The Focal Mechanical Vibration for Balance Improvement in Elderly – A Systematic Review

Figures & data

Table 1 Summary of the Studies Included in the Review

Authors & Year	Diagnosis	n° (M/F); (Mean Age ± SD)	n° TG n° CG	Treatment	Outcome Parameters	Evaluation Time	Conclusions
Bellomo et al^Citation26	Sarcopenic elderly	40 (M); (70.9±5.2)	TG1: 10 TG2: 10 TG3: 10 CG: 10	TG1: Global Sensorimotor Training TG2: Resistance Training for lower limbs TG3: Vibratory mechanical-acoustic focal therapy CG: usual activity	Maximal force contraction: Maximal isometric test; Balance assessment: sway area of CoP (mm^2)	T0: baseline T1: after 12 weeks	Maximal force contraction: TG2>TG3>TG1>CG Balance assessment: TG1>TG3>TG2=CG
Celletti et al^Citation27	Elderly women	350 (F); (73.4±3.11)	TG: 175 CG: 175	TG: vibratory stimulation CG: Sham vibratory stimulation	Risk of falling assessment: POMA	T0: baseline T1: after 30 days T2: after 180 days	Risk of falling assessment: TG>CG
Ehsani et al^Citation33	Healthy young adults Healthy older adults High fall risk older adults	30 (12M/18F); (23.30±2.26) (72.90±2.81) (83.60±9.46)	TG1: 10 TG2: 10 TG3: 10	TG1, TG2, TG3: vibratory stimulation	Balance assessment: CoG	T0: baseline T1: after treatment	Balance assessment: TG1>TG2>TG3
Filippi et al^Citation28	Sedentary life-style women	60 (F); (65.3±4.2)	TG1: 20 TG2: 20 CG: 20	TG1: vibratory stimulation contracted muscles TG2: vibratory stimulation relaxed muscles CG: Sham vibratory stimulation contracted muscles	Balance assessment: sway area of CoP (mm^2) and velocity Leg muscle performance: Vertical jumping test	T0: baseline T1: after 1 day T2: after 30 days T3: after 90 days	Balance assessment: TG1>TG2&CG Leg muscle performance: TG1>TG2&CG
Rabini et al^Citation29	Men and women >60yrs, with OA	50 (11M/39F); (73.72±5.24) (75.08±5.74)	TG: 25 CG: 25	TG: vibratory stimulation CG: Sham vibratory stimulation	Pain, stiffness, functional limitation assessment: WOMAC Physical performance assessment: SPPB Risk of falling assessment: POMA	T0: baseline T1: after 3 day T2: after 3 months T3: after 6 months	Pain, stiffness, functional limitation assessment: TG>CG Physical performance and Risk of falling assessment: TG>CG
Tankisheva et al^Citation30	Post- menopausal women	35 (F); (75.7) (77.6)	TG: 17 CG: 18	TG: Bilateral m. quadriceps, m. gluteus maximus and m. gluteus medius CG: usual activity	Muscle strength: isokinetic dynamometry Muscle mass: CT BMD: DXA Physical Performance assessment: SWT, mPPT	T0: baseline T1: after 6 months	Muscle strength: TG>CG Muscle mass: TG=CG BMD: TG=CG Physical Performance assessment: TG=CG
Wanderley et al^Citation31	Women >60yrs, with balance deficit but independent gait	30 (F); (68.6±5.7) (68.1±4.9)	TG: 15 CG: 15	TG: vibratory stimulation CG: usual activity	Balance assessment: OLS test EO/EC; TUG test; FR test; sway area of CoP (cm^2)	T0: baseline T1: after 1st intervention period T2: after 2nd intervention period	Balance assessment: TG>CG
Yu et al^Citation32	Healthy elderly Young adults	40 (21M/19F); (72±3.2) (22±2.5)	TG1: 20 TG2: 20	TG1, TG2: vibratory stimulation	Balance assessment: sway area of CoP (cm^2)	During treatment (NVO, CVO, TATVO, ATVO; NVT, CVT, TATVT, ATVT)	Balance assessment: in TG1 the ability to balance improves during CVO; in both groups using Combined Vibration decrease CoP sway area.

