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Entraînement du corps entier sur appareil vibratoire contre la fibromyalgie

Appendices

Appendix 1. Levels of evidence in overviews of antiepileptic drugs (Wiffen 2013)

First tier ‐ at least 50% pain intensity reduction over baseline (or its equivalent), without the use of last observation carried forward (LOCF) for dropouts, an intention‐to‐treat (ITT) analysis, in parallel‐group studies with at least 200 participants lasting eight weeks or longer.

Second tier ‐ evidence related to data from at least 200 participants when one or more of the above conditions were not met.

Third tier ‐ evidence related to data from fewer than 200 participants, or with several important methodological problems that limited interpretation.

Appendix 2. Example of a vibration exercise regimen

  • Equipment: vibrating platform (PowerPlate, North America Inc., Northbrook, IL)

  • Characteristics of the vibration: triplanar vibration, frequency of 30 Hz, peak to peak displacement of 4 mm (71.1 ms‐2 ≈ 7.2 g)

  • Starting position: participants stood on the platform with weight through both feet with trunk upright and both knees in 60° of knee flexion

  • Exercise instructions: attempt to hold starting position (isometric contraction)

  • Progression of the exercise regimen:

Weeks 1‐2
1. 6 × 30 s/45 s rest (bilateral squat)
2. 4 × 30 s/45 s (unilateral squat)
Weeks 3‐4
1. 7 × 30 s/45 s rest (bilateral squat)
2. 5 × 30 s/45 s (unilateral squat)
Weeks 5‐6
1. 8 × 30 s/45 s rest (bilateral squat)
2. 6 × 30 s/45 s (unilateral squat)
Weeks 7‐8
1. 9 × 30 s/45 s rest (bilateral squat)
2. 7 × 30 s/45 s (unilateral squat)

From Sañudo 2013.

Appendix 3. Medline (OVID) search strategy

1. Fibromyalgia/ 
2. Fibromyalgi$.tw.                                
3.  fibrositis.tw.                           
4.  or/1‐3                          
5.         exp Exercise/                          
6.         Physical Exertion/                              
7.         Physical Fitness/                                 
8.         exp Physical Endurance/                                
9.         exp Sports/                             
10.       Pliability/                                
11.       exertion$.tw.                          
12.       exercis$.tw.                            
13.       sport$.tw.                               
14.       ((physical or motion) adj5 (fitness or therapy or therapies)).tw.                                
15.       (physical$ adj2 endur$).tw.                           
16.       manipulat$.tw.                                   
17.       (skate$ or skating).tw.                                   
18.       jog$.tw.                                  
19.       swim$.tw.                              
20.       bicycl$.tw.                             
21.       (cycle$ or cycling).tw.                                   
22.       walk$.tw.                               
23.       (row or rows or rowing).tw.                           
24.       weight train$.tw.                                
25.       muscle strength$.tw.                          
26.       exp Yoga/                               
27.       yoga.tw.                                 
28.       exp Tai Ji/                               
29.       tai chi.tw.                               
30.       Ai Chi.tw.                              
31.       exp Vibration/                        
32.       vibration.tw.                           
33.       pilates.tw.                               
34.       or/5‐33                        
35.       4 and 34

Appendix 4. Embase (OVID) search strategy

1 FIBROMYALGIA/

2 fibromyalgi$.tw.

3 fibrositis.tw.

4 or/1‐3

5 exp exercise/

6 fitness/

7 exercise tolerance/

8 exp sport/

9 pliability/

10 exertion$.tw.

11 exercis$.tw.

12 sport$.tw.

13 ((physical or motion) adj5 (fitness or therapy or therapies)).tw.

14 (physical$ adj2 endur$).tw.

15 manipulat$.tw.

16 (skate$ or skating).tw.

17 jog$.tw.

18 swim$.tw.

19 bicycl$.tw.

20 (cycle$ or cycling).tw.

21 walk$.tw.

22 (row or rows or rowing).tw.

23 weight train$.tw.

24 muscle strength$.tw.

