Universal Journal of Public Health 6(5): 240-246, 2018 http://www.hrpub.org
DOI: 10.13189/ujph.2018.060502
Vibroacoustic Therapy and Development of a New
Device: A Pilot Study in the Health Resort Environment
Eha Rüütel1, Ivar Vinkel2,*, Moonika Laanetu3
1Institute of Natural Sciences and Health, Tallinn University, Estonia
2Vinkelheli Ltd, Estonia
3Värska Health Resort, Estonia
Copyright©2018 by authors, all rights reserved. Authors agree that this article remains permanently open access under
the terms of the Creative Commons Attribution License 4.0 International License
Abstract This study was motivated by the
development of a new model of vibroacoustic (VA)
therapy device which, in terms of its design and
characteristics, could be used in various health promotion
and treatment environments. In the case of VA therapy, a
bed or lounge chair is used to transmit special low
frequency sounds for the purpose of affecting the whole
body. In the review of previous studies, the results of
applying VA therapy in the case of somatic and functional
disruptions are described. In this study a new VA device
prototype was used. The study was carried out at a health
resort where, over the course of a two month period,
visitors had the opportunity to participate in VA therapy.
Twenty-six volunteers participated in the study. Data was
collected through self-rate scales, which were completed
at the beginning and end of the VA treatment session. The
results of the study indicated an improvement in feeling –
a reduction in muscle tension, pain, fatigue, anxiety – as
well as the suitability of the device and therapy for health
improvement related purposes, integrated with other
health services.
Keywords Vibroacoustic Therapy, Device for
Vibroacoustic Therapy, Treatment Effect of Vibroacoustic
Therapy, Perceived Health Condition
1. Introduction
1.1. Vibroacoustic Treatment Method
Vibroacoustic (VA) therapy is defined as a treatment
method based on low frequency pulsed, sinusoidal sound
vibrations and music [1-3]. Depending on the choice of
sound vibrations, the effect is either relaxing or
stimulating, which allows for VA therapy to be used for
general relaxation, for the purpose of more specific
physiotherapy and receptive music therapy [2-4]. A
possible interaction with brain activity has been
considered; however, an effect on muscle and tissue has
mainly been assumed [5].
Studies of the VA method have shown a significant
improvement in many somatic and functional disorders,
e.g. reduction in pain, including fibromyalgia [6-8],
decrease in muscle tension and spasms [9-11], and a
reduction in the parameters of blood pressure, pulse rate
and muscle oscillation [12]. Experiments with the method
have produced an improvement in motor function in the
treatment of patients with Parkinson’s disease [13]. VA
treatment has also been shown to have the potential to
help maintain cognition and functional ability in patients
with Alzheimer’s disease [14]. Relaxation is often a
side-effect of VA treatment, influencing the overall state
of health. According to the practice-based evidence of VA
treatment, positive changes in indicators of the perceived
health condition and emotional state [8, 15-17], and an
improvement of physical self-awareness [14, 15], can be
expected. The wide range of applications indicates that
VA treatment could be a useful addition to
multidisciplinary healthcare practices, having been used in
rehabilitation programmes for patients with chronic pain,
musculoskeletal problems, spasticity, and sleep
disturbances [11, 17].
VA therapy uses low frequency sound vibration in the
range of 30–120 Hz [3]. Throughout the duration of the
procedure, music and/or sounds of nature suitable to the
purpose of the procedure were often introduced in the
therapy room as an auditory influence. The most common
length of sessions is 10 to 45 minutes [18].
Vibroacoustic stimuli can be provided through various
kinds of technical devices. According to Boyd-Brewer and
McCaffrey [18], there have not been any reports of
adverse effects concerning the VA method. Patrick [19]
argues that a condition does not exist in which a single
VA stimulation could give a negative result. Practitioners
have observed that during or after the first sessions of VA
therapy drowsiness, dizziness, and/or nausea may occur.