Abbreviations: TG, treatment group; CG, control group; OA, Knee Osteoarthritis; CoP, Center of Pressure; OLS test EO/EC, One-leg stance test Eyes open/Eyes closed; TUG test, Time Up-and-Go test; FR test, Functional reach test; POMA, performance-oriented mobility assessment; WOMAC, Western Ontario and McMaster University Osteoarthritis Index; SPPB, Short Physical Performance Battery; CT, Computed Tomography; BMD, Bone Mass Density; DXA, dual-energy X-ray absorptiometry; SWT, Shuttle walk test; mPPT, modified physical performance test; VAS, visual analogic scale; FES-I, short falls efficacy scale-international; STEADI, Stopping Elderly Accidents, Death and Injuries; CoG, center of gravity; NVO, no vibration during one-legged stance; CVO, combined vibration to the Tibialis anterior tendon and Achilles tendon during one-legged stance; TATVO, Tibialis anterior tendon vibration during one-legged stance; ATVO, achilles tendon vibration during one-legged stance; NVT, no vibration during two-legged stance; CVT, combined vibration to the Tibialis anterior tendon and Achilles tendon during two-legged stance; TATVT, Tibialis anterior tendon vibration during two-legged stance; ATVT, achilles tendon vibration during two-legged stance.

Table 2 Characteristics of Vibration and Parameters Used in the Included Studies

Authors & Year	Treated Muscles/ Muscles Condition	Duration of One Session	Number of Sessions	Total Number of Sessions	Frequency/ Amplitude	System
Bellomo et al^Citation26	Bilateral vastus medialis, vastus lateralis and rectus femoris muscles/Relaxed	15 minutes	1 session per week for 8 weeks,	20	300 Hz	VISS
			3 sessions per week for the last 4 weeks
Celletti et al^Citation27	Bilateral quadriceps/Contracted	30 minutes (for every 10 min of vibrations, there was a 1-min interval)	1 session/day, 3 consecutive days	3	100 Hz/ 0.2–0.5 mm	Cro^® System
Ehsani et al^Citation33	Bilateral m. gastrocnemius/Contracted	1-min warm-up; 30 sec vibratory test; 2-min rest	One day	8	30–40 Hz/ 1±0.002 mm	Focal vibrator attached with Velcro straps to muscle’ belly
Filippi et al^Citation28	TG1: Bilateral quadriceps/Contracted	30 minutes (for every 10 min of vibrations, there was a 1-min interval)	1 session/day, 3 consecutive days	3	100 Hz/ 0.2–0.5 mm	Cro^® System
	TG2: Bilateral quadriceps/Relaxed
Rabini et al^Citation29	Bilateral quadriceps/ Contracted	30 minutes (for every 10 min of vibrations, there was a 1-min interval)	1 session/day, 3 consecutive days	3	100 Hz/ 0.2–0.5 mm	Cro^® System
Tankisheva et al^Citation30	Bilateral m. quadriceps, m. gluteus maximus and m. gluteus medius/Relaxed	30 minutes	5 day per week, consecutive per 6 months	120	25–45 Hz	Powerbox (custom-made vibration design)
Wanderley et al^Citation31	Bilateral Plantar region/ Relaxed	10 minutes	12 sessions over 5 weeks, rest period and further 12 sessions over 5 weeks	24	100 Hz/ 2 mm	Novafon SK2^c
Yu et al^Citation32	Muscle belly of the Tibialis anterior tendon and/or the Achilles tendon/ Contracted	5 sec vibratory test, on one or two legs with eyes closed with and without vibration	One day	8	90 Hz/ 0.33mm	JA1

Table 3 The Results Effect of Focused Vibration on Balance and/or Risk of Fall Assessment: Between-Group Differences

