)
Excluded (n = 3)
trial (n = 3)
analysed (n = 8)
F : Flow chart delineating the complete systematic review
process that was followed.
and experts in the eld of WBV in FM. e databases were
the Cochrane Library (–present), the Physiotherapy
Evidence Database (PEDro; –present), PubMed (–
present), and TRIP (–present). e articles were located
using the key words “bromyalgia” and “vibration” and the
Boolean operator “AND”. Duplicate articles were manually
removed by one of the authors.
Figure  shows a ow chart delineating the complete sys-
tematic review process. e articles were indexed according
to whether they met all of the following inclusion criteria: (a)
thestudyfocusedonWBVtherapy,(b)thestudycohortonly
consistedofpeoplewithFM,(c)thestudywasarandomised
controlled trial (RCT), (d) the whole publication was written
in English, and (e) the article was an original clinical study.
Studies were excluded if they met any of the following criteria:
(a) the study examined the eects of exposure to vibration
within industry or employment of labour and transport and
(b)thestudywasonlypresentedonceasasummaryata
conference, congress, or seminar. e articles were selected
by two independent experts. Disagreements were resolved
through group discussions until a mutual consensus was
reached. e search was nalized on the th of January ,
with no submission deadline being imposed.
2.2. Assessing the Risk of Bias. ePEDroscalewasusedto
assess the risk of bias in the selected articles. is is a scale that
rates the methodological quality of RCTs that evaluate phys-
ical therapist interventions. is scale was chosen because of
its special design and capacity to provide a global overview
of the external and internal validity of the studies []. Each
article was graded by one of the authors, and this grading was
supervised by another author with experience in this task.
Table  shows the consensus results for each article.
2.3. Determining the Level of Evidence. e level of evidence
was determined using the guidelines of the Dutch Institute
Evidence-Based Complementary and Alternative Medicine
T : Risk of bias and level of evidence.
Clinical trial Reference Response to each item on the PEDro scale Level of evidence
 Totalscore
Alentorn-Geli et al. [] yynyy nyyn y Y B
[] yynyy nnyn y Y B
Gusi et al.
[] yyyynnyyy y Y B
[] yyyynnyyy y Y B
[]yyyynnyynyY  B
Sa˜
nudo et al. []yyyynnnynyY  B
[]yyyynnnynyY  B
Sa˜
nudo et al. []yyyynnnyyyY  B
n: criterion not fullled; y: criterion fullled; : eligibility criteria were specied; : subjects were randomly allocated to groups or to a treatment order; :
allocation was concealed; : the groups were similar at baseline; : there was blinding of all subjects; : there was blinding of all therapists; : there was blinding
of all assess ors; : measures of at least one key outcome w ere obtained from more than % of the subj ects who were initially a llocated to groups; : intention-to-
treat analysiswas performed on all subjects who received the treatment or controlcondition as allocated; : theresultsofbetween-groupstatistical comparisons
are reported for at least one key outcome; : the study provides both point measures and measures of variability for at least one key outcome; total score: each
satised item (except the rst) contributes  point to the total score, yielding a PEDro scale score that can range from  to . B: the level of evidence was B
(randomised control trials that lacked double-blinding) (see the Appendix).
for Healthcare Improvement (CBO) []. Table  shows the
results.
2.4. Data Extraction and the Main Measurements Examined.
Data were extracted from the selected articles by one of
the authors. is extraction was checked by another author.
Any disagreement was discussed and ultimately resolved by
a third author if the contact with the original author of the
article could not be established.
For each selected article, the following data were
extracted: (a) the sample and protocol characteristics, namely,
thesamplesize,age,andactivityofthecontrolandWBV
groups (Tab l e  )and(b)thevibrationtherapydetails,namely,
thetypeofdeviceanditsoscillationacceleration,frequency,
and amplitude; the duration of the intervention; the number
of WBV sessions; and the number of vibration series, the rest
period, and the exposure duration in each series (Tab l e  ).
3. Results
3.1. Article Selection. Figure  depicts the process that was
followed in this systematic review. In total,  articles were
found in the electronic search of the Cochrane Library (
articles), PubMed ( articles), Trip ( articles), and PEDro
(eight articles). Aer removing the duplicates,  references
werereviewed.Ofthese,wereexcludedbecauseareviewof
their summaries revealed that the study clearly did not meet
the inclusion criteria. e remaining  articles were then
analysed in more depth to determine whether they satised
the inclusion and exclusion criteria. is led to the exclusion
of three articles because they were not RCTs. Finally, eight
articles belonging to four dierent trials were included in our
systematic review.
3.2. Risk of Bias. Table  shows the risk of bias of each of the
four RCTs, as indicated by the PEDro scale score. All  articles
were on RCTs because this was an inclusion criterion. e
PEDroscalescorerangedfromtopoints(themaximum
score was  points). e average (SD) score was . (.).
e poorest scores were obtained for questions ve (“there
was blinding of all subjects”), six (“there was blinding of all
therapists”; this reects the fact that it is dicult to blind a
WBV therapist), and nine (“intention-to-treat analysis was
performed on all subjects who received the treatment or con-
trol condition as allocated”). Good scores were obtained for
questions one (“eligibility criteria were specied”), two (“sub-
jects were randomly allocated to groups or to a treatment
order”), four (“the groups were similar at baseline”), eight
(“measures of at least one key outcome were obtained from
more than % of the subjects initially allocated to groups”),
 (“the results of between-group statistical comparisons are
reportedforatleastonekeyoutcome),and(thestudy
provides both point measures and measures of variability for
at least one key outcome”).
3.3. Level of Evidence. Table  also indicates the level of evi-
dence in each study. All eight articles had a B level of evidence
because; although every article reported the results of an
RCT, none of these RCTs was double-blind. Table  shows the
level of conclusion according to the Dutch CBO guidelines
(in the appendix). e score ranged from  to  because
only four dierent RCTs were reviewed, all of which had a
B level of evidence.
3.4. Study Characteristics. Tables ,,andsummarize the
study characteristics using the PICOS (Patients, Intervention,
Control, Outcomes, and Study design) approach []. All
four RCTs were performed with adult and elderly women
withFM,andthesamplesizevariedfrom[]to[]
participants.
