Effects of Whole Body Vibration Exercise associated with Quadriceps Resistance Exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial

Advances in regenerative rehabilitation in the rehabilitation of musculoskeletal injuries

In the rapidly advancing field of regenerative medicine, relying solely on cell transplantation alone may be insufficient for achieving functional recovery, and rehabilitation before and after transplantation is crucial. Regenerative rehabilitation functions by synergizing the therapeutic effects of regeneration and rehabilitation to maximize tissue regeneration and patient function. We used the keywords "regenerative rehabilitation" to search across the database for published works; this review discusses the development of regenerative rehabilitation for the treatment of musculoskeletal injuries. Rehabilitation has become a crucial component of regenerative medicine because it can enhance patients' functional activity and facilitate their early return to society. Experimental data increasingly demonstrates that rehabilitation interventions support the regeneration of transplanted tissues.

Changes in gastrocnemius MTU stiffness and their correlation with plantar pressure in patients with knee osteoarthritis

Background

Abnormal, excessive, and repetitive knee load is a critical risk factor for osteoarthritis (OA). The gastrocnemius muscle-tendon unit (MTU) interacts with foot biomechanics and is vital in cushioning the knee load. Abnormal gastrocnemius activation and plantar pressure during walking in patients with knee OA may negatively affect gastrocnemius MTU stiffness, increasing knee load. Few studies investigated the relationship between gastrocnemius MTU stiffness and plantar pressure. This study aimed to evaluate the changes in gastrocnemius MTU stiffness in patients with knee OA and their correlations with plantar pressure and clinical symptoms.

Methods

Thirty women patients with unilateral knee OA and 30 healthy women participants were recruited. Shear wave elastography was used to quantify gastrocnemius MTU stiffness in ankle resting and anatomical 0° positions, defined as natural and neutral positions in this study. A plantar pressure analysis system was used to collect the plantar pressure parameters on the symptomatic side in patients with knee OA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) scores were used to measure the severity of clinical symptoms.

Results

Medial and lateral gastrocnemius (MG and LG) stiffness on both the asymptomatic and symptomatic sides in patients with knee OA was increased compared with that in healthy participants. The MG and LG optimal cutoff stiffness in the natural position was 15.73 kPa and 14.25 kPa, respectively. The optimal cutoff stiffness in the neutral position was 36.32 kPa and 25.43 kPa, respectively, with excellent sensitivity and specificity. The MG and LG stiffness were positively correlated with the percentages of anterior and medial plantar pressure and negatively correlated with the length of pressure center path. The LG and MG were significantly correlated with WOMAC and VAS scores.

Conclusion

Patients with knee OA have increased gastrocnemius muscle stiffness, closely related to plantar pressure and clinical symptoms. Monitoring the gastrocnemius muscle in patients with knee OA can provide an essential basis for its prevention and treatment.

Whole-Body Vibration Impacts on the Degree of Toe Angle and Its Correlation to the Knee Osteoarthritis Index during Level Walking among Female University Students: A Randomized Controlled Trial

Whole-body vibration (WBV) training is used for ankle rehabilitation as it stimulates muscle spindles to excite tonic vibration reflexes, and improves muscle strength, power, joint proprioception, balance, and flexibility. Thus, this study aims to determine the impact of whole-body vibration on the degree of the toe angle and the correlation between the toe angle and knee osteoarthritis index during level walking among female university students. A randomized controlled trial was conducted with 42 participants divided into two groups. The control group performed only home-based exercise (HBE) after education, and the study group received WBV with HBE. The functional status of participants to predict osteoarthritis was evaluated using the Western Ontario and McMaster osteoarthritis index (WOMAC), where the toe angle degree and WOMAC index were assessed before and six weeks after training. The results showed a significant improvement in the toe-in angle of HBE + WBV compared to the HBE group (p = 0.02), and in HBE + WBV, an improvement of the toe angle showed a 43% decrease in the WOMAC index (p = 0.001). In conclusion, WBV for the ankle and foot training program positively affected the degree of the toe angle, that directly affected the subtalar and ankle joint mechanics. Trial registration in the Pan African Clinical Trial Registry PACTR202304816093190 (registered retrospectively, date of registration: 18 April 2023).

