Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease

Objective: To compare the effects of whole body vibration (WBV) and conventional physiotherapy (PT) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson's disease (PD). Design: Randomized controlled rater-blinded trial comparing 2 active interventions, final follow-up assessment 4 weeks after termination of active intervention. Setting: Specialized referral center, hospitalized care. Participants: Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication (N = 27) were randomized (intent-to-treat population) to receive WBV (n = 13) or conventional PT (controls, n = 14). Twentyone patients (per protocol population) completed follow-up (14 men, 7 women; mean age, 73.8y; age range, 62-84y; mean disease duration, 7.2y; mean dopa-equivalent dose, 768mg/d). Intervention: Subjects were randomized to receive 30 sessions (two 15-min sessions a day, 5 days a week) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board. Twenty-one subjects (10 with WBV, 11 controls) were available for follow-up 4 weeks after treatment termination. Main Outcome Measures: The primary measure was Tinetti Balance Scale score. Secondary clinical ratings included stand-walk-sit test, walking velocity, Unified Parkinson's Disease Rating Scale (section III motor examination) score, performance in the pull test, and dynamic posturography. Results: The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls. All secondary measures, except posturography, likewise improved at follow-up compared with baseline in both groups. Quantitative dynamic posturography only improved in patients with WBV (1937-1467mm) whereas there was no significant change in controls (1832-2030mm). Conclusions: Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program. There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training.