Effects of different vibration frequencies on muscle strength, bone turnover and walking endurance in chronic stroke

Non-pharmacological and pharmacological treatments for bone health after stroke: Systematic review with meta-analysis

BACKGROUND

Hemi-osteoporosis is a common secondary complication of stroke. No systematic reviews of pharmacological and non-pharmacological agents for post-stroke bone health have estimated the magnitude and precision of effect sizes to guide better clinical practice.

OBJECTIVES

To examine the benefits and harms of pharmacological and non-pharmacological agents on bone health in post-stroke individuals.

METHODS

Eight databases were searched (PubMed, Cochrane library, Scopus, CINAHL Complete, Embase, PEDro, Clinicaltrils.gov and ICTRP) up to June 2023. Any controlled studies that applied physical exercise, supplements, or medications and measured bone-related outcomes in people with stroke were included. PEDro and the GRADE approach were used to examine the methodological quality of included articles and quality of evidence for outcomes. Effect sizes were calculated as standardized mean differences (SMD) and risk ratio (RR). Review Manager 5.4 was used for data synthetization.

RESULTS

Twenty-four articles from 21 trials involving 22,500 participants (3,827 in 11 non-pharmacological and 18,673 in 10 pharmacological trials) were included. Eight trials were included in the meta-analysis. The methodological quality of half of the included non-pharmacological studies was either poor or fair, whereas it was good to excellent in 8 of 10 pharmacological studies. Meta-analysis revealed a beneficial effect of exercise on the bone mineral density (BMD) of the paretic hip (SMD: 0.50, 95 % CI: 0.16; 0.85; low-quality evidence). The effects of anti-resorptive medications on the BMD of the paretic hip were mixed and thus inconclusive (low-quality evidence). High-quality evidence showed that the administration of antidepressants increased the risk of fracture (RR: 2.36, 95 % CI 1.64-3.39).

CONCLUSION

Exercise under supervision may be beneficial for hip bone health in post-stroke individuals. The effect of anti-resorptive medications on hip BMD is uncertain. The adverse effects of antidepressants on fracture risk among post-stroke individuals warrant further attention. Further high-quality studies are required to better understand this issue.

REGISTRATION

PROSPERO CRD42022359186.

Evidence of whole-body vibration exercises on body composition changes in older individuals: a systematic review and meta-analysis

Introduction: The aging process is associated with changes in body composition, including fat gain and skeletal muscle loss from middle age onward. Moreover, increased risk of functional decline and the development of chronic diseases are also related to aging. Objective: This systematic review and meta-analysis aimed to evaluate the effects of whole-body vibration exercise (WBVE), as a physical exercise, on body composition in people over 60 years of age. Methods: Searches were performed on PubMed, Scopus, Web of Science, and Embase. Only randomized clinical trials evaluating the effects of WBVE on body composition in older individuals were considered. The methodological quality of the studies involved was assessed using the Physiotherapy Evidence Database (PEDro) scale, recommendations from the Cochrane Collaboration were used to assess risk of bias, and quality of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology. RevMan 5.4 was used to calculate standardized mean differences and confidence intervals of 95% (CIs). Results: Eight studies were included in this review with a mean methodological quality score of 7.5, which is considered high quality on the PEDro scale. The included studies suggest that more robust research with protocols and well-designed comparison groups is required to better assess changes in the body composition of older individuals through WBVE. Quantitative results were calculated, with differences in weighted means, differences in standardized means, and 95% confidence intervals (CIs). Conclusion: WBVE evaluated by the studies included in this review did not demonstrate improvements in body composition, and no significant effect of WBVE was found on fat mass with standardized differences (SD = -1.92; 95% CI: -4.81 to -0.98; p = 0.19), lean mass with standardized mean differences (SMD = 0.06 CI 95% [-0.21; -0.33]; p = 0.67), or skeletal muscle mass with standardized differences (SD = 0.10; CI 95% [-1.62; 1.83]; p = 0.91). Therefore, to date, there is lack of adequate evidence to state that WBVE can benefit the body composition of men and women over 60 years of age. However, further studies are required to better understand the physiological impacts of WBVE on body composition. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#myprosperoCRD42021248871, identifier CRD42021248871.

Effect of whole-body vibration training on the recovery of lower limb function in people with stroke: a systematic review and meta-analysis

PURPOSE

The purpose of this meta-analysis was to systematically evaluate the effects of whole-body vibration training (WBVT) on the recovery of lower limb function in people with stroke.

METHODS

The literature search was made in the electronic databases PubMed, Web of Science, Scopus and Embase electronic databases. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. The search was conducted on September 01, 2022. The data analysis software was RevMan 5.3.

RESULTS

A total of 13 RCTs were included, including 687 patients. The results showed that compared with the control group, the overall difference in balance function was statistically significant [MD = 4.23, 95% CI 2.21 ∼ 6.26, p < 0.0001]. There was no significant difference in the evaluation indexes of lower limb motor function, including the TUG, 10MWT, 6MWT, and FMA - LE. The overall difference in lower limb muscle spasticity was statistically significant [MD = -0.53, 95% CI -0.81 ∼ 0.26, p = 0.0001].

CONCLUSIONS

Compared with the control group, using WBVT treatment has a more obvious effect on the recovery of lower limb function and muscle spasticity, and there is no obvious advantage in motor function recovery.IMPLICATIONS FOR REHABILITATIONThis Systematic Review and meta-analysis of evidence suggest that whole-body vibration training is effective in the rehabilitation of lower limb function in patients with stroke.Whole body vibration training may be a better choice for improving balance and spasm in people with stroke.Currently it is not known which whole-body vibration training model with vibration intensity, stimulus type and duration is most effective and to design more targeted interventions.

Said S, Ahmad Tarmizi NA, Loh SP, Lim WC, Nadarajah R, Lim HT, Mohd Zambri NH, Ho YY, Shariff Ghazali S. Non-pharmacological interventions for bone health after stroke: A systematic review

Objective

To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients.

Data sources

Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021.

Methods

A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis.

Results

Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported.

Conclusion

There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.