25 or/5‐24

26 4 and 25

Appendix 5. Cochrane Library (Wiley) search strategy

#1      MeSH descriptor Fibromyalgia explode all trees
#2      fibromyalgia
#3      fibrositis
#4      (#1 OR #2 OR #3)
#5      MeSH descriptor Exercise explode all trees
#6      MeSH descriptor Physical Exertion explode all trees
#7      MeSH descriptor Physical Fitness explode all trees
#8      MeSH descriptor Exercise Tolerance explode all trees
#9      MeSH descriptor Sports explode all trees
#10    MeSH descriptor Pliability explode all trees
#11    exertion*
#12    exercis*
#13    sport*
#14    (physical or motion) near/5 (fitness or therapy or therapies)
#15    physical* near/2 endur*
#16    manipulat*
#17    skate* or skating
#18    jog*
#19    swim*
#20    bicycl*
#21    cycle*
#22    walk*
#23    row or rows or rowing
#24    weight next train*
#25    muscle next strength*
#26    MeSH descriptor Yoga explode all trees
#27    yoga
#28    tai chi
#29    MeSH descriptor Tai Ji explode all trees
#30    MeSH descriptor Vibration explode all trees
#31    vibration
#32    pilates
#33    (#5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR ( # AND 27 ) OR #28 OR #29 OR #30 OR #31 OR #32)
#34    (#33 AND #4)

A second search was conducted in the Cochrane Library of the HTA database, specifically, using the vibration terms alone to supplement the search above with a more sensitive search for health technology assessments of vibration platforms.

#1 MeSH descriptor Vibration explode all trees
#2 vibration

#3 (#1 OR #2)

Appendix 6. CINAHL (EBSCOhost) search strategy

S01      (MH "Fibromyalgia")

S02      TI fibromyalgia or AB fibromyalgia 

S03      TI fibrositis or AB fibrositis  

S04      (MH "Exercise+")     

S05      (MH "Exertion+")     

S06      (MH "Physical Fitness")       

S07      (MH "Exercise Test+")        

S08      (MH "Sports+")       

S09      (MH "Pliability")        

S10     (MH "Physical Endurance+")

S11     TI exertion* or AB exertion*

S12     TI exercis* or AB exercis*  

S13     TI sport* or AB sport*        

S14     TI physical N5 fitness or TI physical N5 therapy or TI physical N5 therapies or AB physical N5 fitness or AB physical N5 therapy or AB physical N5 therapies       

S15     TI motion N5 fitness or TI motion N5 therapy or TI motion N5 therapies or AB motion N5 fitness or AB motion N5 therapy or AB motion N5 therapies     

S16     TI physical* N2 endur* or AB physical* N2 endur*

S17     ( skate* or skating ) or AB ( skate* or skating )  

S18     jog* or AB jog*       

S19     TI swim* or AB swim*        

S20     TI bicycl* or AB bicycl*       

 S21    TI ( (cycle* or cycling) ) or AB ( (cycle* or cycling) )      

S22     TI walk* or AB walk*

S23     TI ( row or rows or rowing ) or AB ( row or rows or rowing )    

S24     TI weight train* or AB weight train*

S25     TI muscle strength* or AB muscle strength*        

S26     TI manipulat* or AB manipulat*     

S27     S1 or S2 or S3        

S28     S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21 or S22 or S23 or S24 or S25 or S26  

S29     S27 and S28 

S30     S27 and S28 

S31     (MH "Yoga Pose") OR (MH "Yoga")  

S32     TX yoga       

S33     TX tai chi      

S34     (MM "Tai Chi")         

S35     TX tai ji        

S36     TX pilates     

 S37    (MH "Pilates") OR "pilates"   

S38     (MH "Vibration")      

S39     TX vibration  

S40     S31 or S32 or S33 or S34 or S35 or S36 or S37 or S38 or S39  

S41     (S27 and (S28 or S40) 

 

Appendix 7. PEDro Physiotherapy Evidence Database (http://www.pedro.org.au/) search strategy

Terms searched:

  1. fibromyalg* AND fitness training

  2. fibromyalg* AND strength training

  3. fibrositis

Appendix 8. Dissertation Abstracts (ProQuest) search strategy

Terms searched fibromyalg* or fibrositis (in citation or abstract)

Appendix 9. Current Controlled Trials (http://www.controlled‐trials.com/) and ClinicalTrials.gov search strategy

Terms searched fibromyalg* or fibrositis

Appendix 10. WHO International Clinical Trials Registry Platform (http://www.who.int/ictrp/en/) search strategy

Terms searched fibromyalg* or fibrositis in Condition

Appendix 11. AMED (OVID) Allied and Complementary Medicine search strategy

OVID AMED (Allied and Complementary Medicine)