Authors & Year	Outcome Parameters	Results
Bellomo et al^Citation26	CoP sway area (mm^2)	T0 Eyes-open				T0 Eyes-closed						T1 Eyes-open							T1 Eyes-closed
		TG1: 7287.8±2402.4				TG1: 7287.8±2402.4						TG1: 4436±1884.9							TG1: 4436±1884.9
		TG2: 6962.4±1558.05				TG2: 6962.4±1558.05						TG2: 6761.2±2301.1							TG2: 6761.2±2301.1
		TG3: 7100.2±2920.5				TG3: 7100.2±2920.5						TG3: 5927.4±2882.4							TG3: 5927.4±2882.4
		CG: 6874.6±2351.3				CG: 6874.6±2351.3						CG: 6941.5±1899.5							CG: 6941.5±1899.5
Celletti et al^Citation27	POMA (point)	T0						T1									T2
		TGa:16.1±1.98						TGa: 22.6±3.44									TGa: 24.4 ±3.21
		TGb:21.4±0.83						TGb: 26.74 ±1.34									TGb: 27.16±1.84
		TGc:24.9±0.87						TGc: 26.07±1.28									TGc: 27.27±1.43
		CGa:16.5±1.71						CGa: ^ᴓ									CGa: ^ᴓ
		CGb:21.1±0.83						CGb: ^ᴓ									CGb: ^ᴓ
		CGc:24.6±1.34						CGc: ^ᴓ									CGc: ^ᴓ
Ehsani et al^Citation33	CoG sway area (cm^2)	T0 Eyes-open			T0 Eyes-closed						T1 Eyes-open 30Hz			T1 Eyes-open 40Hz				T1 Eyes-closed 30Hz				T1 Eyes-open 40Hz
		TG1: 0.40±0.27			TG1: 0.65±0.33						TG1:1.35± 0.99			TG1:1.29±0.71				TG1:1.41±0.97				TG1:1.62±1.18
		TG2: 0.40±0.23			TG2: 0.54±0.33						TG2:0.74±0.27			TG2:0.92±0.40				TG2:0.93±0.64				TG2:1.10±0.52
		TG3: 0.58±0.43			TG3: 1.04±0.59						TG3:1.15±1.08			TG3:0.85±0.60				TG3:1.24±0.60				TG3:1.52±1.07
Filippi et al^Citation28	CoP sway area (mm^2)	T0				T1						T2							T3
		TG1: 339±55				TG1: ^ᴓ						TG1: ^ᴓ							TG1: ^ᴓ
		TG2: 325±59				TG2: ^ᴓ						TG2: ^ᴓ							TG2: ^ᴓ
		CG: 329±56				CG: ^ᴓ						CG: ^ᴓ							CG: ^ᴓ
Rabini et al^Citation29	POMA (point)	T0				T1										T2
		TG:18.60±4.90				TG:22.56±4.07										TG:24.36±2.96
		CG:19.28±4.85				CG:19.08±3.75										CG:18.00±4.07
Tankisheva et al^Citation30	mPPT (points), SWT (m)	T0											T1
		TG: 33.5 (28–36)^†, 317.1 (180–469)^†											TG: 40.5±2.12, 313.3±39.4
		CG: 32.5 (25–36)^†, 307.8 (188–447)^†											CG: 32.6±2.87, 322.3±55.0
Wanderley et al^Citation31	CoP sway area (cm^2)	T0 Eyes-open		T0 Eyes-closed					T1 Eyes-open				T1 Eyes-closed				T2 Eyes-open				T2 Eyes-closed
		TG: 2.95±1.66		TG: 3.40±1.89					TG:2.26±1.21				TG: 2.49±1.61				TG: 2.23±1.30				TG:2.28±1.34
		CG: 3.05±2.16		CG:3.44±2.22					CG:2.77±2.07				CG:3.32±2.16				CG:2.95±1.74				CG:3.55±1.56
Yu et al^Citation32	CoP sway path (mm)	NVO	CVO				TATVO			ATVO			NVT		CVT					TATVT			ATVT
		TG1: 255.51±59.80	TG1: 191.90±40.67				TG1: ^ᴓ			TG1: ^ᴓ			TG1: 180.51±47.53		TG1: 124.42±36.78					TG1: ^ᴓ			TG1: ^ᴓ
		TG2: 220.49±39.75	TG2: 185.65±29.38				TG2: ^ᴓ			TG2: ^ᴓ			TG2: 150.33±30.57		TG2: 120.53±22.35					TG2: ^ᴓ			TG2: ^ᴓ

Notes: Values are expressed as mean ± SD or ranges in parentheses. ^ᴓIndicated value not detectable, because just graphical. ^†Indicate range value (minimum and maximum).

Abbreviations: TG, treatment group; CG, control group; a, patient with high risk of falling; b, patient with moderate risk of falling; c, patient with low risk of falling; CoP, Centre of pressure; CoG, Center of gravity; POMA, performance-oriented mobility assessment; SWT, Shuttle walk test; mPPT, modified physical performance test; NVO, No vibration during one-legged stance; CVO, combined vibration to the Tibialis anterior tendon and Achilles tendon during one-legged stance; TATVO, Tibialis anterior tendon vibration during one-legged stance; ATVO, achilles tendon vibration during one-legged stance; NVT, no vibration during two-legged stance; CVT, combined vibration to the Tibialis anterior tendon and Achilles tendon during two-legged stance; TATVT, Tibialis anterior tendon vibration during two-legged stance; ATVT, achilles tendon vibration during two-legged stance.