Mechanical-based therapies may reduce pain and disability in some patients with knee osteoarthritis: A systematic review with meta-analysis

BACKGROUND

Mechanical-based therapies are not yet recommended to manage osteoarthritis (OA). This systematic review and meta-analysis aim to assess the effects of passive mechanical-based therapies (isolated or combined with other therapies) on patients with knee OA compared to placebo, other isolated or combined interventions.

METHODS

Pubmed, Cochrane, Web of Science and EMBASE were searched up to December 2020. We included randomized and non-randomized trials using therapeutic ultrasound, phonophoresis, extracorporeal shockwave therapy (ESWT) and vibration (single or combined with other therapies) compared to placebo, and/or other physical therapies groups. Biochemical, patient-reported, physical and imaging outcome measures were retrieved. We judged risk of bias using the RoB2 tool for randomized studies, the ROBINS-I tool for non-randomized studies, and the GRADE to interpret certainty of results.

RESULTS

We included 77 clinical studies. Ultrasound and ESWT statistically improved pain and disability comparing to placebo (combined or not with other therapies), and when added to other therapies versus other therapies alone. Ultrasound was statistically inferior to phonophoresis (combined or not with other therapies) in reducing pain and disability for specific therapeutic gels and/or combined therapies. Vibration plus exercise statistically improved pain relief and function versus exercise alone. All meta-analyses showed very-low certainty of evidence, with 15 of 42 (38%) pooled comparisons being statistically significant (weak to large effect).

CONCLUSIONS

Despite the inconsistent evidence with very-low certainty, the potential benefits of passive mechanical-based therapies should not be disregard and cautiously recommended that clinicians might use them in some patients with knee OA.

Low-Frequency Vibration Promotes Tumor Necrosis Factor-α Production to Increase Cartilage Degeneration in Knee Osteoarthritis

OBJECTIVE

Low-frequency vibration accelerates cartilage degeneration in knee osteoarthritis (KOA) rat model. In this article, we investigated whether whole-body vibration (WBV) increases cartilage degeneration by regulating tumor necrosis factor-α (TNF-α) in KOA.

DESIGN

Proteomics analysis was used to filter candidate protein from synovial fluid (SF) in KOA people after WBV. Enzyme-linked immunosorbent assay (ELISA) was used to estimate changes in TNF-α levels in SF. The C57 mice and TNF-α knock-out mice were sacrificed for the KOA model and WBV intervention. The cartilage was tested by ELISA, histology, terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL), immunohistochemistry, and reverse transcriptase polymerase chain reaction. Luciferase activity test in vitro study was conducted to confirm the relationship between TNF-α and the candidate protein.

RESULTS

Differentially expressed proteins were enriched in the glycolytic process, glucose catabolic, and regulation of interleukin-8 (IL-8) secretion processes. Phosphoglycerate kinase, triosephosphate isomerase 1, T cell immunoglobulin- and mucin-domain-containing molecules 2, fumarylacetoacetate hydrolase (FAH), and TNF were the hub node. TNF-α expression increased in SF after WBV (P < 0.05). The cartilage was more degenerated in the TNF-α^-/- mice group compared to controls. A significant change was observed in collagen II and FAH (P < 0.05). TNF-α expression improved in C57 mice (P < 0.05). Apoptosis of chondrocytes was inhibited in TNF-α^-/- mice by the TUNEL test. Luciferase activity significantly increased in TNF-α + FAH-Luc cells (P < 0.05).

CONCLUSION

A novel mechanism underlying WBV-triggered cartilage degeneration was found in KOA that demonstrated the critical regulatory function of TNF-α and FAH during WBV.

Does Whole-Body Vibration Training Have a Concurrent Effect on Bone and Muscle Health? A Systematic Review and Meta-Analysis

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.

Mechanobiology-based physical therapy and rehabilitation after orthobiologic interventions: a narrative review

PURPOSE

This review aims to summarize the evidence for the role of mechanotherapies and rehabilitation in supporting the synergy between regeneration and repair after an orthobiologic intervention.