1     Fibromyalgia/ (1453)
2     Fibromyalgi$.tw. (1626)
3     fibrositis.tw. (20)
4     or/1‐3 (1631)
5     exp Exercise/ (7293)
6     Physical Fitness/ (1655)
7     exp Physical Endurance/ (747)
8     exp Sports/ (3576)
9     Pliability/ (32)
10     exertion$.tw. (1129)
11     exercis$.tw. (18675)
12     sport$.tw. (4952)
13     ((physical or motion) adj5 (fitness or therapy or therapies)).tw. (8773)
14     (physical$ adj2 endur$).tw. (629)
15     manipulat$.tw. (4038)
16     (skate$ or skating).tw. (81)
17     jog$.tw. (158)
18     swim$.tw. (552)
19     bicycl$.tw. (972)
20     (cycle$ or cycling).tw. (3530)
21     walk$.tw. (7139)
22     (row or rows or rowing).tw. (174)
23     weight train$.tw. (149)
24     muscle strength$.tw. (5651)
25     exp pilates/ (22)
26     exp Yoga/ (345)
27     exp Tai chi/ (204)
28     Tai ji.tw. (6)
29     yoga.tw. (448)
30     (hatha or kundalini or ashtunga or bikram).tw. (26)
31     pilates.tw. (62)
32     exp Exercise therapy/ (4945)
33     or/5‐32 (43624)
34     4 and 33 (328)

Appendix 12. Centre for Reviews and Dissemination search strategy

Terms searched in the CRD HTA databas: e(fibromyalg* ) AND (vibrat*).

Appendix 13. Agency for Healthcare Research and Quality – Technology Assessments search strategy

Browsed Musculoskeletal Disorders in Research Summaries, Reviews and Reports.

Appendix 14. CADTH Canadian Search Interface HTA Database search strategy

Term searched: “vibration”.

Appendix 15. Selection strategy

Level one screen

Based solely on the title of the report.

  •   Does the study deal exclusively with fibromyalgia? No – exclude, Yes or uncertain ‐ go to step two.

  •   Does it include exercise? No – exclude, Yes or uncertain – go to step three.

  •   Does the study deal exclusively with adults? No – exclude, Yes or uncertain – go to step four.

  •   Is it an RCT? No – exclude, Yes or uncertain – include.

 Level two screen

Based solely on the abstract of the report.

  • Does the study deal exclusively with fibromyalgia? No – exclude, Yes or uncertain ‐ go to step two.

  • Does it include exercise? No – exclude, Yes or uncertain – go to step three.

  • Does the study deal exclusively with adults? No – exclude, Yes or uncertain – go to step four.

  • Is it an RCT? No – exclude, Yes or uncertain – include.

 Level three screen

Based on the full text of the report.

  • Does the study deal exclusively with fibromyalgia? No ‐ exclude, Yes ‐ go to step two, Uncertain ‐ add to list of questions for trial author and proceed to step two.

  • Is the diagnosis of fibromyalgia based on published criteria? No ‐ exclude, Yes ‐ go to step three, Uncertain ‐ add to list of questions for trial author and proceed to step three.  

  • Does the study deal exclusively with adults? No ‐ exclude, Yes ‐ go onto step four, Uncertain ‐ add to list of questions for trial author and proceed to step four.

  • Is it an RCT? (study uses terms such as "random," "randomized," "RCT," or "randomization" to describe study design or assignment of participants to groups): No ‐ exclude, Yes ‐ go on to step five, Uncertain ‐ add to list of questions for trial author and proceed to step five.

  • Does the study include exercise (study involves at least one intervention that includes exercise)? No ‐ exclude, Yes ‐ go on to step six, Uncertain ‐ add to list of questions for trial author and proceed to step six.

  • Are between‐group data provided for outcomes? No (study contains only fibromyalgia or results are reported in such a way that effects on fibromyalgia cannot be isolated) ‐ exclude, Yes ‐ include the study, Yes but uncertain about one or more of steps 1 to 5 to reserve judgement until trial authors are contacted.

Level four screen (classification of study using team's intervention listing)

  • Classification of design

    • Number of interventions

    • Type of comparisons:

      • Head‐to‐head comparison?

      • Exercise to control?

