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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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.
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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