Physical Medicine

WBV may modestly improve dynamic balance after stroke but evidence is low certainty

In 12 RCTs (n=486), whole‑body vibration (WBV) interventions improved dynamic balance versus control (SMD 0.69, 95% CI 0.27–1.11). Heterogeneity was substantial (I2 = 72.6%), and overall certainty of evidence was rated low. Subgroup analyses found benefit both for WBV alone and WBV combined with other rehab, with exploratory dose suggestions of ~6 sessions/week, ~20–22 minutes for 5–6 weeks. Findings are hypothesis‑generating; substantial between‑study variability and risk‑of‑bias concerns limit firm clinical adoption. 1

Implementation support improved fidelity but not patient cardiovascular risk

In a 26‑site implementation study, sites with support had greater fidelity gains (mean increase 0.9 vs 0.2) over 18 months. Higher fidelity increased odds of delivering physical activity and somatic interventions (OR 1.73 and OR 1.52). Smoking cessation and somatic care delivery increased at supported sites, yet fidelity did not associate with changes in cardiovascular risk factors. Implementation support improved processes but did not demonstrate patient‑level cardiovascular benefit within study follow‑up. 2

Visual training improves balance but not subjective function after lower extremity injury

Meta-analysis of 18 RCTs (n=707) found visual training improved static balance (SMD 0.46, 95% CI 0.10–0.81) and dynamic balance (SMD 0.88, 95% CI 0.31–1.44). No significant benefits were observed for subjective functional recovery, physical function, or sport performance. Effects were larger in men, chronic ankle instability, and with stroboscopic methods, but overall certainty was very low. Visual training may be a useful adjunct for balance rehabilitation, not a proven route to better patient‑reported function. 3