      • Composite to control

  • Control group

    • Classify type of control

  • Exercise

    • Enter types of exercise interventions used in the study

    • Complete the naming of intervention groups

Appendix 16. 2011 ACSM position stand: guidance for prescribing exercise

The following recommendations were derived from Garber 2011.

Recommendations for cardiorespiratory fitness

  • Moderate‐intensity cardiorespiratory exercise training for ≥ 30 minutes/d on ≥ 5 days per week for a total of ≥ 150 minutes per week, vigorous‐intensity cardiorespiratory exercise training for ≥ 20 minutes/d on ≥ 3 days per week (≥ 75 minutes/wk), or a combination of moderate‐ and vigorous‐intensity exercise to achieve total energy expenditure ≥ 500 to 1000 MET min/wk

Recommendations for muscular fitness

  • On 2 to 3 days per week, adults should also perform resistance exercises for each of the major muscle groups, as well as neuromotor exercise involving balance, agility, and coordination

  • Two to four sets of resistance exercise per muscle group is recommended, but even a single set of exercise may significantly improve muscle strength and size

  • Rest interval between sets if more than one set is performed: 2 to 3 minutes

  • Resistance equivalent of 60% to 80% of one repetition max (1RM) effort. For novices, 60% to 70% of 1RM is recommended; for experienced, exercises ≥ 80% may be appropriate

  • Selected resistance should permit completion of 8 to 12 repetitions per set or number needed to induce muscle fatigue but not exhaustion

  • For people who wish to focus on improving muscular endurance, lower intensity (< 50% of 1RM) can be used with 15 to 25 repetitions in no more than 2 sets

Recommendations for flexibility

  • Series of flexibility exercises for each of the major muscle–tendon groups with a total of 60 seconds per exercise on ≥ 2 days per week is recommended. Series of exercises targeting major muscle‐tendon units of the shoulder girdle, chest, neck, trunk, lower back, hops, posterior and anterior legs, and ankles is recommended. For most individuals, this routine can be completed within 10 minutes

  • Stretches should be held for 1 to 30 seconds at the point of tightness or slight discomfort. Older persons may realize greater improvements in range of motion with longer durations (30 to 60 seconds) os stretching. A 20% to 75% maximum contraction held for 3 to 6 seconds followed by a 10 to 30 second assisted stretch is recommended for PNF (proprioceptive neuromuscular facilitation) techniques

  • Repeating each flexibility exercise 2 to 4 times is effective

Study flow diagram for vibration training interventions.
Figuras y tablas -
Figure 1

Study flow diagram for vibration training interventions.

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)
Figuras y tablas -
Figure 2

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15
Figuras y tablas -
Figure 3

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 5

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.
Figuras y tablas -
Analysis 1.1

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.
Figuras y tablas -
Analysis 1.2

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.

Comparison 1 WBV vs C, Outcome 3 Withdrawal.
Figuras y tablas -
Analysis 1.3

Comparison 1 WBV vs C, Outcome 3 Withdrawal.

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.1

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.2

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.3

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.4

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figuras y tablas -
Analysis 2.5

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.
Figuras y tablas -
Analysis 2.6

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.1

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.2

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.3

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.4

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.
Figuras y tablas -
Analysis 3.5

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figuras y tablas -
Analysis 3.6

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.
Figuras y tablas -
Analysis 3.7

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.

Summary of findings for the main comparison. Whole body vibration versus control

Whole body vibration versus control

Patient or population: individuals with fibromyalgia
Setting: community
Intervention: whole body vibration (WBV)
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV

Health‐related quality of life
assessed by FIQ total scale, 0 to 100, 0 is best

Follow‐up: 12 weeks

Mean health‐related quality of life was 59 points

Mean health‐related quality of life in intervention group was 3.73 points lower (10.81 lower to 3.35 higher) at post‐test than in control group

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute improvement: 4% (95% CI 11% better to 3% worse)

Relative change: 6.7% improvement (95% CI 19.6% improvement to 6.1% worse)

NNTB: n/ac

Pain intensity

Not measured

Not measured

Not measured

Not measured

Not measured

Fatigue

Not measured

Not measured

Not measured

Not measured

Not measured

Stiffness

Not measured

Not measured

Not measured

Not measured

Not measured

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events
(narrative)