Universal Journal of Public Health 6(5): 240-246, 2018 241
These side effects usually disappear within a short period
of time. Based on their practical experience, Wigram [20]
and Grocke, and Wigram [1:228-229] have listed
contraindications and precautions regarding the use of the
VA method: acute inflammation, pacemakers, psychoses,
pregnancy (for the reason that there is a lack of any
relevant empirical studies), acute physical states (first
require consultation with their doctor), and hypotension
(the method may further reduce blood pressure). There are
also some psychological factors that should be taken into
consideration, e.g. excessive sensitivity to vibration or
subjective aversion or fear of the treatment may block the
positive effect of VA therapy [11]. It must be emphasised
here that VA therapy is a non-invasive, relaxing and
enjoyable treatment, which was never intended to be
administered as an aggressive treatment for any condition
[1].
1.2. Development of the New Vibroacoustic Treatment
Device
In Estonia, VA devices that mainly affect the entire
body are used. Tallinn University has contributed to VA
therapy practice, research and development of the
equipment since the 1980s. The first model was produced
as a small series in Estonia from 1990-1991. In addition,
different models have been tested in terms of their design
and sound transmission specifics. The prototype of the
newest device (Figure 1) was developed by the Centre of
Excellence in Health Promotion and Rehabilitation of
Haapsalu College, Tallinn University 1. The prototype
(Figure 1) and the pilot study in which it was used were
introduced at the 1st International VIBRAC Conference in
Lahti, Finland, in 2016, by the authors of the current
article.
Figure 1. The prototype of the VA device 2015.
The goal of developing the device was to prepare an
aesthetic design that was also convenient to use and, in
terms of technical and acoustic indicators, a suitable
device for carrying out vibroacoustic therapy, which can
be fit into various environments and the production of
1 The software for the device was created for VA treatment practitioners
and professionals in cooperation with SMARTdo Ltd, which obtained
the licence to manufacture the new VA lounge chair from the Centre of
Excellence and has named it healBED.
which is possible on an industrial scale. The speakers for
both the vibrational and acoustic stimuli are placed into
the main body of the device. The headphones for the
acoustic stimuli can be plugged into the jack built into the
lounge chair.
The ergonomic design of the lounge chair allows for
improved relaxation as the position of the lower legs is
higher than that of the thighs and back. Based on the
incline of the upper and lower portion of the lounge chair
the upper and lower parts of the body are located at the
site of the corresponding speakers, and when the body is
moved during the procedure it will not shift off of the
speaker. The upper body is raised slightly, which allows
for eye contact with the conductor of VA treatment. The
comfort of moving onto and from the lounge chair was
ensured by the fact that the hands can be placed higher
than the lower back.
In order to minimise the sound transmitted into the
environment from the lounge chair, eight air-filled rubber
spacers are installed as insulation between the bottom of
the lounge chair and the support structure. The lounge
chair’s support structure rests on the floor at the foot end
with a tapered bottom and with little wheels on the end by
the head.
2. Current Study
The purpose of the current study was to test the new
VA device in the environment of a health resort and
measure the effect of short-term VA treatment on
perceived health. Värska Health Resort is located in
southeastern Estonia and offers various treatment and care
procedures, and longer (5-10 day) spa treatment and
relaxation packages, in which mineral water procedures
play an important part. The list of services also includes
VA therapy and music therapy. In this study, VA
treatment was a supplementary procedure for those
visitors who voluntarily wished to participate in the study
and try the new VA device.
Based on previous studies with healthy test subjects [21]
and rehabilitation centre patients [11], and experience
with the application of VA treatment at Värska Health
Resort, improvements were expected in the indicators of
perceived health after the VA treatment session. Since VA
treatment and participation in the study was voluntary for
visitors to the health resort, and the time spent in the
health care institution was minimal, the number of VA
treatment sessions taken by visitors was of interest, along
with the changes in how they felt during the VA treatment
process.
The goal of the study was to determine whether the
changes in the indicators of perceived health indicate that
the new VA treatment device can be used with clients
with various health complaints for general health
promotion purposes in the health resort environment.
242 Vibroacoustic Therapy and Development of a New Device: A Pilot Study in the Health Resort Environment
3. Method
The pilot study was carried out within the framework of
naturalistic outcome research, using repeated measures
design, in which participants served as their own controls.
Pilot studies are not aimed to test hypothesis and therefore
do not require sample size power calculations [22].
