Vibration Therapy for Poststroke Clinical Balance: A Domain-Specific Systematic Review and Multilevel Meta-Analysis

Balance impairment is a major target of poststroke rehabilitation, but the effectiveness of mechanical vibration therapy remains uncertain. This systematic review and multilevel meta-analysis evaluated vibration therapy for validated clinical balance outcomes after stroke and explored potential effect modifiers. The review was prospectively registered in PROSPERO (CRD420251110102).

PubMed, MEDLINE, Embase, the Cochrane Library, and Web of Science were searched from inception to 31 March 2026. Nineteen controlled studies contributed 22 effect-size estimates. The primary analysis used standardized between-group changes from baseline and a three-level random-effects model with study-clustered CR2 inference. Sensitivity analyses, FDR-adjusted moderator analyses, risk-of-bias assessment, and GRADE were performed.

Vibration therapy improved clinical balance on average (Hedges' g = 0.593, 95% CI 0.191-0.995; p = 0.006), although the 95% prediction interval crossed the null. Restriction to 16 randomized trials yielded a similar effect (g = 0.507, 95% CI 0.141-0.873; p = 0.010). Excluding studies at high or serious risk of bias attenuated the effect to g = 0.161 (95% CI -0.116-0.439; p = 0.217). None of seven moderators remained significant after FDR correction. The BBS-specific mean difference was 3.326 points (95% CI 1.714-4.938). Certainty was low for randomized and very low for non-randomized evidence.

Vibration therapy may improve poststroke clinical balance on average, but heterogeneity and sensitivity to study quality limit confidence in effect magnitude and reproducibility. Current evidence does not support a specific vibration protocol; rigorous dose-ranging randomized trials are needed.