Gusi 2010: "The program was reasonably safe: only 5% of the participants (n = 1) dropped out of the program because of acute pain in the legs. The program was completed by 85% of the participants, without secondary adverse effects" (page 1076; 1 study)

All‐cause withdrawal
assessed by number of people who dropped out

Study population

RR 1.43 (0.27 to 7.67)

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 4% more events (95% CI 16% fewer to 24% more)

Relative change: 43% more (73% fewer to 667% more)

NNTH: n/ac

10 per 100

(2 of 20)

14 per 100

(3 of 21)

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImpresicion: number of participants lower than 400 rule of thumb; wide confidence interval (downgraded twice)

bHigh risk of biases including detection, performance, and reporting biases

cNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figuras y tablas -
Summary of findings for the main comparison. Whole body vibration versus control
Summary of findings 2. Whole body vibration plus mixed exercise versus control

Whole body vibration plus mixed exercise versus control

Patient or population: individuals with fibromyalgia
Setting: unspecified
Intervention: WBV + MX
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV + MX

Health‐related quality of life
assessed by FIQ total scale, 0‐100, 0 is best

Mean health‐related quality of life was 59.64 points at the end of the study

Mean health‐related quality of life in the intervention group was 16.02 points lower (31.57 lower to 0.47 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 16% improvement (95% CI 32% to 0.5% improvement). Relative change: 24% (47% to 0.7%)c

NNTBd: 3 (2 to 237)

Pain Intensity
assessed by FIQ scale, 0 to 100 mm, 0 is no pain

Mean pain intensity was 69.38 mm in the control group at the end of the study

Mean pain Intensity in the intervention group was 28.22 mm lower (43.26 lower to 13.18 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 28% (95% CI 43% to 13%). Relative difference: 39% (95% CI 18% to 60%)

NNTBd: 2 (1 to 4)

Fatigue
assessed by FIQ scale, 0 to 100 mm, 0 is best

Mean fatigue was 75.17 mm at the end of the study

Mean fatigue in the intervention group was 32.84 mm lower (49.2 lower to 16.48 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 33% (95% CI 49% to 16%). Relative difference: 47% (95% CI 23% to 70%)

NNTBd: 2 (1 to 4)

Stiffness
assessed by FIQ scale, 0 to 100 mm scale, 0 is best

Mean stiffness was 68.71 mm at the end of the study

Mean stiffness in the intervention group was 26.27 mm lower (42.96 lower to 9.58 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference 26% (95% CI 43% to 10%). Relative difference: 36.5% (95% CI 60% to 23%)

NNTBd: 2 (1 to 6)

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events (narrative)

Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, 1 patient exhibited a mild anxiety attack on the first session of WBV" (page 978)

Sañudo 2013: "This study, however, demonstrated that WBV training is safe (no adverse events)..." (page 683)

All‐cause withdrawal
assessed by number of people who dropped out

33 per 100

(7 of 21)

8 per 100
(2 of 25)

RR 0.25, 95% CI 0.06 to 1.12

46
(2 RCTs)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 24% (95% CI 3 to 51)

NNTHd: n/a

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImprecision: Number of participants lower than 400 rule of thumb; wide confidence interval. Need for more studies with more participants to reach optimal information size (downgraded twice)

bHigh risk of biases including reporting and selection biases. Need for methodologically better designed and executed studies

cBaseline control group mean (SD) = 67 (15.81), n = 10

dNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figuras y tablas -
Summary of findings 2. Whole body vibration plus mixed exercise versus control
Table 1. Glossary of terms

Term

Definition

Allodynia

Pain resulting from a stimulus that would not normally provoke pain

Amplitude

Absolute value of maximum displacement from a zero value during 1 period of an oscillation

Damping

Energy dissipation properties of a material or system under cyclic stress

Endurance

Two forms of endurance that refer to health‐related physical fitness include cardiorespiratory endurance (also known as cardiovascular endurance, aerobic fitness, aerobic endurance, exercise tolerance), which "relates to the ability of the circulatory and respiratory systems to supply fuel during sustained physical activity and to eliminate waste products after supplying fuel," and muscle endurance, which "relates to the ability of muscle groups to exert external force for many repetitions" (Caspersen 1985)

Frequency

Number of cycles or completed alternations per unit time of a wave or oscillation

Hertz

One hertz is 1 cycle per second; therefore, when an individual is exposed to a vibration of 30 Hz, targeted muscles receive 30 cycles of vibration per second, which makes muscles contract and relax 30 times in the same period