Participants
The participants were recruited from among the visitors
to the health resort, with some participants being health
resort employees. The study was carried out over a period
of two months. The total number of participants was 26,
aged 13-74; 23 (88%) women and 3 (12%) men. VA
treatment was added to procedures selected beforehand by
visitors (water treatment, mud bath, massage,
physiotherapy, salt chamber or consultation with a
psychologist or social worker) for general relaxation
purposes after the health check during the consultation
with rehabilitation physician. Participants had different
health problems; the indicators for the selection were
muscle pain, headache, fatigue, symptoms of anxiety
and/or depression, heightened blood pressure. In the case
of contraindications for the VA treatment or doubts
thereof, the individual was not incorporated into the study.
Background data associated with the health of participants
was not collected by the VA treatment specialist.
Questionnaires and Data Collection
Data was collected through self-rate scales, which were
completed at the beginning and end of each session.
The Numerical Rating Scales (NRS) with 11 divisions
(0 – 10) were used to measure muscle tension, pain,
tiredness, anxiety, physical discomfort, and general
condition of health. Simple numerical rating scales are
increasingly being employed to measure subjectively
assessed health indicators like pain, fatigue, depression,
anxiety, sleep, physical and social functions, irrespective
of health condition, age or gender [23].
Health and Comfort Semantic Differential Scales (SDS)
include six bipolar scales with seven divisions, which are
used to describe changes taking place during the therapy
session [21, 24]. Scales were completed at the beginning
and end of each session.
Participants were asked to provide brief written
feedback on the VA treatment after the last treatment
session. The feedback questionnaire assessing the comfort
of the lounge chair included five 7-point scales (sitting on
the chair, rising from the chair, chair stability, comfort of
the mattress, body position on the chair).
Equipment and Procedure
The VA treatment device was used at 40 Hz, which was
recommended in previous research for general relaxation
and pain reduction [2, 4, 6, 8], and improvement of
cognitive function [5, 25]. Based on the request of the
client, relaxing music or a nature soundscape [26, 27] was
added as an auditory sound. The treatment lasted 23
minutes, 3 times per week.
Data Analysis
Data was analysed using Wicoxon matched pairs test.
NRS-s was turned in such a way that greater numbers
expressed a better health conditions; the aggregate
indicator of six scales was found by totalling indicators of
the scales. SDS-s were entered as 7 point numerical scales,
with the greater number indicating a better state of health
and comfort, e.g. the endpoints of the scale 1 =
uncomfortable ... 7 = comfortable.
Ethical Considerations
Participants were recruited from visitors to the health
resort, where the visitors had the opportunity to also select
VA, among other treatments. A new VA prototype device
model was used during the study, which was tested during
the course of development and no harmful effects were
found. Participation in the VA treatment was voluntary.
The contraindications to VA treatment were taken into
account in recruitment and in the event of the occurrence
of contraindications or the suspicion thereof, the volunteer
was not included in the study. All participants gave their
informed consent to participate in the study. Participants
were informed about the treatment method and that the
objective of the study was to test the suitability of the
device for use in a health resort environment for the
purposes of health promotion. In the research data, each
participant was assigned a code and data analysis was
conducted using coded data.
4. Results
Changes in perceived physical condition
The changes during the first VA treatment session are
shown in Table 1. Muscle tension, pain, fatigue and
anxiety diminished and a general condition of health
increased significantly.
Table 1. Wicoxon matched pairs test of pre- and post-measurements of
the 1st VA treatment session (N = 26)
Before
M/ SD
After
M /SD
Z
Muscle tension 3.88/ 2.82 2.08/ 2.54 3.55***
Pain 2.04/ 2.76 1.11/ 2.25 2.80**
Fatigue 4.20/ 2.82 2.60/ 2.73 2.56*
Anxiety 2.58/ 2.76 1.35/ 2.13 2.47*
Physical
discomfort
2.83/ 2.71 1.67/ 3.00 1.85
General
condition of
health
6.16/ 2.48 7.88/ 1.99 2.98**
* p < .05; ** p < .01; *** p < .001
Universal Journal of Public Health 6(5): 240-246, 2018 243
Number of Therapy Sessions and Treatment Effect
Table 2 presents the number of participants in VA treatment and NRS aggregate indicators separately for those
continuing and terminating VA treatment. The NRS aggregate indicator was calculated from the first to the fourth
session, since in connection with being present for a short period of time in the health care institution most participants
(77%) took part in 1-4 sessions. The table presents the average of the aggregate indicator of NRS for the number of
completed sessions, comparing the pre- and post-measurements of sessions. For comparison, Wilcoxon matched pairs
test was used.