METHODS

A selective literature search was performed using Web of Science, OVID, and PubMed to review research articles that discuss the effects of combining mechanotherapy with various forms of regenerative medicine.

RESULTS

Various mechanotherapies can encourage the healing process for patients at different stages. Taping, bracing, cold water immersion, and extracorporeal shockwave therapy can be used throughout the duration of acute inflammatory response. The regulation of angiogenesis can be sustained with blood flow restriction and resistance training, whereas heat therapy and tissue loading during exercise are recommended in the remodeling phase.

CONCLUSION

Combining mechanotherapy with various forms of regenerative medicine has shown promise for improving treatment outcomes. However, further studies that reveal a greater volume of evidence are needed to support clinical decisions.

The Application of Whole-Body Vibration Training in Knee Osteoarthritis

With the gradual increase of the aging population in Chinese society, the incidence of knee osteoarthritis showed an increasing trend. However, there are very few practical solutions for it. As a novel neuromuscular training technique, whole-body vibration training has become a candidate for treating knee osteoarthritis. In this review, we firstly elaborated on the mode of action and influence factors of the whole-body vibration training. Next, we summarized its effects in knee osteoarthritis, including improving knee function and some uncertain muscle function and proprioception effects. Next, we also summarized its possible mechanisms, including improving bone microstructure, delaying articular cartilage degeneration, modulating inflammatory cells and inflammatory factors. Then, we summarized the clinical effectiveness of whole-body vibration training by analyzing some clinical randomized controlled trials. Finally, based on the above summary, we analyzed and listed the limitations of whole-body vibration training in treating knee osteoarthritis and found the shortcomings in the existing studies. This review provides ideas for the future application of whole-body vibration training in the treatment of knee osteoarthritis.

Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: A randomized controlled trial

BACKGROUND

Systemic lupus erythematosus (SLE) is a complex rheumatic autoimmune disease characterized by periods of exacerbations that can present damage in organs with important clinical manifestations.

OBJECTIVE

The aim of this study was to evaluate the effect of 12-week whole-body vibration exercise (WBVE) on the fatigue, functional ability and quality of life of women with systemic lupus erythematosus (SLE) in chronic glucocorticoids use (CGU).

METHODS

Twenty-one women were allocated randomly in the WBVE group or isometry group. The participants of WBVE group were positioned on the vibrating platform with 130° knee flexion and received the intervention twice a week for 12 weeks. The isometry group performed the same position and time, but without the stimulus of mechanical vibration. Fatigue, functional ability and the quality of life were evaluated at weeks 0, 6, and 12.

RESULTS

From a sample of seventy-seven individuals, seventeen participants completed the study, 8 in WBVE group and 9 in isometry group. Fatigue reduced in the WBVE group at 6 and 12 weeks of intervention (p = 0.04) and (p = 0.03) respectively. There was a significant improvement in the functional ability evaluated by the Health Assessment Questionnaire in the WBVE group compared to the isometry group (p = 0.03).

CONCLUSION

WBVE would be a useful intervention for control of fatigue and improvement of the functional ability of women with SLE in CGU.

Effect of whole body vibration on HIF-2α expression in SD rats with early knee osteoarthritis

INTRODUCTION

To investigate the effect of different frequencies of whole body vibration (WBV) on articular cartilage of early knee osteoarthritis (OA) rats and determine whether WBV would influence the pathway of hypoxia-inducible factor-2α (HIF-2α) regulation-related genes after 8 weeks of treatment.

MATERIALS AND METHODS

Forty 8-week-old OA rats were divided into five groups: sham control (SC); high frequency 60 Hz (HV₁); high frequency 40 Hz (HV₂); middle frequency 20 Hz (MV) and low frequency 10 Hz (LV). WBV (0.3 g) treatment was given 40 min/day and 5 days/week. After 8 weeks, rats were killed and knees were harvested. OA grading score: Osteoarthritis Research Society International (OARSI), and the expression of related genes: interleukin-1β (IL-1β), HIF-2α, matrix metalloproteinases-13 (MMP-13), and collagen type II alpha 1 (COL2A1), at both mRNA and protein levels were analyzed.