3.5. WBV Equipment. Two RCTs us ed the Powe r Plat e
vibratory platform [], and the other two RCTs used
the Galileo vibratory platform []. e Galileo plat-
form produces a horizontal sine-wave vibration, whereas the
Power Plate platform produces a vertical sine-wave vibration
(Figure ).
Evidence-Based Complementary and Alternative Medicine
T : Sample characteristics and protocol.
Clinical trial
Sample characteristics Protocol
Reference Tot a l s a m ple
size (𝑛)
Age of whole
cohort (mean ±
SD) (years)
Treatment of the control
group(s)
Tre atmen t of the
vibration group WBV protocol
Alentorn-Geli et
al.
[]
[]
*
*
. ±.
. ±.
Static and dynamic tasks on a
vibratory platform without
vibratory stimulus
EG: traditional physical
exercise plus static and
dynamic tasks on a vibratory
platform without vibratory
stimulusCG:noexercise
programme
Static and dynamic tasks
with a WBV protocol
Traditional exercise,
followed by static and
dynamic tasks with a
WBV protocol
Static and dynamic tasks on a vibratory platform with vibratory
stimulus:
(a) Static squat at of knee exion
(b) Dynamic squat between and of knee exion
(c) Maintenance of ankle plantar exion with legs in extension
(d) Flexion-extension of the right leg between and of
knee exion
(e) Flexion-extension of the le leg between and of
knee exion
(f) Squat at of knee exion, shiing the body weight from
one leg to the other
Gusi et al.
[]
[]
[]
*
**
*
**
*
–
–
–
None WBV protocol
e stance of the participants on the platform alternated
between the following: (a) feet placed perpendicular to the
midline axis of the platform, with the right foot positioned
slightly ahead of the le foot. e toes of the right foot and the
heel of the le foot were then lied  mm above the surface of
the platform. e knees were bent and maintained at a knee
angle. (b) Feet were placed perpendicular to the midline axis of
the platform, with the le foot positioned slightly ahead of the
right foot. e toes of the le foot and the heel of the right foot
were lied  mm above the surface of the platform. e knees
were bent and maintained at a knee angle
Sa˜
nudo et al. []
[]
*
*
 ±. 
 ±.  Physical exercise Physical exercise plus
WBV protocol
ree sets of  s performed with both feet in contact with the
platform and four sets of  s with only one foot in contact with
the platform (s per foot). In each set, the participants stood
with both knees in isometric knee exion
Sa˜
nudo et al. []** . ±. Physical exercise Physical exercise plus
WBV protocol
Sixsetsofsperformedwithbothfeetontheplatformand
four sets of  s with only one foot in contact with the platform
( s per foot)
In each set, the participants stood with both knees in 
isometric knee exion
CG: control group; EG: exercise group; *𝑛for treatment eects analysis; **𝑛for intention-to-treat analysis.
Evidence-Based Complementary and Alternative Medicine
T:WBVtherapyandactivity.
Authors Freq.
(Hz)
Amp.
(mm)
Vibration
device
Typ e of
vibration
Duration
(weeks)
Number
of sessions Number of series Time series (s) Rest between
series (s)
Alentorn-Geli
et al. [,]  Power
Plate
Vertical
sine wave 
ree in the rst two sessions
Six in the last nine sessions  
Gusi et al.
[]. Galileo Horizontal
sine wave  
sinsessions
sinsessions
 s in sessions –

Sa˜
nudo et al.
[,] *
** Galileo Horizontal
sine wave *
** *
** 
Sa˜
nudo et al.
[]  Power
Plate
Vertical
sine wave *
** *
** 
Freq.: frequency; Amp.: amplitude.
*With both feet in contact with the platform; **With one foot in contact with the platform.
T : Level of conclusion according to the Dutch CBO guide-
lines.
Outcome measure Level of
conclusion
Balance
Quality of life
Serum insulin-like growth factor-
Strength
Fatigue
Pain
Depression
Stiness
Disability index (bromyalgia impact questionnaire)
CBO: Institute for Healthcare Improvement.
Level:onetrialoflevelAoratleasttwoindependenttrialsoflevelB(see
the Appendix); : one trial of level B or C (see the Appendix).
3.6. WBV Parameters
3.6.1. Frequency and Amplitude. e four RCTs diered in
terms of the amplitude and frequency of the vibration.
e two RCTs that used the horizontal sine-wave vibration
employed an amplitude of - mm and a frequency of .–
 Hz, and the two RCTs that used the vertical sine-wave
vibrationemployedanamplitudeofmmandafrequency
of  Hz.
3.6.2. Performance on the Platform. e postures used in the
four RCTs also varied. In three RCTs, patients maintained
a static posture on the platform during vibration [,
], whereas, in the fourth RCT, patients performed both
static and dynamic tasks during vibration [,]. In two
RCTs, both feet were always on the platform during vibration
[,], and, in the other two RCTs, some series were
performed with only one foot on the platform [,,]. e
knee angle varied between and in the two static-task
RCTs and between and in the dynamic-and-static-
task RCT.
F : Power Plate and Galileo vibration platforms.
3.6.3. Description of Training. All four RCTs sought to anal-
yse the long-term eects of WBV therapy. In two of the three
RCTs,  weeks of WBV therapy were performed [,,,
]. e authors of the rst RCT [,]chosethisduration
because, although it would be inadequate for a traditional
exercise program, it should be sucient for the develop-
ment of WBV-induced adaptations that would improve pain,
fatigue, stiness, and depression in patients with FM. e
Gusi et al. RCT had the longest WBV therapy, which con-
sisted of  sessions over  weeks []. e number of
series ranged from three to ten, and each lasted between s
and  s with a rest interval of – s (Table ).
3.7. Key Measurements and Eects. e measurements with
the highest level of conclusion (Tab l e  )werebalance,
HRQoL,fatigue,anddisabilityassessedusingthebromyal-
gia impact questionnaire (FIQ) []. e level of conclusion
for pain was lower than that for the other measures, but
Evidence-Based Complementary and Alternative Medicine
T : Outcome measures.