Hyperalgesia

Increased pain from a stimulus that normally provokes pain

Natural frequency

Frequency at which a system oscillates when not subjected to continuous or repeated external forces

Paresthesia

Abnormal sensation that is spontaneous or is evoked by a stimulus (eg, numbness)

Phase angle

Particular stage or point of advancement in a cycle; fractional part of the period through which time has advanced, measured from some arbitrary origin often expressed as an angle (phase angle); the entire period being taken is 360°

Figuras y tablas -
Table 1. Glossary of terms
Table 2. List of Abbreviations

Abbreviation

Description

A

amplitude

ACR

American College of Rheumatology

ACSM

American College of Sports Medicine

AE

aerobic exercise

EMG

electromyography

f

frequency

FIQ

Fibromyalgia Impact Questionnaire

FX

flexibility

g

gravitational load (G‐force) = 1 cm/s2

HR

heart rate

HRQL

health‐related quality of life

hz

Hertz

ITT

intention‐to‐treat

kg

kilogram

m/s2

unit of acceleration: 1 Gal = 0.01 m/s2

MCID

minimal clinically important difference

MD

mean difference

MX

mixed intervention (includes more than 1 mode of physical activity)

n

number of studies

N

number of individuals

RD

risk difference

Relax

relaxation

RT

resistance training

s

seconds

SD

standard deviation

SE

standard error

SMD

standardized mean difference

sTNFR1 and sTNFR2

soluble tumor necrosis factor receptor 1 and 2

VAS

visual analogue scale

WBV

whole body vibration

wk

week(s)

WU

warm‐up

Figuras y tablas -
Table 2. List of Abbreviations
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters

Vibration + Mixed vs Mixed + Placebo vs Control

Author, year

Intervention

Frequency (times per week | length in weeks)

Total duration

Supervised or home program

Aerobic component

Resistance component

Flexibility Component

Other

I (intensity): ACSM classification and physiological measure; M (mode): mode of exercise; T (time): duration of aerobic component in minutes

M (muscle groups, joints or areas of body); I (intensity resistance, repetitions, sets); T (type), T (time)

M (muscle groups, joints or areas of body); T (type of stretch, repetition, set), T (time)

Alentorn‐Geli 2008

AE + FX + Relax

2 times/wk

6 weeks

90’

Not specified

I: moderate to vigorous (65%‐85% HR max), T: primarily level ground walking with games and dance, T: 30'

Not applicable

M: 5 whole body stretches involving lower and upper limbs, neck, back; T: dynamic, 5 reps held for 30 s with 30 s rests, T: 25'

Relaxation

Vibration + Mixed vs Mixed

Sañudo 2010

AE + RT + FX

2 times/wk

6 weeks

60’

Supervised

I: light to moderate (50%‐69% HR max), M: not specified, T: 4‐6 intervals of 2‐3’, 1‐2’ rest between intervals

M: major muscle groups, I: 8 exercises, 1 × 8‐10 reps with 1‐3 kg, T: not specified

M: not specified, I: 1x 3 reps holding for 30s, T: not specified

Sañudo 2013

AE + RT + FX

2 times/wk

8 weeks

45‐60’

Supervised

I: moderate (65%‐70% HR max), M: not specified, T: 10‐15’

M: deltoids, biceps, neck, hips, back, and chest, I: 1 set of 8‐10 reps for 8 different muscle groups against 1‐3 kg, T: 15‐20’

M: deltoids, biceps, neck, hips, back, and chest

I: 1 set of 3 reps for 8‐9 different ex, maintained for 30 s, T: 10’

Figuras y tablas -
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters
Table 4. Vibration specifications

Study name/year

Name of device

Vibration frequency and amplitude

Position of participant

Stabilizing support

Footwear

Static/Dynamic; unilateral/bilateral

Alentorn‐Geli 2008

PowerPlate

(PowerPlate International B.V., Badhoevendorp,

The Netherlands)

30 Hz; 2 mm vertical amplitude

The following 6 exercises were performed for 30 s each during whole body vibration (WBV) and were repeated 6 times with recovery of 3 minutes between repetitions

