The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis

PLOS ONE RESEARCH ARTICLE The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis Xiaoye Cai ID1, Guoping Qian2, Siyuan Cai3, Feng Wang4, Yingjuan Da1, Zbigniew Ossowski ID2* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Shanghai Normal University Tianhua College, Shanghai, P. R. China, 2 Gdansk University of Physical Education and Sport, Gdańsk, Poland, 3 Victoria university of Wellington, Wellington, New Zealand, 4 Shanghai Ocean University, Shanghai, P. R. China * Abstract Objective OPEN ACCESS Citation: Cai X, Qian G, Cai S, Wang F, Da Y, Ossowski Z (2023) The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis. PLoS ONE 18(3): e0282604. https://doi.org/10.1371/journal. pone.0282604 Editor: Nili Steinberg, The Wingate College of Physical Education and Sports Sciences at the Wingate Institute, IL, ISRAEL Received: April 21, 2022 Accepted: February 18, 2023 Published: March 10, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0282604 Copyright: © 2023 Cai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The aim of this meta-analysis was to evaluate the effect of whole-body vibration training on lower limb motor function in children with cerebral palsy in randomized-controlled trials (RCTs). Methods Two independent reviewers systematically searched the records of nine databases (PubMed, Cochrane, Web of Science, EMBASE, CNKI, etc.) from inception to December 2022. Tools from the Cochrane Collaboration were used to assess risk of bias. Standard meta-analyses were performed using Stata 16.0 and Revman 5.3. For continuous variables, the arms difference was calculated as the weighted mean difference (WMD) between the values before and after the intervention and its 95% confidence interval (95% CI). Results Of the 472 studies identified, 13 (total sample size 451 participants) met the inclusion criteria. Meta-analysis showed that WBV training could effectively improve GMFM88-D [WMD = 2.46, 95% CI (1.26, 3.67), P<0.01] and GMFM88-E [WMD = 3.44, 95% CI (1.21, 5.68), P = 0.003], TUG [WMD = -3.17, 95% CI (-5.11, -1.24), P = 0.001], BBS [WMD = 4.00,95% CI (3.29, 4.71), P<0. 01] and the range of motion of ankle joint and the angle of ankle joint during muscle reaction in children with cerebral palsy. The effect of WBV training on 6MWT walking speed [WMD = 47.64, 95% CI (-25.57, 120.85), p = 0.20] in children with cerebral palsy was not significantly improved. Conclusion WBV training is more effective than other types of conventional physical therapy in improving the lower limb motor function of children with cerebral palsy. The results of this metaanalysis strengthen the evidence of previous individual studies, which can be applied to the PLOS ONE | https://doi.org/10.1371/journal.pone.0282604 March 10, 2023 1 / 18 PLOS ONE Funding: The authors received no specific funding for this work. Whole-body vibration and lower extremity function in children with cerebral palsy clinical practice and decision-making of WBV training and rehabilitation in children with cerebral palsy. Competing interests: The authors have declared that no competing interests exist. Abbreviations: CP, cerebral palsy; WBV, wholebody vibration; RCTs, randomized controlled trials; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis; GMFM88-D/E, Gross motor function measurement-88 in Zone D/E; 6MWT, 6-min walk test; TUG, Timed Up and GO test; BBS, Berg Balance Scale; Ankle-ROM, The range of motion of ankle joint; Ankle-R1/R2, The angle of ankle (1/2) joint during muscle reaction; WMD, weighted mean difference; 95% CI, 95% confidence intervals; BoNT-A, Botulinum toxin type A; WBVAO, whole-body vibration combined with action observation. Introduction Cerebral palsy (CP) is long-standing dyskinesia of motor posture caused by chronic brain injury to the developing fetus or infant [1], and it frequently results in limited motor abilities in children, of whom spastic cerebral palsy is the most common [2, 3]. More than 50% of children have lower limb movement disorders, such as lower limb muscle contracture, ankle stiffness and deformity, hip and knee flexion when standing and walking, sharp foot crossing, etc., which seriously affect the normal growth development and motor function of children [1–4]. Whole-body vibration (WBV) training method is a new non-traditional training method [5], through external intervention, which allows subjects to generate adaptive responses to vibration stimulation through a specially designed vibration platform [6, 7]. Currently, it is used as a clinical treatment to increase muscle strength, usually involving a series of static or dynamic movements in a standing posture on a vibrating pad. It was originally used by elite athletes to increase speed and strength [8]. In recent years, this method has been widely popularized and applied in many fields abroad, and has also achieved some positive therapeutic and training effects. WBV appears to be a promising adjunct to conventional treatment involving CP patients. According to the studies evaluated by these authors, WBV may help to improve walking ability, walking speed, overall mobility, muscle mass and force production, and reduce spasticity [8]. Furthermore, some authors concluded that horizontal WBV training should be included in rehabilitation programs for children with CP, as it can improve their physical performance without harmful effects [9]. Studies have also confirmed that WBV training can improve the lower limb function of children with cerebral palsy [10, 11]. However, due to the various experimental design protocols of relevant studies regarding the application of WBV training in lower limb rehabilitation of cerebral palsy patients at this stage, the small number of study subjects and the uneven quality of the comprehensive review literature often lead to conflicting final study conclusions. Therefore, it is necessary to comprehensively and systematically evaluate the effect of WBV training on the lower limb rehabilitation of children with cerebral palsy. This study intends to select randomized controlled trials on the impact of WBV training on lower limb motor function of children with cerebral palsy and evaluate the results of the consistent study by meta-analysis. To comprehensively and quanti (...truncated)