Authors Reference Instrument Outcome measure CG baseline CG aer treatment EG baseline EG aer treatment Treatment eect Reported eect
Alentorn-Geli et al.
[]ELISA IGF- NR NR NR NR NR =
[]
FIQ Functional capacit y NR NR NR NR NR Δ
 mm VAS
Pain NR NR NR NR NR Δ↑
Fatigue NR NR NR NR NR Δ↑
Stiness NR NR NR NR NR
Depression NR NR NR NR NR =
Gusi et al.
[]FIQ Functional capacity . ±.
. ±.*. ±.
. ±.*. ±.
. ±.*. ±.
. ±.*.
.*
D questionnaire Quality of life . ±. NR . ±. NR NR =
[]Biodex Balance System Dynamic balance . ±.
. ±.*.
.*. ±.
. ±.*.
.*.
.*
[]Biodex Balance System
SB overall SI (). ±. . ±. . ±. . ±. .
SB anteroposterior SI (). ±. . ±. . ±. . ±. .
SB mediolateral SI (). ±. . ±. . ±. . ±. . =
Sa˜
nudo et al.
[]
T-Force Dynamic Measurement
System Knee extensor strength . ±. . ±. . ±. . ±. . =
Biodex Balance System
OE overall SI .   ±. . ±. . ±. . ±. . =
OE mean deection . ±. . ±. . ±. . ±. . =
OE anteroposterior SI . ±. . ±. . ±. . ±. . =
OE anteroposterior mean deection . ±. . ±. . ±. . ±. . =
OE mediolateral SI . ±. . ±. . ±. . ±. .
OE mediolateral mean deection . ±. . ±. . ±. . ±. . =
CE overall SI . ±. . ±. . ±. . ±.. =
CE mean deection . ±. . ±. . ±. . ±. . =
CE anteroposterior SI . ±. . ±. . ±. . ±. . =
CE anteroposterior mean deection . ±. .±. . ±. . ±. . =
CE mediolateral SI .   ±. . ±. . ±. . ±. .
CE mediolateral mean deection . ±. . ±. . ±. . ±. . =
[]
FIQ Functional capacit y . ±. . ±. . ±. . ±. . Δ
SF- Quality of life . ±. . ±. . ±. . ±. . Δ↑
T-Fo rce S ystem
Maximumpowerofkneeextensormuscles . ±. . ±. . ±. . ±. . =
Number of repetitions . ±.  . ±. . ±.   .   ±. . Δ
Muscular fatigue index . ±. . ±. . ±. . ±. . =
Sa˜
nudo et al. []Biodex Stability System
OE overall SI . (.) . (.) . (.) . (.) . =
OE mean deection . (.) . (.) . (.) . (.) . =
OE anteroposterior SI . (.) . (.) . (.) . (.) . =
OE anteroposterior mean deection . (.) . (.) . (.) . (.) . =
OE mediolateral SI . (.) . (.) . (.) . (.) . Δ↑
OE mediolateral mean deection . (.) . (.) . (.) . (.) .
CE overall SI . (.) . (.) . (.) . (.) . =
CE mean deection . (. ) . (.) . (.) . (.) . =
CE anteroposterior SI . (.) . (.) . (.) . (.) . =
CE anteroposterior mean deection . (.) . (.) . (.) . (.) . =
CE mediolateral SI . (.) . (.) . (.) . (.) . Δ
CE mediolateral mean deection . (.) . (.) . (.) . (.) . =
T-Fo rce S ystem Number of repetitions . (.) . (.) . (.) . (.) . =
CG: control group; EG: exercise group; NR: not reported; ELISA: enzyme-linked immunosorbent assay; IGF-: serum insulin-like growth factor-; FIQ: bromyalgia impact questionnaire; SB: static balance; VAS:
visual analogue scale; OE: open eyes; CE: closed eyes; SI: stability index; =: no signicant dierence relative to baseline and/or the control group; : statistically signicant improvement in the WBV group relative
to the control group; Δ: statistically signicant improvement in the WBV group relative to baseline; : statistically signicant improvement in the control group relativetobaseline.
*Intention-to-treat analysis.
Evidence-Based Complementary and Alternative Medicine
becausepainisamainsymptomofFM,itwasanalysed
independently.
3.7.1. Balance. ree of the RCTs [,]evaluatedthe
eects of WBV therapy on balance, specically dynamic
balance and static balance. One of these RCTs analysed static
balance with both open and closed eyes. All three RCTs used
a Biodex Balance System to measure balance. is device
measures the tilt about each axis during dynamic conditions
and calculates a mediolateral stability index, an anteropos-
terior stability index, and an overall stability index [].
ese indices are SDs that assess uctuations around a zero
point that is established prior to testing when the platform
is stable (rather than around the group mean). A lower score
indicates better balance.
One study showed that WBV signicantly improved the
dynamic balance of the WBV group compared to the control
group []. In three studies, mediolateral and anteroposterior
indices were both measured, but, in two studies, only the
mediolateral stability index improved [,], and, in the
other study, only the anteroposterior stability index improved
[].
3.7.2. Quality of Life. Two studies assessed HRQoL [,]
using the global score of the -Item Short Form Health Sur-
vey (SF-, Medical Outcome Study) []orthe15D©ques-
tionnaire []. Both questionnaires are not specically devel-
oped for FM. e 15D©questionnaire assesses  HRQoL
dimensions, namely, moving, seeing, hearing, breathing,
sleeping, eating, speech, eliminating, usual activities, mental
function, discomfort and symptoms, depression, distress,
vitality, and sexual activity []. e SF- is a well-known
questionnaire that assesses limitations, bodily pain, vitality,
mental health, and general health perception []. Signicant
improvement in SF- score []wasreported,butnotinthe
15D©[].
3.7.3. Fatigue. ree of the RCTs assessed the eect of WBV
therapy on fatigue [,,]. Several dierent measures of
fatigue were used: the number of repetitions of half squat
performed in  s; a fatigue index, expressed as the decline in
thepeaktorquefromthestartofthehalfsquatexercise(rst
ve repetitions) to the end of the exercise (last ve repeti-
tions); and the  mm visual analogue scale contained in the
FIQ.