RESULTS

After 8 weeks of WBV, our data showed that lower frequency (10 Hz) was more effective than the higher ones, yet they all suggested that WBV alleviates the erosion of knee articular cartilage in early OA. The expression of IL-1β, HIF-2α and MMP-13 decreased with frequency and reached the lowest level at 10 Hz, the expression of COL2A1 increased with frequency and reached the highest level at 10 Hz.

CONCLUSIONS

This study demonstrates that WBV could alleviate the degeneration of knee joints in an early OA rat model. WBV regulates related gene expression at both mRNA and protein levels. HIF-2α could be a therapeutic target. The effect of WBV is frequency dependent; the lower frequency shows better effects.

Effect of Whole-Body Vibration on the Functional Responses of the Patients with Knee Osteoarthritis by the Electromyographic Profile of the Vastus Lateralis Muscles during the Five-Repetition Chair Stand Test: A Randomized Crossover Trial

Knee osteoarthritis (KOA) can cause functional disability. Neuromuscular function is relevant in the development and progression of KOA. It can be evaluated by the analysis of the surface electromyography (sEMG), which has an important role in the understanding of KOA. Whole-body vibration (WBV) is an intervention suggested to treat KOA. The objective of this work was to verify the effectiveness of WBV on the functionality of lower limbs by the electromyographic profile of the vastus lateralis (VL) muscles during the five-repetition chair stand test (5CST) in patients with KOA. This was a two-period crossover trial study (8-week washout). Nineteen patients with KOA were allocated to the group submitted to WBV (WBVG), with peak-to-peak displacement of 2.5 to 7.5 mm, frequency from 5 to 14 Hz, and acceleration peak from 0.12 to 2.95 g, or to the control group (0 Hz) (2 days per week for 5 weeks). The 5CST and the sEMG of the VL during 5CST were evaluated before and after the interventions. Results: Significant differences in 5CST were evident only in WBVG (p = 0.018), showing a decrease of the execution time. The sEMG profile showed no significative difference. Therefore, only 10 sessions of WBV with comfortable posture can bring about improvement in functionality of KOA patients without alteration of the muscle excitation.

Impact of Exercise Therapy on Molecular Biomarkers Related to Cartilage and Inflammation in Individuals at Risk of, or With Established, Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To investigate the impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in individuals at risk of, or with established, knee osteoarthritis by conducting a systematic review of randomized controlled trials (RCTs).

METHODS

We conducted a literature search up to September 2017 in 5 major databases with no restriction on publication year or language. Data were extracted from the first available follow-up time point, and we performed a narrative synthesis for the effect of exercise therapy on molecular biomarkers related to cartilage and inflammation. A subset of studies reporting sufficient data was combined in a meta-analysis, using an adjusted random-effects model.

RESULTS

Twelve RCTs involving 57 study comparisons at 4 to 24 weeks following an exercise-therapy intervention were included. Exercise therapy decreased molecular biomarkers in 17 study comparisons (30%), had no effect in 36 (63%), and increased molecular biomarkers in 4 study comparisons (7%). Meta-analyses of 9 biomarkers showed that exercise therapy was associated with nonsignificant reductions of the C-reactive protein level, C-terminal crosslinking telopeptide of type II collagen, tumor necrosis factor (TNF), soluble TNF receptors 1 and 2, C2C neoepitope of type II collagen, and cartilage oligomeric matrix protein, compared to nonexercising control groups, and exercise therapy had no effect on interleukin-6 and soluble interleukin-6 receptor.

CONCLUSION

Exercise therapy is not harmful, because it does not increase the concentration of molecular biomarkers related to cartilage turnover and inflammation, implicated in osteoarthritis progression. The overall quality of evidence was downgraded to low because of the limited number of RCTs available.

