Supervisors info:
Νανάς Σεραφείμ, Καθηγητής, Ιατρικής Σχολής, ΕΚΠΑ
Φιλίππου Αναστάσιος, Καθηγητής, Ιατρικής Σχολής, ΕΚΠΑ
Βασιλειάδης Ιωάννης, Καθηγητής, Ιατρικής Σχολής, ΕΚΠΑ
Summary:
Introduction: During the past decade, the use of vibration has been researched by the scientific community, as a therapeutic modality, highlighting its therapeutic value on the musculoskeletal, respiratory, vascular and endocrine systems, in both healthy and clinical populations. The underlying mechanism of vibration is mainly based on the activation of the tonic vibration reflex, where the involuntary activation of muscle groups, on a spinal cord level, renders the vibration device a potentially promising therapeutic aid for the early mobilization of patients in prolonged bed rest status, with none or minimum participation in the physiotherapy rehabilitation program. Restriction of physical movement in conditions of prolonged bed rest brings about multisystem effects followed by significant reduction in the functional capacity and quality of life of the sufferer, even without coexistence of any underlying disease. Hence, the purpose of the present systematic review focuses on studying the systematic effect of vibration on all body systems and functions that are affected by prolonged bed rest. The over-arching objective here is to draw conclusions about the therapeutic value of vibration as a means of preventing and treating multisystem complications arising from immobility.
Method: The present review has been developed following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes), while the articles quality control has been performed according to the PEDro scale. Three scientific databases (PubMed, Cohrane and Greynet) have been used to collect the individual articles, which a)map the pathophysiological changes that occur in the body during prolonged immobilization in a horizontal position and b) study the use of vibration plates as the main means of compensating for the aforementioned adjustments. The main exclusion criterion was the different immobilization model, aside from the supine positioning (immobilization of unilateral limb suspension, part of a limb, 6 °head-down tilt bed rest). That is, immobilization models that did not simulate the immobilization experienced by critically ill patients during their long-term hospitalization.
Results: A total of 1066 articles were identified by the three scientific databases. From the thorough study of the articles that were directly related to the objective of the study and according to the selection and exclusion criteria, 15 studies remained, which were used for the present systematic review. In terms of methodological quality assessment, 11 studies were classified as moderate, 2 as of low quality and 1 as of high quality. The 15 articles, which emerged during the literature review, have been grouped according to the design of the review, into two main research protocols. The first research protocol (Berlin study, Berlin Bed-Rest, BBR) refers to the study of the application of the vibration plate with the synchronous active participation of the sample, performing a cycle of closed chain resistance exercises, while the second research protocol referred to the use of the vibration plate without the active participation of the sample. Fourteen (14) of the studies were implemented based on the Berlin study and were related to healthy volunteers, while the remaining 1 followed the second research protocol and was directly related to critically ill patients. The 14 studies based on the Berlin study protocol showed that vibration in combination with resistance exercises prevents, decelerates or normalizes the multisystemic changes that occur due to immobility. The study conducted to critically ill patients showed that vibration is an easy and safe method for the early mobilization of those patients, capable of activating the muscular system without any active participation on the patients’ behalf.
Future Studies: In the present systematic review, supine positioning of patients was used as a model of immobilization, in order to study the use of vibration as a countermeasure against multisystem deconditioning. However, further clinical trials are needed in order to: 1) examine the systematic effects of vibration, 2) isolate it from other related therapeutic practices, in order to draw safe conclusions regarding its role in a rehabilitation program, and 3) have the benefit of vibration without patient active participation required.
Conclusions: The application of the vibration plate on patients in supine position is feasible and can therefore be part of the rehabilitation program in situations where immobilization of the person is necessary. The two main research protocols used in this systematic review showed clear indications regarding the effective use of vibration as an alternative way of early mobilization and, in consequence, prevention of multisystem deconditioning due to long-term immobilization
Keywords:
Bed rest, Immobilization, ICU, Vibration