In one study, WBV improved fatigue relative to both
baseline and the control group []. In another study, WBV
improved the number of repetitions relative to baseline [].
In the third study, WBV did not have a signicant eect on
fatigue [].
3.7.4. Disability Index. e disability caused by FM was
assessed in three RCTs using the Spanish version of the
FIQ []. One study [] used this questionnaire to evaluate
HRQoL. However, the FIQ is an instrument that assesses the
eectofFMsymptomsonhealthstatusandthedisability
index and does not measure HRQoL [].
In one RCT [], the WBV-treated patients exhib-
ited a signicant improvement in FIQ score relative to
the untreated control patients. In the other two RCTs [,
,,], patients undergoing WBV during traditional exer-
cises showed signicant improvements in FIQ score relative
to baseline. However, there were no statistically signicant
dierences between the traditional exercise only group
and the exercise + vibration group.
3.7.5. Pain. PainisthemostimportantsymptominFM,butit
was assessed specically in only one study, which reported an
improvementin pain compared to both baseline and the con-
trol groups []. However, pain is part of the FIQ and 15D©
questionnaires that were used to evaluate HRQoL in two of
the other RCTs [,].
4. Discussion
e four RCTs revealed that WBV therapy may improve
several symptoms of FM, namely, disability, pain, poor
HRQoL, poor balance, and fatigue.
e duration of the treatment could be extremely relevant
when assessing the eects of WBV on disability caused by
FM. Two RCTs only involved  weeks of complementary
vibration therapy, and one RCT involved  weeks of vibration
therapy. is latter RCT reported a signicant improvement
in FIQ score relative to the control group, whereas the other
two RCTs only reported within-group improvements. It may
be that the eect of WBV therapy on FIQ score can only be
observed with longer treatments.
With regard to pain, the single study examining this
outcome used the  mm VAS to show that WBV therapy
signicantly improved pain compared to both baseline and
the control groups []. However, the level of conclusion for
this measure was , which is low. Pain is also a subscale of the
FIQ. ree articles assessed the eects of vibration on total
FIQ score, but they did not report the changes in this dimen-
sion. In patients with chronic back pain, evidence suggests
that vibration could alleviate pain [,]. e mechanism
bywhichWBVcouldreducepainperceptionwasdiscussed
widely in a previous review []. However, it is possible that
the mechanisms that lead to a reduction of pain in diseases
characterised by local pain do not work in FM patients,
because FM is characterised by widespread pain, and the
causeofpainislikelytobedierent.Becausepainisoneofthe
main symptoms of FM, additional studies that assess the
eects of WBV on pain in FM are needed.
ere were large dierences in treatment eects on bal-
ance. ese discrepancies may reect dierences between
the WBV protocols. Eects of the two vibratory platforms
(Galileo and Power Plate) on balance were compared by
Sa˜
nudo et al. [,,], who reported that the mediolateral
stabilityindexwasimprovedbyboththeGalileoplatformand
the Power Plate platform. However, in the study of Adsuar et
al., which used the Galileo platform, only the anteroposterior
stability index improved []. Given that mediolateral sway
is more correlated with fall risk [], the protocol of Sa˜
nudo
et al. may be better at preventing falls.
With regard to fatigue, Sa˜
nudo et al. compared the two
vibratory platforms with the same protocol. ey found that
only the Galileo platform induced a signicant improvement
Evidence-Based Complementary and Alternative Medicine
in the number of repetitions of a half squat exercise per-
formed in  s. However, it cannot be concluded that these
improvements were due to an improvement in cardiorespi-
ratory tness. Devices that assess oxygen consumption in a
more objective way must be used to evaluate this measure.
ree RCTs yielded ve articles [,,]that
showed that when WBV therapy complemented a physical
exercise programme, there were signicant improvements
in muscle performance (increased strength and decreased
fatigue) or balance that were larger and more signicant than
the improvements obtained by standard exercise (Table ).
us, adding WBV can enhance the benets of a physical
exercise programme. Given that WBV only requires a few
minutestobedelivered,itcouldbeagoodcomplementto
usual physical exercise protocols.
e dierences between studies in the eect of WBV
on balance [,,], fatigue [,,], and FIQ score
[,,] could be attributed to dierences in the baseline
scores or dierences in the vibration protocols in terms of
the type of vibration, the duration of treatment, and the rest
intervals. e disparities could also reect dierences in the
instrument that was used in the evaluation. In support of this,
thebaselineFIQscoresintheSa˜
nudo et al. and Alentorn-Geli
et al. studies dier by almost %; thus, it can be expected that
these studies will dier in the degree of improvement that
is observed. Other variables should be considered to better
explain these dierences, including the weather [], patient
weight [], and patient age, which may be a surrogate marker
of the eect of menopause on women with FM [].
e four RCTs diered markedly in terms of important
characteristics, namely, the type of vibration (vertical or hor-
izontal sine wave), the type of therapy (vibration or exercise +
vibration), and the vibration protocol (frequency, amplitude,
time series, rest interval, and duration). erefore, additional
studies that assess the eect of WBV in dierent settings are
needed. ese studies should compare (a) dierent protocols
withthesamedeviceandthesametypeoftherapy,(b)
dierent devices with a similar protocol and the same type
of therapy, and (c) dierent types of therapies with the same
device and the same protocol. ese studies will identify the
optimal characteristics of vibration therapy that are needed to
improve functional capacity, HRQoL, balance, and other key
symptoms of FM.
To our knowledge, the acute eects of WBV on FM symp-
toms have not been assessed by any study. However, a study
on patients with low back pain showed that a single WBV ses-
sion induced statistically signicant within-group changes in
lumbopelvicpainperception[]. Another study on patients
with low back pain reported that WBV therapy induced a
greater reduction in pain aer  months than aer  months
[]. is suggests that the duration of WBV in the RCTs
analysed in this study (– weeks) was too short to signi-
cantly reduce pain. erefore, additional trials that assess the
eects of both short- and long-term (– months) WBV
therapy on FM-associated pain are needed. Studies that
examine the eects of long-term WBV therapy on balance are
also needed because several studies showed that long WBV
treatments (– months) signicantly improved postural
control and static and dynamic balance in populations that
sharesomeofthecharacteristicsofpatientswithFM(i.e.,
postmenopausal or elderly women) [].
e present systematic review only identied a limited
number of studies on the eects of WBV therapy on FM.
is reects the fact that the RCTs on this issue only started
very recently; the rst completed study was published in .
e small number of trials together with their wide varia-
tion in terms of PICOS (Participants, Intervention, Control,
Outcome Measurements, and Study design) hampers meta-
analysis. is explains why the CBO guidelines []indicated
that the level of conclusion regarding the eect of WBV
therapy on FM was .
ere are several limitations that should be considered.
