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Effect of WBVT on neuromuscular control following ACL reconstruction

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Effect of WBVT on neuromuscular control following ACL reconstruction

Vol: 2| Issue: 5| Number:63| ISSN#: 2564-2537
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

The effect of early whole-body vibration therapy on neuromuscular control after anterior cruciate ligament reconstruction: a randomized controlled trial

Am J Sports Med. 2013 Apr;41(4):804-14. doi: 10.1177/0363546513476473. Epub 2013 Mar 4

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Synopsis

48 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.

Publication Funding Details +
Funding:
Non-funded
Conflicts:
None disclosed

Risk of Bias

7/10

Reporting Criteria

18/20

Fragility Index

N/A

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)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

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

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

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.

What was the principal research question?

Is there any effect after 6 months of WBVT combined with conventional rehabilitation started one month after ACLR , compared to conventional rehabilitation training alone?

Study Characteristics -
Population:
48 patients who had undergone ACLR with a single-bundle approach, and undergoing 6 months of postoperative rehabilitation.
Intervention:
WBVT group: Along with conventional rehabilitation, patients also received WBVT starting at 1 month after surgery (2 sessions/week for a total 16 sessions). WBVT was performed using the Fitvibe Excel Pro (GymnaUniphy, Belgium), with vertical vibration frequency between 20-60Hz and amplitude of 2-4mm. Conventional rehabilitation was comprised of cryotherapy, magnetotherapy, neuromuscular electrical stimulation, mobilization exercise, stretching exercise, strengthening exercise, proprioceptive training, gait recovery, and home exercise. (n=24; 19 completed to follow-up)
Comparison:
No WBVT group: Patients received 6 months of strictly the conventional rehabilitation as described above without WBVT. (n=24; 20 completed follow-up)
Outcomes:
The Biodex dynanometer and Biodex Stability System were used to assess knee joint position sense and postural control, respectively. Isokinetic muscle testing (peak torque measurements) was performed with the Cybex NORM machine. The Single-Legged, Triple Hop, Shuttle Run and Carioca tests were used to evaluate functional outcome. Clinical assessment of knee stability was made through KT-1000 arthrometer measurements, and the Anterior Drawer, Lachman, and Pivot-shift tests. Knee range of motion was also assessed using a goniometer.
Methods:
RCT, Single-center, Asessor-blinded
Time:
6 months, with follow-up at 1 and 3 months

What were the important findings?

  • 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.

What should I remember most?

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.

How will this affect the care of my patients?

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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