(a) static squat at 100° of knee flexion

(b) dynamic squat between 90° and 130° of knee flexion

(c) maintained ankle plantar‐flexion with legs in extension

(d) flexion‐extension of right leg between 100° and 130° of knee flexion

(e) flexion‐extension of left leg between 100° and 130° of knee flexion

(f) squat at 100° of knee flexion shifting body weight from 1 leg to the other

For adaptation purposes, only tasks (a), (b), and (c) (repeated 3 times) were performed during first 2 sessions

Yes ‐ for all tasks, individuals held onto the supporting bar

Does not state

Static bilateral

Gusi 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

12.5 Hz; 3 mm vertical amplitude

Participants alternated between 2 stances for each repetition

Stance A: feet perpendicular to midline axis of the platform with right foot placed slightly ahead of left foot. Toes of right foot and heel of left foot lifted 4 mm above surface of the platform. Knees bent to 45° angle. Back and head kept straight

Stance B: as per Stance A, except with left foot placed slightly ahead of right foot

Not reported and not pictured in Figure 2

Balance testing was performed barefoot. Does not specify that exercise was done barefoot, but Figure 2 indicates this

Static and dynamic both unilateral and bilateral

Sañudo 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

20 Hz; variable amplitude of 2‐3 mm

Three sets of 45 s of bilateral static squat with 120 s recovery between sets (amplitude = 3 mm) followed by 4 sets of 15 s of unilateral static squat on each leg (amplitude = 2 mm).

During WBV, participants stood with both knees in 120° isometric knee flexion (half‐squatting position) as measured by a goniometer

Does not state

Does not state

Static unilateral and bilateral

Sañudo 2013

PowerPlate,

North America Inc.,

Northbrook, IL,

United States

30 Hz; vertical displacement of 4 mm (71.1 m/s‐2 ≈ 7.2 g)

Standing on the platform, with knees in 120º isometric knee flexion (measured by a goniometer) and trunk upright

Bilateral static squat: 6 sets of 30 s, with 45‐s recovery between sets

Unilateral static squat: 4 sets of 30 s each leg

Does not state

All participants wore sport shoes for vibration exercises

Static unilateral and bilateral

Figuras y tablas -
Table 4. Vibration specifications
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other

Quality assessment

No. of participants

Quality

Importance

No. of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Aerobic exercise (AE) intervention

AE control

Health‐related quality of life (HRQL), 0‐100, lower is best

2

Randomized trial

Very serious1

Not serious

Not serious

Serious2

23

26

⊕⊝⊝⊝
very low

CRITICAL

Pain intensity, 0‐100, lower is best

1

Randomized trial

Serious3

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

CRITICAL

Fatigue, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Stiffness, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Physical function, not reported

Withdrawals

3

Randomized trial

Very serious4

Not serious

Not serious

Serious2

3/39 (7.69%)

4/38 (10.52%)

⊕⊝⊝⊝
very low

IMPORTANT

Adverse events:Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, one patient exhibited a mild anxiety attack on the first session of WBV" (page 978); Sañudo 2010: Trial authors clarified that one person in the comparison group ("other exercise group") dropped out owing to an injury that was not an injury related to the program (participant fell down on the street); Sañudo 2013: "This study, however, demonstrated that WBV training is a safe (no adverse effects), suitable (no dropouts due to the intervention), and effective (increased lower limb muscle strength) way to exercise the musculoskeletal system, and potentially a feasible intervention for those patients who cannot participate in conventional strength training" (page 683)

Figuras y tablas -
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other
Comparison 1. WBV vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 HRQL, 1‐100 scale, lower means better HRQL Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Balance, degrees of displacement, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Withdrawal Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. WBV vs C
Comparison 2. WBV + MX vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 WBV + MX vs C: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Withdrawal Show forest plot

2

46

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.06, 1.12]

Figuras y tablas -
Comparison 2. WBV + MX vs C
Comparison 3. WBV + MX vs Other

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best Show forest plot

2

49

Mean Difference (IV, Random, 95% CI)

‐6.67 [‐14.65, 1.31]

2 WBV + MX vs Other: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best Show forest plot

2

54

Std. Mean Difference (IV, Random, 95% CI)

0.77 [0.20, 1.35]

6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

2

54

Mean Difference (IV, Random, 95% CI)

‐0.22 [‐1.56, 1.11]

7 Withdrawal Show forest plot

3

77

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.17, 3.11]

Figuras y tablas -
Comparison 3. WBV + MX vs Other