First, standardised criteria to assess the level of evidence are
needed. Authors of systematic reviews oen use dierent
criteria [] that depend on the methodological quality (i.e.,
RCT versus low-quality trials) of the analysed studies. e
scales of measurement may vary across the criteria, and the
best method for assessing the risk of bias is not clear [].
However, only RCTs were considered in the current system-
atic review. Second, some bias may have been introduced
because the search strategy omitted articles in languages
other than English. Signicant results are easier to publish
than nonsignicant results and, consequently, the latter are
more likely to appear in national journals that are written in
anativelanguage[]. WBV dose-response analysis was not
included because of the variability among devices and proto-
cols, and the few available references in FM patients.
As emphasised in the Introduction, FM entails a huge cost
to governments. erefore, studies on the cost-eectiveness
andutilityofWBVasatherapyinaconditionthatisas
prevalent and widespread as FM are needed.
5. Conclusions
WBV may be an adequate treatment for FM as a main therapy
or when added to a physical exercise programme as it could
improve the balance, disability index, quality of life, fatigue,
and pain of patients with FM. However, the small number
of RCTs on WBV in FM and their wide variation in terms
of vibration protocol, intervention, and measurements ham-
pered our comparison of these trials. Additional studies that
denitively clarify the eects of WBV therapy on FM are
needed.
Appendix
Levels of Evidence and Conclusion according
to the Dutch CBO Guidelines
Levels of Evidence according to the Dutch CBO Guidelines
A: systematic review containing at least two independent
trials of level A;
A: randomised comparative double-blind study of good
quality and sucient size;
B: comparative trials, but not all characteristics of A
(also, patient control studies and cohort studies);
Evidence-Based Complementary and Alternative Medicine
C: noncomparative trials;
D: expert opinion.
LevelofConclusionaccordingtotheDutchCBOGuidelines.
Conclusionisbasedonthefollowing:
() research on level A of at least two independent trials
of level A;
() one trial of level A or at least two independent trials
of level B;
() one trial of level B or C;
() expert opinion.
CBO: Institute for Healthcare Improvement.
Conflict of Interests
e authors declare that there is no conict of interests
regarding this paper.
Acknowledgments
In the framework of the Spanish National R + D + i Plan,
the current study was cofunded by the Spanish Ministry of
Economy and Competitiveness with the Reference DEP-
. is study was also cofunded by the Government
of Extremadura and European Union Regional Develop-
ment Funds (FEDER), a way of making Europe (Reference
GR). e author Daniel Collado-Mateo is a predoctoral
student funded by the foundation “Tatiana P´
erez de Guzm´
an
el Bueno.
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... Numerous studies have examined the effects of WBV on muscle strength, balance ability, mobility, pain, lung function, cognitive performance, vasodilatory capacity, and daily activities [1,[4][5][6][7][8][9][10][11][12][13]. Previous reviews have reported a positive effect of WBV in older adults, patients with fibromyalgia, chronic obstructive pulmonary disease (COPD), diabetes, osteoarthritis, stroke, spinal cord injury, or cerebral palsy [1,5,11,[13][14][15][16][17][18][19][20][21][22][23]. ...
... Numerous studies have examined the effects of WBV on muscle strength, balance ability, mobility, pain, lung function, cognitive performance, vasodilatory capacity, and daily activities [1,[4][5][6][7][8][9][10][11][12][13]. Previous reviews have reported a positive effect of WBV in older adults, patients with fibromyalgia, chronic obstructive pulmonary disease (COPD), diabetes, osteoarthritis, stroke, spinal cord injury, or cerebral palsy [1,5,11,[13][14][15][16][17][18][19][20][21][22][23]. The mechanisms of WBV may be related to certain effects of vibration, such as stimulation of subcutaneous proprioceptors, muscle spindles that cause muscle contraction, and Golgi tendon organs that improve tonic and antagonist vibration reflexes [13,22,24]. ...
... Previous reviews have reported a positive effect of WBV in older adults, patients with fibromyalgia, chronic obstructive pulmonary disease (COPD), diabetes, osteoarthritis, stroke, spinal cord injury, or cerebral palsy [1,5,11,[13][14][15][16][17][18][19][20][21][22][23]. The mechanisms of WBV may be related to certain effects of vibration, such as stimulation of subcutaneous proprioceptors, muscle spindles that cause muscle contraction, and Golgi tendon organs that improve tonic and antagonist vibration reflexes [13,22,24]. ...
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... Thus, it remains uncertain the active component of this therapy (24). Some reviews highlighted the need for further research in this field to improve understanding of the effects of WBV in patients with fibromyalgia (9,25). Furthermore, these previous studies did not measure important parameters such as motor function, proprioception or vibration sensitive threshold. ...
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... 10 Whole-body vibration training (WBVT) has been used in the last 2 decades as an alternative training modality to modify body composition as well as to increase muscle strength in young 11 and older 12 adults. Furthermore, WBVT has been proven to be as effective as other training methods, such as resistance training, 13,14 and, notably, WBVT has increasingly become an interesting instrument in the recovery process of clinical patients, including those with multiple sclerosis, 15 fibromyalgia, 16 or chronic obstructive pulmonary disease, 17 among others. This modality of training has advantages compared with other types of training, for instance, a lower perceived exertion and less timeconsuming sessions. ...