Effect of the Combined Intervention with Passive Whole-Body Vibration and Auriculotherapy on the Quality of Life of Individuals with Knee Osteoarthritis Assessed by the WHOQOL-Bref: A Multi-Arm Clinical Trial

The aim of this study was to determine the effect on the quality of life of two non-pharmacological interventions isolated or in combination: (i) passive whole-body vibration exercise (WBVE), and (ii) auriculotherapy (AT). One hundred three participants with knee osteoarthritis (KOA) were allocated to: (a) a vibration group (WBVEG; n = 17) that performed WBVE (peak-to-peak displacement: 2.5 to 7.5 mm, frequency: 5 to 14 Hz, Peak acceleration: 0.12 to 2.95 g), two days/weekly for five weeks, (b) an AT group (ATG; n = 21), stimulation of three specific auriculotherapy points (Kidney, Knee and Shenmen) in each ear pavilion, (c) WBVE + AT (WBVE + AT; n = 20) and (d) respective control groups (WBVE_CG, n = 15; AT_CG, n = 12; WBVE + AT_CG, n = 18). The participants filled out the WHOQOL-bref Questionnaire before the first and after the last sessions. Statistical differences in the various domains of the WHOQOL-bref were not found. In conclusion, WBVE or AT alone or combined did not contribute in altering the quality of life of individuals exposed to these interventions.

Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial

Metabolic syndrome (MetS) is related to overweight and obesity, and contributes to clinical limitations. Exercise is used for the management of MetS individuals, who are often not motivated to perform this practice. Whole body vibration exercise (WBVE) produces several biological effects, besides being safe, effective, and feasible for MetS individuals. This pseudo-randomized and cross-over controlled trial study aimed to analyze the effects of WBVE on MetS individuals’ neuromuscular activation using the surface electromyography (sEMG) pattern (root mean square (RMS)) of the vastus lateralis (VL) muscle and on the range of motion (ROM) of the knees. Participants (n = 39) were allocated to two groups: the treatment group (TG), which was exposed to WBVE, and the control group (CG). WBVE interventions were performed twice a week, for a period of 5 weeks. ROM and sEMG were analyzed at baseline, after the first session, and before and after the last session. sEMG (%RMS) significantly increased in the acute effect of the last session of WBVE (108.00 ± 5.07, p < 0.008, right leg; 106.20 ± 3.53, p < 0.02, left leg) compared to the CG. ROM did not significantly change in TG or CG. In conclusion, 5 weeks of WBVE exerted neuromuscular effects capable of increasing VL muscle RMS in individuals with MetS, this effect being potentially useful in the physical rehabilitation of these individuals.

Early Post-Operative Intervention of Whole-Body Vibration in Patients After Total Knee Arthroplasty: A Pilot Study

(1) Background: Knee osteoarthritis causes pain, weakness, muscle atrophy, and disability. The application of whole-body vibration in patients with knee osteoarthritis can improve strength, balance, and functional activities. The purpose of the study is to evaluate the effects of early whole-body vibration intervention in patients after total knee arthroplasty. (2) Method: A single-blinded randomized control trial. Fifty-two patients with knee osteoarthritis post total knee replacement from a medical center in southern Taiwan were randomly assigned to either a whole-body vibration group or control group. Main outcome measures included pain severity, leg circumference, knee range of motion, knee extensor strength, a five-times sit to stand test, and a timed up and go test. (3) Results: Immediately post treatment, the patients in the vibration group showed a significant increase in knee extensor strength and improvement in calf swelling compared to the control group. A trend toward decrease in pain severity and improvement in functional performance were observed in both groups without a significant difference between the groups. There was no significant difference in knee range of motion (ROM) and functional performance between the groups. (4) Conclusions: The whole-body vibration intervention in patients early post total knee arthroplasty showed significant immediate effect in increasing knee extensor strength and decreasing calf swelling.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Whole Body Vibration Training on Muscle Strength and Brain-Derived Neurotrophic Factor Levels in Elderly Woman With Knee Osteoarthritis: A Randomized Clinical Trial Study

Background: Osteoarthritis of the knee (kOA) is a chronic, progressive, degenerative health condition that contributes to the imbalance between the synthesis and destruction of articular cartilage. Recently, whole body vibration (WBV) training has been recommended as an effective alternative for strength training in elderly people, and various physiological effects are obtained in response to exercise performed on a vibratory platform, such as an increase in muscle activation and improved muscle performance. However, the effects of WBV particularly on the strength of the quadriceps muscle and neuronal plasticity are unknown.

