Effect of WBVT on neuromuscular control following ACL reconstruction .
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by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(8):19 Am J Sports Med. 2013 Apr;41(4):804-14. doi: 10.1177/0363546513476473. Epub 2013 Mar 448 patients who underwent anterior cruciate ligament reconstruction (ACLR) were randomized to receive whole body vibrational therapy (WBVT), starting at one month postoperatively, combined with standard neuromuscular rehabilitation versus neuromuscular rehabilitation alone. The purpose was to determine the effect of WBVT on neuromuscular performance over 6 months following ACLR. The results indicated that blind postural control, quadriceps and hamstring strength, and functional performance in shuttle run and single-legged hop tests was significantly improved with WBVT, without compromised knee stability.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
2/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure for the management of ACL injury. While stability may be improved, it is not uncommon for patients to experience functional deficits. It has been established that rehabilitation within the first 3 postoperative months is important for long-term functional recovery, although rehabilitation programs often struggle to find the appropriate balance between intensity, efficiency, and safety of neuromuscular exercises so early following surgery. It has been suggested that whole-body vibration therapy (WBVT) may be of benefit in the recovery of ACLR patients, although the clinical efficacy of this treatment is unknown.
Was war die wichtigste Forschungsfrage?
Is there any effect after 6 months of WBVT combined with conventional rehabilitation started one month after ACLR , compared to conventional rehabilitation training alone?
- Differences between groups in the Joint Position Sense Test after 6 months were non-significant with tests performed at 60 deg (overall P=0.08) and 30 deg (overall P=0.057) of flexion of the reconstructed knee, as well as 60 deg (overall P=0.638) and 30 deg (overall P=0.510) flexion of the contralateral knee.
- Postural control with eyes closed in the Overall Stability Index (OSI), Anterior-Posterior Stability Index (API), and Medial-Lateral Stability Index was significantly better in the WBVT group compared to the control group over 6 months (overall P=0.013, <0.001, and 0.002, respectively). There was no significant difference between groups in these parameters when the tests were performed with the eyes open.
- Quadriceps peak torques at 60 degrees, 180 degrees, and 300 degrees were significantly higher in the WBVT group after 6 months when considering the reconstructed knee (overall p=0.012, 0.013. and 0.005, respectively). Hamstrings peak torques of the reconstructed knee at 60 degrees and 300 degrees were also significantly higher in the WBVT group (overall p=0.045 and 0.014, respectively), but not at 180 degrees (p=0.070).
- Single-legged hop test of the reconstructed knee and Shuttle run times were significantly better in the WBVT group at 6 months (overall p=0.022 and 0.036, respectively). Triple-hop test and Carioca test did not significantly differ between groups.
- KT-1000 arthrometer side-to-side difference, anterior-drawer test, Lachman test, and pivot-shift test revealed no significant difference between groups.
- Better limb symmetry after 6 months was exhibited by the WBVT group compared to the control group.
Was sollte ich mir besonders merken?
The onset of whole body vibrational therapy on month after ACL reconstruction, in conjunction with standard neuromuscular rehabilitation, was associated with significantly better blind postural control, quadriceps and hamstring strength, and functional performance in shuttle run and single-legged hop tests, although knee joint position sense, triple hop, and carioca were not affected. Knee stability was not compromised by the early onset of the rehabilitation protocol.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The findings of this research suggest that early whole body vibrational therapy may improve neuromuscular performance following ACL reconstruction. Continuing WBVT for more than 2 months should be investigated to determine if there are any other beneficial effects of this therapeutic protocol.
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