Upper extremity function and disability recovery with vibration therapy after stroke: a systematic review and meta-analysis of RCTs

 Absolutely fucking useless! You didn't write a rehab protocol from all this earlier research, did you?

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Upper extremity function and disability recovery with vibration therapy after stroke: a systematic review and meta-analysis of RCTs

• Yueh-Hsun Lu,
• Hung-Ju Chen,
• Chun-De Liao,
• Po-Jung Chen,
• Xin-Miao Wang,
• Chieh-Hsiang Yu,
• Po-Yin Chen &
• Chueh-Ho Lin 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 221 (2024) Cite this article

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Abstract

Background

This study aimed to investigate the therapeutic effects of vibration therapy for improving upper extremity motor impairment, function, and disability recovery in people with stroke.

Design

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, the Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Knowledge Resource Integrated Database, and Google Scholar were searched from inception to May 31, 2024. Randomized controlled trials (RCTs) that evaluated the effects of vibration therapy on upper extremity motor impairment, function, and disability recovery post-stroke were analyzed.

Setting and participants

Participants with a diagnosis of stroke with hemiplegia (or hemiparesis) were recruited.

Methods

Methodological quality assessment was performed using the PEDro quality score. Upper extremity motor impairment, function, and disability were the primary outcomes. Upper extremity motor impairment was measured using the Fugl-Meyer Assessment scale and other methods. Upper extremity functions were evaluated using the Wolf Motor Function test or other tools assessing manipulative activities. Disability was assessed using the Functional Independence Measure, Barthel index, and other methods.

Results

Overall, 30 RCTs including 1621 people with stroke were selected. Compared with the control, vibration therapy exerted significant effects on upper extremity motor impairment [standardized mean difference (SMD) = 1.19; p < 0.00001)], function (SMD = 0.62; p < 0.00001), and disability recovery (SMD = 1.01; p < 0.00001). The subgroup analysis revealed that focal vibration therapy (SMD = 2.14) had favorable effects on disability recovery compared with whole-body vibration therapy (SMD = 2.0). Interventions lasting 4–8 weeks showed significant improvements in motor impairment (SMD = 1.19), motor function (SMD = 0.57), and disability (SMD = 0.84); additionally, the effects of vibration therapy combined with conventional rehabilitation (SMD = 1.03) were superior to those of vibration therapy alone (SMD = 0.21).

Conclusions

Vibration therapy may be(You aren't familiar with earlier research, are you?  YOU'RE FIRED!) a reliable rehabilitation program to improve upper extremity motor functions and disabilities. Furthermore, vibration therapy should be performed at the earliest possibility after stroke for at least 4–8 weeks.

Trial registration The protocol of this study was registered with PROSPERO (Registration number: CRD42022301119).

Background

Brief Summary Vibration therapy (VT) significantly reduces upper extremity (UE) motor impairment, enhances UE motor function, and improves disability outcomes in people with stroke. Combining VT with standard rehabilitation is recommended, starting as early as possible after a stroke and continuing for at least 8 weeks. Both low and high vibration frequencies are effective, but focal muscle vibration is particularly beneficial for disability recovery.

Feeding, dressing, and writing are the most common activities of daily living that require motor function and participation of the upper limbs [1, 2]. These activities are essential for maintaining independence and quality of life. Neurologic disorders such as stroke, which often results in hemiparesis, where one side of the body becomes weak or paralyzed, may lead to poor motor function, muscle weakness, spasticity in paretic limbs, and disability [1, 2].

Full recovery of motor function and disabilities of the upper limbs occurs in less than 20% of people with stroke undergoing rehabilitation programs [1, 3]. Hence, many of these people with stroke have poor motor function and disability in the upper limbs, affecting their quality of life substantially [4, 5]. This impairment often necessitates long-term rehabilitation and support to manage daily activities [2, 3]. Consequently, independence and social participation can be significantly compromised for these individuals.

Compared with previous rehabilitation programs, vibration therapy (VT) stimulates muscle activity through the excitation of the tonic vibration reflex which activates efferent Ia, resulting in α-motor neuron excitation to generate muscle fiber strength and induce motor function performance [6, 7]. This implies that weak muscle activity and motor function in paretic limbs could be improved using VT. Recent studies investigated the effects of the whole-body vibration (WBV) on improving disabilities in the upper limbs for people with stroke by asking them to sit on a chair and place their hands on the WBV platform [8, 9]. After 4 weeks of the intervention, the people with stroke in the experimental group treated with WBV showed better motor function improvements in the upper limbs than those in the control group undergoing a traditional rehabilitation program [8, 9]. Furthermore, several studies have developed focal muscle vibration (FMV) to improve motor function and disabilities in people with stroke [10,11,12].

However, vibration force transmission from WBV or FMV to the targeted upper limbs is different being a complex process that could be influenced by various biomechanical mechanisms and result in different outcomes according to the type of vibration application [13, 14]. Previous studies often used vibrations < 20 Hz for muscle relaxation and reduction of spasticity [15, 16]. Research also shows that vibrations in the range of 20–30 Hz can improve gait balance [17]. Since the resonance frequencies of some important human organs are between 5 and 20 Hz, previous studies have considered 20 Hz as a safety threshold for vibration frequency [18].

Hence, optimal vibration protocols to improve motor function and disabilities should be established with strong evidence before applying them to improve motor and functional recovery in individuals with stroke in the clinical setting [7, 19, 20]. Therefore, it is crucial to develop an optimal evidence-based VT protocol for improving motor function and disability recovery to help clinical therapists enhance upper limb recovery in people with stroke.

Despite the potential of VT, its use in the upper extremities (UEs) and benefits on function and disability recovery have rarely been discussed; furthermore, evidence-based treatment effects are not well-established. Therefore, this meta-analysis aimed to investigate the effects of VT protocols on UE motor impairment, function, and disability recovery in people with stroke.

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