Deciphering the Heterogeneity of Vibration Therapy for Post-Stroke Gait: A Systematic Review and Meta-Regression...

Background: Despite the increasing use of vibration therapy (VT) in neurorehabilitation, its efficacy on post-stroke gait recovery remains controversial due to substantial heterogeneity in study protocols and outcome assessments. Previous systematic reviews have often aggregated disparate gait metrics and stroke stages, potentially obscuring domain-specific therapeutic effects and limiting clinical applicability. Furthermore, the specific influence of vibration parameters, such as frequency and amplitude, on gait outcomes has not been sufficiently quantified. Objective: This protocol outlines a systematic review and meta-regression analysis designed to rigorously evaluate the clinical efficacy of VT on the multidimensional recovery of gait function in stroke survivors. Unlike prior reviews, this study aims to decipher the heterogeneity of treatment effects by analyzing outcome variations based on specific gait domains and exploring associations between individual vibration parameters and treatment effect estimates. Methods: In adherence to PRISMA-P guidelines, a comprehensive search will be conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus for randomized and non-randomized controlled trials involving adult stroke survivors. Interventions will include whole-body vibration (WBV) and focal muscle vibration (FMV) compared to sham or standard care. To address the multidimensional nature of gait, outcomes will be strictly categorized into four domains: (1) gait speed, (2) gait endurance, (3) functional mobility, and (4) spatiotemporal parameters. Methodological quality will be assessed using the Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. Data synthesis will utilize random-effects models, and prespecified meta-regression analyses will be employed to investigate the influence of key moderators, including vibration frequency, amplitude, and session duration. Discussion: This review aims to move beyond simple efficacy verification by exploring potential moderators of treatment effects and generating hypotheses regarding vibration parameters that may be associated with more favorable gait outcomes. By providing granular evidence across distinct gait domains and analyzing parameter-specific effects, this study is expected to resolve existing conflicting evidence and offer precise guidance for the clinical application of VT in post-stroke gait rehabilitation.