Table 2. Number of clients and means/standard deviations of the aggregate indicator of the NRSs
VAT
sessions N
Continued Terminated
N
Before
M/ SD
After
M/ SD / Z
N
Before
M/ SD
After
M/ SD/ Z
1 27 21 15.6/ 10.0 7.3/ 7.4/ 3.1** 6 16.3/ 17.1 11.3/ 17.3/ns
1-2 21 16 14.7/ 9.6 7.7/ 8.1/ 3.6*** 5 9.0/ 7.5 4.6/ 4.5/ 2.2*
1-3 16 11 15.9/ 9.4 9.7/ 9.1/ 3.4*** 5 8.5/ 8.6 3.7/ 3.1/ 2.2*
1-4 11 6 16.4/ 9.7 11.9/ 10.5/ 2.6** 5 13.0/ 8.9 7.0/ 7.3/2.3*
* p < .05; ** p < .01; *** p < .001
The data presented in Table 2 show that those who continued VA treatment felt the significant impact of the VA
therapy session on their physical health. There was no statistical difference in the before and after session aggregate
NRS for those who quit VA treatment after the first session and the effect was lower for those who withdrew after the
second, third and fourth session.
Changes in the state of health and comfort
The direction of statistically significant change in the state of health and comfort measured by SDS are shown in
Table 3. The significant change was towards comfortable, calm and loose (p < .001, N = 25). Measurements from the
first session are presented in order to present the effect of the new therapy method on participants. The minimum and
maximum value of the scale corresponding to the polarities is indicated in the table header.
Table 3. Changes in perceived state of health and comfort during the first therapy session
min = 1
Before
M/ SD
After
M/ SD/ Z
max = 7
uncomfortable 4.44/ 1.04 5.96/ 1.31/ 3.54*** comfortable
restless 5.04/ 1.72 6.40/ 0.76/ 3.07** calm
tense 4.28/ 1.72 5.88/ 1.36/ 3.12** loose
sad 5.44/ 1.66 6.00/ 1.44/ 1.65 joyous
fearful 5.40/ 1.71 5.92/ 1.19/ 1.60 courageous
sluggish 4.64/ 1.60 5.32/ 1.77/ 1.63 alert
** p < .01; *** p < .001
In addition to the results measured with scales, it became clear from the feedback of participants that they were
satisfied with the shape and inclines of the lounge chair, the mattress and the chair’s stability. Sitting on and rising from
the lounge chair were both suitable and acceptable. Feedback questionnaire was filled in by 24 participants (Table 4), 2
participants gave an oral positive feedback.
It was noted in the comments that the lounge chair is sufficiently comfortable, of appropriate height, and has a
pleasant shape. Proposals were also made regarding the softness of the mattress and the height of the head support. It
was difficult for participants in VA therapy to compare it with other treatments. It was claimed that it was so different.
One participant described the experience as follows: ‘I believe that it really can’t be compared with other procedures.
You don’t feel any warmth or direct physical effect. The vibration is only slightly perceptible. The therapy has a
different kind of effect, through the body and the spirit. It is very difficult to describe what it is. It’s kind of like a
process.’ Based on the feedback of participants as well as the observations of the specialist, carrying out the procedure,
most of the participants fell asleep during the procedure. The comment was made that after the end of the affect, it
would be nice to rest in the lounge chair for a while longer.