Table 4 Level and Methodological Quality of the Evidence of the Included Studies

Authors & Year	Level of Evidence	Study	Eligibility Criteria*	Random Allocation	Concealed Allocation	Baseline Comparability	Blind Subjects	Blind Therapists	Blind Assessors	More Than 85% Follow-Up	Intention to-Treat Analysis	Between Group Comparisons	Point Estimates and Variability	Total Score
Bellomo et al^Citation26	III	RTC	No	Yes	No	No	No	No	Yes	Yes	No	No	Yes	4/10
Celletti et al^Citation27	II	RTC	No	Yes	Yes	Yes	No	No	Yes	Yes	No	Yes	Yes	7/10
Ehsani et al^Citation33	III	CS	Yes	No	No	No	No	No	No	Yes	Yes	Yes	Yes	4/10
Filippi et al^Citation28	II	RTC	Yes	Yes	No	Yes	No	No	Yes	Yes	No	Yes	Yes	6/10
Rabini et al^Citation29	II	RTC	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9/10
Tankisheva et al^Citation30	II	RTC	Yes	Yes	No	Yes	No	No	Yes	Yes	No	Yes	Yes	6/10
Wanderley et al^Citation31	II	RTC	Yes	Yes	No	Yes	No	No	Yes	Yes	Yes	Yes	Yes	7/10
Yu et al^Citation32	III	CSS	Yes	No	No	Yes	No	No	No	Yes	No	Yes	Yes	4/10

Note: *This criteria item does not contribute to total score.

Abbreviations: RTC, randomized trial clinical; CSS, cross-sectional study; CS, clinical study.

Figure 1 PRISMA flow-diagram indicating the selection of studies included in the review.

Notes: PRISMA figure adapted from Moher D, Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology. 2009;62(10). Creative Commons²¹.

Bellomo RG, Iodice P, Maffulli T, et al. Muscle strength and balance training in sarcopenic elderly: a pilot study with randomized controlled trial. Eur J Inflamm. 2013;11(1):193–201. doi:10.1177/1721727X1301100118

 Web of Science ®Google Scholar

Celletti C, Fattorini L, Camerota F, et al. Focal muscle vibration as a possible intervention to prevent falls in elderly women: a pragmatic randomized controlled trial. Aging Clin Exp Res. 2015;27(6):857–863. doi:10.1007/s40520-015-0356-x25850540

 PubMed Web of Science ®Google Scholar

Ehsani H, Mohler J, Marlinski V, Rashedi E, Toosizadeh N. The influence of mechanical vibration on local and central balance control. J Biomech. 2018;71:59–66. doi:10.1016/j.jbiomech.2018.01.02729459070

 PubMed Web of Science ®Google Scholar

Filippi GM, Brunetti O, Botti FM, et al. Improvement of stance control and muscle performance induced by focal muscle vibration in young-elderly women: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(12):2019–2025. doi:10.1016/j.apmr.2009.08.13919969163

 PubMed Web of Science ®Google Scholar

Rabini A, De Sire A, Marzetti E, et al. Effects of focal muscle vibration on physical functioning in patients with knee osteoarthritis: a randomized controlled trial. Eur J Phys Rehabil Med. 2015;51(5):513–520.25990196

 PubMed Web of Science ®Google Scholar

Tankisheva E, Bogaerts A, Boonen S, et al. Effects of a six-month local vibration training on bone density, muscle strength, muscle mass, and physical performance in postmenopausal women. J Strength Cond Res. 2015;29(9):2613–2622. doi:10.1519/JSC.000000000000089525992656

 PubMed Web of Science ®Google Scholar

Wanderley FS, Alburquerque-Sendín F, Parizotto NA, Rebelatto JR. Effect of plantar vibration stimuli on the balance of older women: a randomized controlled trial. Arch Phys Med Rehabil. 2011;92(2):199–206. doi:10.1016/j.apmr.2010.10.01421272715

 PubMed Web of Science ®Google Scholar

Yu M, Piao YJ, Kim SH, Kim DW, Kim NG. Effects of tendon vibration during one-legged and two-legged stance in elderly individuals. Int J Precis Eng Manufactur. 2010;11(6):969–977. doi:10.1007/s12541-010-0117-x

 Web of Science ®Google Scholar

Moher D, Liberati A, Tetzlaff J, Altman DG; The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.100009719621072

 PubMed Web of Science ®Google Scholar