Objective: The aim of this study was to evaluate the effects of adding WBV to squat training on the isometric quadriceps muscle strength (IQMS) and the plasma levels of brain-derived neurotrophic factor (BDNF) in elderly woman with kOA.

Methods: Fifteen elderly women ≥65 years of age with kOA were randomized into two interventions: (1) the vibration group (VG), in which participants performed squat exercise training in association with WBV or (2) the exercise group (EG), in which participants performed squat exercise training without vibration, for 12 weeks 3×/week.

Results: Compared to the EG group, the VG group demonstrated a significantly greater delta (Δ) in IQMS values (IC95% 0.43–7.06; p ≤ 0.05) and in Δ BDNF plasma levels (IC95% −32.51 to 4.217; p ≤ 0.05) after the intervention period. There was an association between increase of Δ BDNF plasma levels and increase of Δ IQMS (β = 0.57; R² = 0.32; p = 0.03).

Conclusion: The addition of WBV to squat exercise training improves lower limb muscle performance in elderly women with kOA. These findings suggest that the improvement in muscle performance is related to neuromuscular adaptations induced by WBV.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03918291.

Long-Term Effects of Whole-Body Vibration on Human Gait: A Systematic Review and Meta-Analysis

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.

Whole Body Vibration Exercise for Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

This study systematically reviews previous work on the effects of whole body vibration exercise (WBVE) on pain associated with chronic musculoskeletal disorders.

DATA SOURCES

Seven electronic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane, Physiotherapy Evidence Database [PEDro], and the China National Knowledge Infrastructure) were searched for articles published between January 1980 and September 2018.

STUDY SELECTION

Randomized controlled trials involving adults with chronic low back pain (CLBP), osteoarthritis (OA), or fibromyalgia were included. Participants in the WBVE intervention group were compared with those in the nontreatment and non-WBVE control groups.

DATA EXTRACTION

Data were independently extracted using a standardized form. Methodological quality was assessed using PEDro.

DATA SYNTHESIS

Suitable data from 16 studies were pooled for meta-analysis. A random effects model was used to calculate between-groups mean differences at 95% confidence interval (CI). The data were analyzed depending on the duration of the follow-up, common disorders, and different control interventions.

RESULTS

Alleviation of pain was observed at medium term (standardized mean difference [SMD], -0.67; 95% CI, -1.14 to -0.21; I², 80%) and long term (SMD, -0.31; 95% CI, -0.59 to -0.02; I², 0%). Pain was alleviated in osteoarthritis (OA) (SMD, -0.37; 95% CI, -0.64 to -0.10; P<.05; I², 22%) and CLBP (SMD, -0.44; 95% CI, -0.75 to -0.13; P<.05; I², 12%). Long-term WBVE could relieve chronic musculoskeletal pain conditions of OA (SMD, -0.46; 95% CI, -0.80 to -0.13; P<.05; I², 0%). WBVE improved chronic musculoskeletal pain compared with the treatment "X" control (SMD, -0.37; 95% CI, -0.61 to -0.12; P<.05; I², 26%), traditional treatment control (SMD, -1.02; 95% CI, -2.44 to 0.4; P>.05; I², 94%) and no treatment control (SMD, -1; 95% CI, -1.76 to -0.24; P<.05; I², 75%).

CONCLUSIONS

Evidence suggests positive effects of WBVE on chronic musculoskeletal pain, and long durations of WBVE could be especially beneficial. However, WBVE does not significantly relieve chronic musculoskeletal pain compared with the traditional treatment. Further work is required to identify which parameters of WBVE are ideal for patients with chronic musculoskeletal pain.

The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study

Background

Knee osteoarthritis (KOA) is common in elderly people, causes pain, loss of physical functioning, and disability. This was a two-arm, superiority, quasi-experimental trial. The aim of this study was to evaluate the effectiveness of a home-based exercise intervention (HBEI) to reduce KOA symptoms and improve the physical functioning of elderly patients.