244 Vibroacoustic Therapy and Development of a New Device: A Pilot Study in the Health Resort Environment
Table 4. Participants’ feedback of the comfort of the lounge chair
Indicator
Valid N
Mean
Median
Minimum
Maximum
SD
Sitting on the chair
24
6.7
7.0
5
7
.6
Rising from the
chair 24 6.7 7.0 5 7 .6
Chair’s stability
24
6.9
7.0
5
7
.4
Mattress
24
6.8
7.0
6
7
.4
Body position on
the chair 24 6.5 7.0 5 7 .7
5. Discussion
VA devices have a broad spectrum of use, having a
therapeutic effect on physical health problems, such as
pain and muscle tension and spasms, as well as cognitive
decline and mood disorders. This creates the possibility to
add the treatment method to various treatment and health
programmes. This pilot study focused specifically on the
application of the VA treatment on purposes of health
promotion. The general relaxing effect of VA therapy is
known to the practitioners of VA procedures. Campbell,
Hynynen and Ala-Ruona [8] have pointed out that
increased relaxation may help to reset the learnt response
of dysfunctional pain processing associated with the
cumulative negative effects of chronic pain, anxiety, and
depression. They underline the relationship between
increased relaxation, decreased stress, and regulation and
resetting of learnt pain responses.
Despite the limitations of the pilot study (small sample
size, different health problems of those participating in the
study, lack of a control group) the pre-post session
measurements showed promising changes in the perceived
health indicators. The study design left health resort
visitors with the freedom to decide whether they wished to
try VA treatment and how many sessions they wanted to
take. Typically, the required frequency and number of
sessions that are necessary to achieve the goal of VA
treatment and results is specified. An interesting result
that was encountered was the clear distribution of
participants into those who immediately felt a benefit
from VA treatment, and continued with treatment; and
those who cancelled the treatment, and in regards to
whom, on the basis of the data, the claim can be made that
they didn’t feel a significant effect from VA therapy on
their well-being.
In a previous study [11] the measurements of spasticity
showed that the biggest decline in the indicator took place
during the first three VA treatment days and the results of
the study showed that the effect of the number of
treatment days (four treatment days compared with five
treatment days) on self-rated spasticity, fatigue, anxiety,
and physical discomfort was not statistically significant.
However, the number of treatment days had a significant
effect on the general perceived health condition and pain.
Data from this study and the previous study permit the
conclusion to be made that the addition of VA treatment,
for example, weeklong rehabilitation, spa treatment and
relaxation packages, is appropriate. Without a doubt, the
effect of VA treatment in these packages must be more
precisely determined. Certain assumptions may, however,
be made based on a previous qualitative intervention study
[28] conducted on teenage girls suffering from heightened
anxiety, in which VA treatment was used as one
influencer. The research provided essential information
about the processes taking place during VA treatment.
Participants emphasised the novel bodily sensation, which
also appeared in the feedback of the participants in this
study, and the importance of the physical component of
VA treatment. In this previous research, participants
emphasised the positive bodily experience that can be
expressed through two categories: a) physical
self-awareness – discovering the significance of bodily
needs (rest, relaxation, care); and b) physical comfort –
fulfilling bodily needs.
Campbell, Hynynen & Ala-Ruona [8] point out that the
use of VA treatment is growing, but the evidence
supporting its efficacy is somewhat lacking. However,
they admit that even though non-controlled studies are
unable to report on the efficacy of a treatment, reporting
protocols followed in a naturalistic setting provide
information on how a treatment may function within a
larger context. Thus, even though the design weakness of
the study must be taken into consideration when drawing
conclusions about this study, it can still be admitted that
the prototype of the new VA device felt comfortable to the
user and the changes in the indicators of perceived health
indicate that the procedure did not have a negative effect
and can be used for general health purposes in the health
resort environment. It also seems appropriate to combine
VA treatment with other treatments and health procedures.
In subsequent studies attention should be focused on the
more specific role of VA treatment and the synergies in
various integrated treatment programmes.
Conflicts of Interest
There are no conflicts of interest.
Universal Journal of Public Health 6(5): 240-246, 2018 245
Acknowledgements
The authors would like to acknowledge the support of
the Värska Health Resort.
The study was carried out within the framework of the
Tallinn University Haapsalu College TA/112 project
Health Promotion and Rehabilitation Centre
(15.09.2011−31.08.2015) funded by the European
Regional Development Fund.
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