The Effect of Vibration on the Acceleration of Wound Healing of Diabetic Neuropathic Foot Ulcer: A Prospective Experimental Study on Human Patients

Vibration therapy for patients with hard-to-heal wounds: A systematic review and meta-analysis of experimental studies

INTRODUCTION

Hard-to-heal wounds lead to functional loss, decreased quality of life, and prolonged hospitalization due to delayed healing. The healthcare costs of managing such wounds are substantial. Vibration therapy has been proposed as an alternative treatment for hard-to-heal wounds but no comprehensive reviews have quantitatively analyzed its efficacy.

MATERIALS AND METHODS

Six databases were systematically searched for relevant articles on August 1, 2024. The methodologies of the studies included in the analysis were assessed using Version 2 of the Cochrane Risk of Bias tool for randomized trials and ROBINS-I tool for non-randomized studies. A random-effects model was applied to aggregate the pooled effect size. Heterogeneity was assessed using I2. A forest plot was generated for meta-analysis.

RESULTS

Ten studies were included in the meta-analysis. Vibration therapy significantly reduced neuropathy (pooled standardized mean difference [SMD] = -0.79; 95 % CI = -1.51 to -0.07; p = 0.03; I2 = 61.40 %) and enhanced the ulcer healing area (pooled SMD = 0.92; 95 % CI = 0.60 to 1.23; p < 0.001; I2 = 0.00 %) of patients with hard-to-heal wounds. However, the intervention did not significantly alleviate pain (pooled SMD = -0.51; 95 % CI = -1.38 to 0.36; p = 0.25; I2 = 74.15 %). Significant heterogeneity was identified in the pooled result for pain and neuropathy.

CONCLUSIONS

Vibration therapy appears to enhance ulcer healing and reduce neuropathy. These results may help researchers and healthcare providers to further develop vibration therapy to address the underlying requirements for bridging the evidence-practice gap in wound care. Future studies should consider the safety and potential adverse outcomes of vibration therapy to ensure its appropriate application for treating hard-to-heal wounds.

Efficacy of the combination of Chinese herbal medicine and negative pressure wound therapy in the treatment of patients with diabetic foot ulcer: A meta-analysis

This study aimed to systematically evaluate the clinical efficacy of Chinese herbal medicine combined with negative pressure wound therapy (NPWT) in the treatment of diabetic foot ulcers (DFU). Computerised searches of the China National Knowledge Infrastructure, Wanfang, Chinese BioMedical Literature Database, PubMed, Cochrane Library and Embase databases were conducted for randomised controlled trials on the use of Chinese herbal medicines combined with NPWT for the treatment of DFU. The search period ranged from the time of establishment of each database to July 2023. Literature screening and data extraction were performed independently by two investigators, and the quality of the included studies was assessed. The meta-analysis was performed using Review Manager 5.4 software. A total of 25 studies were analysed, including 1777 DFUs, with 890 and 887 patients in the experimental and control groups, respectively. The results showed that the treatment of DFUs with a Chinese herbal medicine in combination with NPWT increased the overall effectiveness (odds ratio [OR] = 4.32, 95% confidence interval [CI]: 2.96-6.30, p < 0.001), wound healing rate (mean difference [MD] = 18.35, 95% CI: 13.07-23.64, p < 0.001) and ankle brachial index (MD = 0.10, 95% CI: 0.06-0.14, p < 0.001); reduced the wound healing time (MD = -11.01, 95% CI: -13.25 to -8.78, p < 0.001) and post-treatment wound area (MD = -1.73, 95% CI: -2.46 to -1.01, p < 0.001); decreased the C-reactive protein level (MD = -3.57, 95% CI: -5.13 to -2.00, p < 0.001); and increased vascular endothelial growth factor level (MD = 19.20, 95% CI: 8.36-30.05, p < 0.001). Thus, Chinese herbal medicines combined with NPWT can effectively promote wound healing, reduce inflammation and shorten the disease course in patients with DFU, while demonstrating precise clinical efficacy.

Efficacy of wearable vibration dressings on full-thickness wound healing in a hyperglycemic rat model

Local low-frequency vibration promotes blood flow and wound healing in hard-to-heal diabetic foot ulcers (DFUs). However, vibration treatment is challenging in patients with DFUs due to wound management difficulties and low adherence. Consequently, developing wearable self-care devices becomes imperative for effective wound healing. This study introduces a wearable vibration dressing and assesses its impact on wound healing in hyperglycemic rats. Low-frequency vibration at 52 Hz was applied to the wound for 40 min/day in awake rats. Relative wound areas on post-wounding days (PWDs) 4-7 were significantly smaller and the wound closure rate was significantly higher in the vibration group than in the control group (p < 0.05, respectively). The total haemoglobin at baseline and after vibration on post-wounding day 7 was significantly larger in the vibration group than in the control group (p < 0.05). On PWD 7, the thickness of the granulation tissue was significantly higher in the vibration group than in the control group (p < 0.05). Moreover, the number of blood vessels at the wound site and vascular endothelial growth factor A protein expression were significantly higher in the vibration group than in the control group (p < 0.05, respectively). The ratio of (CD68+ /iNOS+ )/(CD163+ ) macrophages in the vibration group was significantly lower than that in the control group (p < 0.05). These results indicate the potential of wearable vibration dressings as new self-care devices that can promote angiogenesis and blood flow, improve inflammation, and enhance wound healing in DFUs.