Methods

A total of 171 elderly patients (60 years of age or older) with KOA were recruited from four community centers. Patients from two community centers were randomly assigned to the intervention group (IG) and the other two centers were randomly assigned to the control group (CG). Participants in the IG received a 12-week HBEI (including four 2-h sessions supervised by a physiotherapist and fortnightly telephone support) combined with health education, while patients in the CG only received health education. The participants and physiotherapists were aware of the group assignment and alternative treatment components, but the study’s hypotheses were not disclosed to the participants. Pain intensity, joint stiffness, lower-limb muscle strength, balance, mobility, and quality of life were measured before and after the intervention by the same blinded assessor.

Results

A total of 171 patients (IG: n = 84, CG: n = 87) were enrolled. Data were obtained from 141 patients with an average age of 68 (range, 60–86 years) who completed the 12-week study (IG: n = 71, CG: n = 70). No significant group differences were found in any outcome measures at baseline. At week 12, the pretest/posttest changes 3significant between-group differences in decreases in pain intensity (− 1.60 (CI, − 2.75 to − 0.58)) and stiffness (− 0.79 (CI, − 1.37 to − 0.21)), with the IG exhibiting significantly larger improvements on both measures than the CG. The IG also showed significantly greater improvements on all the secondary outcomes than the CG did.

Conclusions

HBEI may be effective for relieving KOA symptoms, increasing the physical functioning, and improving quality of life in community-dwelling KOA elderly patients. A large randomized controlled trial with long-term follow-up is needed to confirm these findings.

Trial registration

Chinese Clinical Trails Registry number ChiCTR1800017026 (retrospectively registered). Registered 9 July 2018.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2521-4) contains supplementary material, which is available to authorized users.

Rehabilitation following regenerative medicine treatment for knee osteoarthritis-current concept review

The purpose of this manuscript is to provide a current concept review for the rehabilitative management of knee osteoarthritis (KOA) following regenerative medicine intervention. A proposed comprehensive regenerative rehabilitative program has been created, based on a literature review of the current best practices of rehabilitative methods and non-operative management in KOA patients with an emphasis on the goals of regenerative medicine: to optimize self-healing and functional tissue recovery. Regenerative medicine promotes regeneration and joint restoration by using blood-based procedures such as platelet rich plasma, stem cell and cell-based or tissue engineering. Regenerative medicine procedures are variable and lack of standardization in product preparation, administration, and different treatment protocols. The lack of standardization imposes challenges in regenerative rehabilitation. Over the last decade, there is growing evidence in regenerative medicine and its uses in non-operative management of various pathologies. Advances in regenerative medicine technologies brings radical innovations to establish new and effective rehabilitation protocols promoting restoration of function through tissue regeneration and repair optimizing the standard of care, specifically in rehabilitation when combined with regenerative protocols for patients with KOA is the most common degenerative disease in the knee and can affect any synovial joint in the body. It is a leading cause of disability affecting the quality of lives of millions of people world-wide. Conventional methods of mild to moderate KOA are focused on short-term symptomatic relief and do not promote joint homeostasis or regeneration of injured tissue. Regenerative medicine emphasizes a paradigm shift in patient-centered care promoting regeneration and joint restoration by using blood-based procedures such as platelet rich plasma, stem cell and cell-based or tissue engineering. The purpose of this current concept review is to outline a comprehensive post-regenerative rehabilitative program in the management of KOA based on the best available evidence. Our proposed regenerative rehabilitation program is intended to align the goals of regenerative medicine with the current, high-level evidence of non-operative management for KOA, to optimize self-healing and functional tissue recovery.

Whole-body vibration exercise for low back pain: A meta-analysis protocol of randomized controlled trial

BACKGROUND

Low back pain (LBP) affects about 80% of the population at some time in their lives. Exercise therapy is the most widely used nonsurgical intervention for low back pain in practice. Thus, whole-body vibration (WBV) exercise is becoming increasingly popular in relieving musculoskeletal pain and in improving function. However, the efficacy of WBV exercise is not without dispute for low back pain. This meta-analysis, with its comprehensive and rigorous methodology, will provide better insight into this problem.