Article
Objectives To assess the effects of whole-body vibration training (WBVT) on body composition, metabolic and cardiovascular risk variables and lower-limb strength in overweight/obese subjects. Data sources A systematic review with meta-analysis was conducted in three databases (PubMed-Medline, Web of Science and Cochrane Library), from inception through to January 26, 2020. Study selection Studies analysing the effect of WBVT on body composition variables, metabolic profile, blood pressure, heart rate and lower-limb strength in overweight/obese population, with interventions of a minimum length of two weeks were included. Data extraction After applying the inclusion and exclusion criteria, 23 studies involving 884 obese/overweight subjects (experimental group: 543; weight= 79.9kg; body mass index (BMI) = 31.3kg/m², obesity class I according to World Health Organization, WHO) were used in the quantitative analysis. The gender of the participants involved in the studies were: a) 17 studies included only females; b) one study included only males (boys) and c) five studies included both genders. Meta-analysis, subgroup analysis and meta-regression methods were used to calculate the mean difference and standardized mean difference (MD and SMD; ±95% confidence intervals [CI]) as well as to analyse the effects of pre-post-intervention WBVT and differences from control groups. Data synthesis WBVT led to a significant decrease in fat mass (-1.07kg, not clinically significant). In addition, WBVT reduced systolic blood pressure (-7.01mmHg clinically significant), diastolic (-1.83mmHg) and heart rate (-2.23bpm), as well as increased the lower extremity strength (SMD=0.63; 0.40–0.86). On the other hand, WBVT did not modify the weight, BMI, muscle mass, cholesterol, triglycerides or glucose. Conclusions WBVT could be an effective training modality to reduce blood pressure (clinically relevant) and resting heart rate. In addition, WBVT led to improved lower-limb strength. However, these findings were not consistent with significant improvements on other variables associated with metabolic syndrome (body composition, cholesterol, triglycerides and glucose). PROSPERO: CRD42020170923.
... Furthermore, these studies did not measure important parameters such as motor function, proprioception, or vibration-sensitive threshold. Some reviews [20,24,25] have highlighted the need for further research in this field to improve understanding of the effects of WBV in patients with fibromyalgia and have suggested that additional research needs to include different devices with the same protocol, as well as among different groups of patients in terms of gender. In our study, 10% of participants were men, according to the gender-related epidemiology of fibromyalgia [1]. ...
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Whole body vibration has been proven to improve the health status of patients with fibromyalgia, providing an activation of the neuromuscular spindles, which are responsible for muscle contraction. The present study aimed to compare the effectiveness of two types of whole body vibrating platforms (vertical and rotational) during a 12-week training program. Sixty fibromyalgia patients (90% were women) were randomly assigned to one of the following groups: group A (n = 20), who performed the vibration training with a vertical platform; group B (n = 20), who did rotational platform training; or a control group C (n = 20), who did not do any training. Sensitivity measures (pressure pain and vibration thresholds), quality of life (Quality of Life Index), motor function tasks (Berg Scale, six-minute walking test, isometric back muscle strength), and static and dynamic balance (Romberg test and gait analysis) were assessed before, immediately after, and three months after the therapy program. Although both types of vibration appeared to have beneficial effects with respect to the control group, the training was more effective with the rotational than with vertical platform in some parameters, such as vibration thresholds (p < 0.001), motor function tasks (p < 0.001), mediolateral sway (p < 0.001), and gait speed (p < 0.05). Nevertheless, improvements disappeared in the follow-up in both types of vibration. Our study points out greater benefits with the use of rotational rather than vertical whole body vibration. The use of the rotational modality is recommended in the standard therapy program for patients with fibromyalgia. Due to the fact that the positive effects of both types of vibration disappeared during the follow-up, continuous or intermittent use is recommended.
... WBV may be helpful in the management of this disorder, since it could offer benefits in regard to balance, fatigue, pain, disability and health-related quality of life. A systematic literature review surmised that WBV could be an effective treatment for fibromyalgia as a main therapy or in addition to physical exercise programmes [48]. However, the comparison of the small number of available trials was limited by significant differences in intervention, protocol and assessment. ...
Article
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Whole body vibration (WBV) has attracted increasing interest in recent years as an exercise modality with potential to improve neuromuscular performance and to increase bone mass and density. The utility of WBV in the management of various chronic conditions and in the promotion of physical fitness have been examined. Despite many promising findings, the question of whether WBV can play a role in the fostering of physical fitness in elderly people or the treatment of chronic diseases, such as lower back pain, fibromyalgia, osteoporosis, obesity and diabetes is currently unclear. Further research is required to explore the therapeutic potential of WBV as an exercise modality and to investigate whether WBV training could become a viable (add-on) treatment for low back pain, fibromyalgia or osteoporosis in post-menopausal women. Furthermore, potential long-term risks should be investigated.
Article
Background: Aging results in musculoskeletal disorders, which are a leading cause of disability worldwide. While conventional nonpharmacological treatments have included interventions such as resistance exercise, there are subgroups of people who may be at risk of exercise-related injuries, for example, falls. Whole-body vibration (WBV) is an intervention that helps improve musculoskeletal function and is viable for those with limited mobility. Objectives: Whether WBV has a dual effect on bone and muscle conditions remains unknown. We aim to assess the evidence of the effects of WBV on bone and muscle parameters concurrently in older people. Methods: Under Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic literature search was performed in MEDLINE, EMBASE, EMCARE, and the Cochrane Central Registry of Controlled Trials. The main outcomes were changes in bone and muscle parameters. Results: Our meta-analysis showed that WBV does not have significant synergistic effects on measured bone (bone mineral density [BMD] in the hip and lumbar spine) and muscle (lean muscle mass and sit-to-stand time) outcomes, compared to controls (i.e., no WBV included). Conclusion: While there were no significant results, the included studies are limited by small sample size and variable intervention protocols and follow-up periods. Further trials should endeavor to measure both bone and muscle outcomes concurrently with a longer follow-up time. Osteoporosis status in participants must also be considered as it is not yet possible to exclude that WBV may have a significant effect on BMD in people with known osteoporosis. WBV does not appear to simultaneously influence bone and muscle health in older people, and future research is required to establish a regimen that may lead to measurable clinical efficacy.
