Biofeedback

Biofeedback

                Electromyographic biofeedback is a modality that seems to be gaining increased popularity in clinical settings.  It is a therapeutic procedure that uses electronic or electromechanical instruments to accurately measure, process, and feedback reinforcing information via auditory or visual signals.  In clinical practice, it is used to help the patient develop greater voluntary control in terms of either neuromuscular relaxation or muscle reeducation following injury. (Prentice,  Therapeutic Modalities in Rehabilitation)

IN FAVOR

The article “Management of Stress Urinary Incontinence With Surface Electromyography-Assisted Biofeedback in Women of Reproductive Age” by Rett et al. was a case study of twenty-six women of reproductive age.  The purpose of the study was to test the ability of a biofeedback-assisted pelvic floor muscle exercise (PFME) program as a viable conservative alternative to surgery.  The twenty-six women were treated for twelve therapy sessions using a surface electromyography assisted biofeedback unit. All women were of reproductive age.  Results were determined from a seven day voiding diary, a one hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality of life questionnaire.  All variables were taken before and after intervention.  Results that were found were that the frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after intervention.  What they defined as an “objective cure” was found in 61.5% of the women.  There was also a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions during the intervention. They concluded that a short-term intervention of PFME with sEMG-assisted biofeedback could be helpful in treating symptoms of SUI in women of reproductive age and that this may be a reasonable conservative management option.

Rett, M. et al. (2007).  Management of Stress Urinary Incontinence With Surface Electromyography—  

             Assisted Biofeedback in Women of Reproductive Age.  Journal of the American Physical           

             Therapy Association. 87: 136-142.

The goal of this randomized-controlled, double-blind investigation of patients with chronic low back pain was to determine the effectiveness and efficacy of respiratory feedback in comparison to a strict placebo group. Participants were randomized either to a respiratory feedback (RFB) or a non-contingent respiratory feedback group. RFB is considered to be a valuable tool to train individuals to calm their breathing in order to become more relaxed. Those in the non-contingent group received a constant signal corresponding to a breathing rate of roughly 8 breaths/min which was independent of the participants breathing (i.e. not prompted by the participant). This is a type of pseudo-feedback, in which biofeedback signals mask actual body processes. The participants performed a HEP 30 min per day for 15 days. A respiratory associated relaxation index (RI) was utilized to quantify the level of relaxation through calmed breathing. Compared to placebo (non-contingent) RFB, real RFB induced a higher RI, higher reductions in pain at rest and during activity, and in psychopathological symptoms. Results did not, however, display significant difference between-groups, although symptom reductions were more evident in the RFB group from pre-posttest.

Kapitza,K. P., Passie, T., Bernateck, M., & Karst, M. (2010). First non-contingent respiratory 

               biofeedback     placebo versus contingent biofeedback in patients with chronic low back pain: a 

               randomized, controlled, double-blind trial. Applied psychophysiology and biofeedback, 35(3), 

               207-17. doi:10.1007/s10484-010-9130-1.

               

             The article “A randomized controlled trial of anorectal biofeedback for constipation” by Hart et. al. was a study to examine the efficacy of anorectal biofeedback v. a biofeedback control for treating constipation.  Twenty-one subjects with pelvic floor dyssynergia were placed in either the biofeedback treatment group or the biofeedback control group.  The treatment group received pelvic floor and external sphincter training using a rectal biofeedback probe.  The control group was administered upper trapezius relaxation training using biofeedback.  The study showed that overall constipation severity scores of the treatment group improved by 35.5% and obstructive defacation scores decreased by 37%.  Irritable Bowel Syndrome Quality of Life scores for the treatment group improved by 28% while the control group decreased 13%.  Although the study shows benefits to biofeedback, it was greatly underpowered because there were only 21 subjects.  Further research should be conducted.

Hart, Stacy L., Janet Waimin Lee, Julia Berian, Taryn R. Patterson,  Amanda del Rosario, Madhulika G.

Varma.  A randomized controlled trial of anorectal biofeedback for constipation.  Int J.

Colorectal Dis, 8 Nov., 2011.  DOI 10.1007/s00384-011-1355-9. 

ARTICLES AGAINST

The article by Moreland and Thomson was a literature review and meta-analysis conducted to examine the efficacy of EMG biofeedback compared with conventional physical therapy for improving upper-extremity function in patients who suffered a stroke.  A literature search was conducted from the years 1976-1992 of single-blinded randomized control trials.  Six studies were selected that met nine different criteria.  Because all of the analyses were statistically non-significant, the studies to date did not conclusively demonstrate that EMG biofeedback was superior to conventional therapy.  The estimated size of the effect was small therefore it was recommended that therapists consider factors such as cost, ease of application, and patient preference when deciding between the two forms of treatment.

Moreland, J, Thompson, M.  Efficacy of Electromyographic Biofeedback Compared With Conventional                   Physical Therapy for Upper-Extremity Function in Patients Following Stroke:  A Research                   Overview and Meta-analysis.  Physical Ther. 1994. Jun ;(74)6: 534-543.

The objective of this literature review and meta-analysis was to find a complementary and alternative medicine (CAM) for Raynaud’s Syndrome. Although the study was inconclusive as to what  type of CAM was most effective in treating Raynaud’s the only conclusion is came to was that biofeedback was actually not only not significant in a change of frequency, duration and severity of Raynaud attacks, it actually favored the control. Many trials had to be excluded, however, due to their lack of quality of statistics. Only one study that was included which demonstrated more significance towards the control versus biofeedback. Therefore, still, this is not conclusive in determining that biofeedback in not a useful tool.

Malenfant,D., Catton, M., & Pope, J. E. (2009). The efficacy of complementary and alternative medicine                    in the treatment of Raynaud’s phenomenon: a literature review and meta-analysis.             

                  Rheumatology (Oxford, England), 48(7),791-5. doi:10.1093/rheumatology/kep039

             The article “Behavioral and Physical Treatments for Migraine Headache” by Goslin et. al. is a meta-analysis of comparative clinical trials of behavioral and physical treatments of migraine headaches.  The studies in this review were prospective, controlled trials of behavioral or physical treatments whose purpose was to prevent attacks of migraine headaches or relieve symptoms.  Biofeedback treatments were not described in detail, but simply as thermal biofeedback combined with relaxation training and EMG biofeedback.  The biofeedback techniques did not prove to be statistically significant for treating migraine headaches when compared to a control.

 

Goslin RE, Gray RN, McCrory DC, et al. Behavioral and Physical Treatments for Migraine Headache.                           Rockville (MD): Agency for Health Care Policy and Research (US); 1999 Feb. (Technical 

                 Reviews,   No. 2.2.) Summary

               

Mallory Mahoney, Adam Mathers, Brandon Smith