METHODS

Published articles will be identified using electronic searches from 1950 to 2018. The Cochrane Library, PubMed, Web of Science, Embase, CINAHL-Ebsco, PEDro, and China Biology Medicine will be searched for randomized controlled trials. Studies without a parallel comparison group will be excluded. Two reviewers will independently select relevant studies that investigate on WBV exercise for patients with LBP. Data extraction will be done independently by the same 2 reviewers who selected the studies. The primary outcome will be to assess pain, back-specific disability index, and adverse effect. Continuous data will be pooled by calculating the mean difference using the random-effects model.

RESULTS

The results of the final meta-analysis will provide an evidence of WBV exercise for low back pain.

CONCLUSION

This meta-analysis will provide a detailed summary of the evidence on the effects of WBV exercise on patients with LBP, in comparison with general exercise or without treatment. This review will benefit to researchers and policy makers who are interested in the treatment of LBP by WBV exercise.

Osteoarthritis year in review 2017: rehabilitation and outcomes

OBJECTIVE

The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs).

DESIGN

A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1^st 2016 to May 15^th 2017 using the terms 'osteoarthritis', 'randomized controlled trial', and 'systematic review'. Inclusion criteria were: clinically or radiologically diagnosed patients with OA, rehabilitation treatment, RCT or SRs. A selection of the included studies is discussed based on study quality and perceived importance to the field; including those that are innovative, inform the direction of the field or generate controversy. Methodological quality of the included studies was assessed using the PEDro-scale for RCTs and the Amstar guideline for SRs.

RESULTS

From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields.

CONCLUSIONS

Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.

Acute and chronic neuromuscular adaptations to local vibration training

Vibratory stimuli are thought to have the potential to promote neural and/or muscular (re)conditioning. This has been well described for whole-body vibration (WBV), which is commonly used as a training method to improve strength and/or functional abilities. Yet, this technique may present some limitations, especially in clinical settings where patients are unable to maintain an active position during the vibration exposure. Thus, a local vibration (LV) technique, which consists of applying portable vibrators directly over the tendon or muscle belly without active contribution from the participant, may present an alternative to WBV. The purpose of this narrative review is (1) to provide a comprehensive overview of the literature related to the acute and chronic neuromuscular changes associated with LV, and (2) to show that LV training may be an innovative and efficient alternative method to the 'classic' training programs, including in the context of muscle deconditioning prevention or rehabilitation. An acute LV application (one bout of 20-60 min) may be considered as a significant neuromuscular workload, as demonstrated by an impairment of force generating capacity and LV-induced neural changes. Accordingly, it has been reported that a training period of LV is efficient in improving muscular performance over a wide range of training (duration, number of session) and vibration (frequency, amplitude, site of application) parameters. The functional improvements are principally triggered by adaptations within the central nervous system. A model illustrating the current research on LV-induced adaptations is provided.

QUALITY OF LIFE OF PATIENTS WITH METABOLIC SYNDROME IS IMPROVED AFTER WHOLE BODY VIBRATION EXERCISES

Background:

Whole body vibration exercises (WBVE) improve the quality of life (QoL) of different populations. Metabolic syndrome patients (MetS) may be favored by physical activity. Questionnaires are used to assess the QoL. The aim was to evaluate the QoL of patients with MetS that have undergone WBVE with a brief WHOQOL (WHOQOL-BREF).

Material and Methods:

MetS patients were randomly divided into three groups: (i) control group (CG), (ii) treated with WBVE once per week (WBVE1) and (iii) treated with WBVE twice per week (WBVE2). In the first session, the patient was sat in a chair in front of the platform with the feet on its base in 3 peak to peak displacements (2.5, 5.0 and 7.5 mm) and frequency of 5 Hz was used. From the second to the last session, patients were subjected to the same protocol, however they were standing on the base of the platform and the frequency was increased up to 14 Hz. The patients fulfilled the WHOQOL-BREF before the first and after the last sessions. Cronbach coefficients were determined to each domain of the WHOQOL-BREF and test Wilcoxon (p<0.05) was used.

Results:

The patients of the WBVE1 group had improvements in the physical, psychological and environment domains while in the WBVE2, the improvements were in the physical and social relationships domain of the WHOQOL-BREF.

Conclusion:

It was observed that the WBVE in a protocol (one or two times per week) with a progressive and increased frequency improves the QoL of patients with MetS in different domains of the WHOQOL-BREF.