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Background: Whole body vibration (WBV) is currently increasing in popularity as a treatment modality for musculoskeletal disorders and improving health-related quality of life. Recent research has shown that WBV can reduce low back pain and improve the functional abilities for patients, however, optimal frequency and duration of vibration for therapeutic use is unclear. This review was conducted to summarize and determine the efficacy of whole body vibration therapy on individuals with non-specific low back pain (NLBP) and evaluated methodological quality of the included studies. Methods: Online literature searches through the Web of Science, PubMed, Cochrane Library databases, PEDro, Ovid, EBSCO (Medline) and Scopus were conducted up to December 2019. Randomized controlled trials investigating the effect of WBV on pain intensity and/or functional ability in individuals with non-specific low back pain (NLBP) were included. Details of the sample characteristics, treatment of the comparison group, WBV parameters and outcome measures were recorded, and methodological quality appraised using the PEDro scale. Results: 7 published RCTs (418 patients) were included in the systematic review. Due to heterogeneity in vibration parameters and prescriptions, and small number of studies, no meta-analysis was performed. Four out of the six included studies using pain as an outcome measure showed that WBV had a beneficial effect on pain compared with the control group, whereas only two trials were considered to be of high methodological quality. Among the six studies which measured functional ability, three studies with good quality reported significant between-group differences in favor of WBV. Conclusions: There is limited evidence suggests that WBV is beneficial for NLBP when compared with other forms of interventions (stability training, classic physiotherapy, routine daily activity). Due to the small sample sizes and statistical heterogeneity, we still cannot draw conclusions that WBV is an effective intervention. Further high-quality studies are needed before clinical recommendations can be provided to support its use in a general population with NLBP and to explore the optimal treatment protocol. Trial registration: PROSPERO registration number: CRD42017074775.
Article
We aimed to analyze the evidence on the effects of physical exercise in patients with fibromyalgia (FM) and to assess the characteristics of published studies, especially the quality of the evidence, through an umbrella review. This umbrella review followed the PRISMA guidelines and was documented in the PROSPERO registry (CRD42017075687). We searched the PubMed, Web of Science, SportDiscus, Scopus, Cinahl, and Cochrane Library databases. The methodological quality of systematic reviews was assessed using AMSTAR 2. We only selected systematic reviews (with or without meta-analyses) investigating the effects of any type of physical exercise in patients with FM syndrome. Thirty-seven systematic reviews (total = 477) fulfilled the criteria. Most studies were rated as being of low or moderate quality. A variety of exercises were used as treatment for FM symptoms, with positive results. Most of the reviews investigated the effects of aerobic exercise and strength training. No serious adverse events were reported. The largest effects of exercise were seen in terms of improved pain intensity and quality of life. Altogether, exercise may be an effective treatment for FM symptoms. Thus, aerobic exercise and strength training are effective programs for the treatment of FM. By summarizing the findings and effect sizes of the reviewed studies, we observed that the evidence for improvement of pain level and quality of life was the strongest. The results have potential to influence evidence-based practice. Future studies should analyze the long-term effects of exercise.
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Background: Whole-body vibration is commonly used in physical medicine and neuro-rehabilitation as a clinical prevention and rehabilitation tool. The goal of this systematic review is to assess the long-term effects of whole-body vibration training on gait in different populations of patients.Methods: We conducted a literature search in PubMed, Science Direct, Springer, Sage and in study references for articles published prior to 7 December 2018. We used the keywords “vibration,” “gait” and “walk” in combination with their Medical Subject Headings (MeSH) terms. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used. Only randomized controlled trials (RCT) published in English peer-reviewed journals were included. All patient categories were selected. The duration of Whole-Body Vibration (WBV) training had to be at least 4 weeks. The outcomes accepted could be clinical or biomechanical analysis. The selection procedure was conducted by two rehabilitation experts and disagreements were resolved by a third expert. Descriptive data regarding subjects, interventions, types of vibration, training parameters and main results on gait variables were collected and summarized in a descriptive table. The quality of selected studies was assessed using the PEDro scale. Statistical analysis was conducted to evaluate intergroup differences and changes after the WBV intervention compared to the pre-intervention status. The level of evidence was determined based on the results of meta-analysis (effect size), statistical heterogeneity (I2) and methodological quality (PEDro scale).Results: A total of 859 studies were initially identified through databases with 46 articles meeting all of the inclusion criteria and thus selected for qualitative assessment. Twenty-five studies were included in meta-analysis for quantitative synthesis. In elderly subjects, small but significant improvements in the TUG test (SMD = −0.18; 95% CI: −0.32, −0.04) and the 10MWT (SMD = −0.28; 95% CI: −0.56, −0.01) were found in the WBV groups with a strong level of evidence (I2 = 7%, p = 0.38 and I2 = 22%, p = 0.28, respectively; PEDro scores ≥5/10). However, WBV failed to improve the 6MWT (SMD = 0.37; 95% CI: −0.03, 0.78) and the Tinetti gait scores (SMD = 0.04; 95% CI: −0.23, 0.31) in older adults. In stroke patients, significant improvement in the 6MWT (SMD = 0.33; 95% CI: 0.06, 0.59) was found after WBV interventions, with a strong level of evidence (I2 = 0%, p = 0.58; PEDro score ≥5/10). On the other hand, there was no significant change in the TUG test despite a tendency toward improvement (SMD = −0.29; 95% CI: −0.60, 0.01). Results were inconsistent in COPD patients (I2 = 66%, p = 0.03), leading to a conflicting level of evidence despite a significant improvement with a large effect size (SMD = 0.92; 95% CI: 0.32, 1.51) after WBV treatment. Similarly, the heterogeneous results in the TUG test (I2 = 97%, p < 0.00001) in patients with knee osteoarthrosis make it impossible to draw a conclusion. Still, adding WBV treatment was effective in significantly improving the 6 MWT (SMD = 1.28; 95% CI: 0.57, 1.99), with a strong level of evidence (I2 = 64%, p = 0.06; PEDro score ≥5/10). As in stroke, WBV failed to improve the results of the TUG test in multiple sclerosis patients (SMD = −0.11; 95% CI: −0.64, 0.43). Other outcomes presented moderate or even limited levels of evidence due to the lack of data in some studies or because only one RCT was identified in the review.Conclusions: WBV training can be effective for improving balance and gait speed in the elderly. The intervention is also effective in improving walking performance following stroke and in patients with knee osteoarthrosis. However, no effect was found on gait quality in the elderly or on balance in stroke and multiple sclerosis patients. The results are too heterogenous in COPD to conclude on the effect of the treatment. The results must be taken with caution due to the lack of data in some studies and the methodological heterogeneity in the interventions. Further research is needed to explore the possibility of establishing a standardized protocol targeting gait ability in a wide range of populations.
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Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47–.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57–.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from “fair” to “substantial,” and the reliability of the total PEDro score was “fair” to “good.”
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Elderly patients with diabetes and peripheral neuropathy are more likely to experience falls. However, the information available on how such falls can be prevented is scarce. We investigated the effects of whole-body vibration (WBV) combined with a balance exercise program on balance, muscle strength, and glycosylated hemoglobin (HbA1c) in elderly patients with diabetic peripheral neuropathy. Fifty-five elderly patients with diabetic neuropathy were randomly assigned to WBV with balance exercise group, balance exercise (BE) group, and control group. The WBV and BE groups performed the balance exercise program for 60 min per day, 2 times per week, for 6 weeks. Further, the WBV group performed WBV training (up to 3 × 3 min, 3 times per week, for 6 weeks). The control group did not participate in any training. The main outcome measures were assessed at baseline and after 6 weeks of training; namely, we assessed the postural sway and one leg stance (OLS) for static balance; Berg balance scale (BBS), timed up-and-go (TUG) test, and functional reach test (FRT) for dynamic balance; five-times-sit-to-stand (FTSTS) test for muscle strength; and HbA1c for predicting the progression of diabetes. Significant improvements were noted in the static balance, dynamic balance, muscle strength, and HbA1c in the WBV group, compared to the BE and control groups (P < 0.05). Thus, in combination with the balance exercise program, the short-term WBV therapy is beneficial in improving balance, muscle strength and HbA1c, in elderly patients with diabetic neuropathy who are at high risk for suffering falls.
Article
Study Design. A randomized controlled trial with a 6-month follow-up period was conducted. Objective. To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain. Summary of Background Data. Chronic lower back pain involves muscular as well as connective and neural systems. Different types of physiotherapy are applied for its treatment. Industrial vibration is regarded as a risk factor. Recently, vibration exercise has been developed as a new type of physiotherapy. It is thought to activate muscles via reflexes. Methods. In this study, 60 patients with chronic lower back pain devoid of "specific" spine diseases, who had a mean age of 51.7 years and a pain history of 13.1 years, practiced either isodynamic lumbar extension or vibra- tion exercise for 3 months. Outcome measures were lum- bar extension torque, pain sensation (visual analog scale), and pain-related disability (pain disability index). Results. A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups. Lumbar extension torque increased sig- nificantly in the vibration exercise group (30.1 Nm/kg), but significantly more in the lumbar extension group (59.2 Nm/kg; SEM 10.2; P 0.05). No correlation was found between gain in lumbar torque and pain relief or pain- related disability (P 0.2). Conclusions. The current data indicate that poor lum- bar muscle force probably is not the exclusive cause of chronic lower back pain. Different types of exercise ther- apy tend to yield comparable results. Interestingly, well- controlled vibration may be the cure rather than the cause
Article
Objective: To study the effects of whole-body vibration exercises on the mobility function, balance and general health status, and its feasibility as an intervention in frail elderly patients. Design: Pilot randomized controlled trial. Subjects: Forty-four frail older persons (85.27 ± 3.63 years) meeting the Fried Frailty Criteria. Interventions: All eligible subjects were randomly assigned to the experimental group, who received a whole-body vibration exercise alone (vibration amplitude: 1-3 mm; frequency: 6-26 Hz; 4-5 bouts × 60 seconds; 3-5 times weekly), or a control group, who received usual care and exercises for eight weeks. Main measures: The Timed Up and Go Test, 30-second chair stand test, lower extremities muscle strength, balance function, balance confidence and General Health Status were assessed at the beginning of the study, after four weeks and eight weeks of the intervention. Results: Whole-body vibration exercise reduced the time of the Timed Up and Go Test (40.47 ± 15.94 s to 21.34 ± 4.42 s), improved the bilateral knees extensor strength (6.96 ± 1.70 kg to 11.26 ± 2.08 kg), the posture stability (surface area ellipse: 404.58 ± 177.05 to 255.95 ± 107.28) and General Health Status (Short-form Health Survey score: 24.51 ± 10.69 and 49.63 ± 9.85 to 45.03 ± 11.15 and 65.23 ± 9.39, respectively). The repeated-measures ANOVA showed that there were significant differences in the Timed Up and Go Test, 30-second chair stand test, bilateral knees extensor strength, activities-specific balance confidence score and general health status between the two groups (P < 0.05). No side-effects were observed during the training. Conclusions: Whole-body vibration exercise is a safe and effective method that can improve the mobility, knee extensor strength, balance and the general health status in the frail elderly.
Article
Objective: To determine whether an 8-week exercise programme supplemented with whole-body vibration improves body balance and dynamic strength in women with fibromyalgia. Design: Randomized controlled trial. Patients: Forty-six participants diagnosed with fibromyalgia. Methods: Participants were randomly assigned to: (i) an exercise training group with whole-body vibration (n = 15), which performed twice-weekly exercise sessions (aerobic exercise, strengthening and flexibility) combined with 3 whole-body vibration training sessions a week (bilateral squats: 6-9 sets of 30 s with 45-s recovery between sets; and unilateral squat: 4-7 sets of 30 s, 30 Hz-4 mm); (ii) an exercise group (n = 15) with the same combined exercise therapy; and (iii) a usual-care control group (n = 16). Results: Statistically significant improvements in the Medio-Lateral Stability Index and Medio-Lateral Mean Deflection with open eyes were found in the whole-body vibration exercise group compared with the control group. Non-significant effects were found for lower-limb physical function. Conclusion: The results show that a traditional exercise programme, supplemented with whole-body vibration training, improved balance in women with fibromyalgia. This may represent a key factor for falls prevention in this patient group.