Biofeedback may effectively improve headache and urinary incontinence related to prostatectomy, according to a systematic review published in the Journal of General Internal Medicine.
First popularized in the 1960s, biofeedback is currently used to address a wide range of clinical conditions. However, there remains uncertainty regarding the evidence base for this treatment.
The authors searched the MEDLINE, CINAHL, PsychINFO, EBM Reviews, and Epistemonikos databases for high-quality systematic reviews and meta-analyses conducted through September 2018, and solely included controlled studies. They selected 1 recent systematic review per condition and categorized outcomes as being: diagnosis-related, secondary to the condition, associated with the individual’s global health (eg, quality of life), and harms.
Confidence ratings were computed for each review, individual reviews were categorized according to biofeedback having no, unclear, or insufficient effect; potential positive effect; or positive effect. The findings were presented as evidence maps, which depict the type of outcome (by color) and confidence level (by bubble size) for each condition, allowing for easy visualization of the efficacy of the methodology for an array of conditions.
A total of 16 high-quality systematic reviews, examining 16 different clinical conditions, were included, with sample sizes and numbers of trials ranging from 56 to >3500 and 1 to 94, respectively. Biofeedback was consistently found, across many trials, to be efficacious for the treatment of migraine and tension-type headache pain, as well as postprostatectomy urinary incontinence. In a smaller number of trials, biofeedback was found to offer some benefit for stroke and balance recovery and/or fecal incontinence. There was no benefit found for the management of hypertension or female urinary incontinence, although these assessments were based on trials with small sample sizes and other limitations. The only review that reported harms associated with the use of biofeedback was for its application in patients with fibromyalgia.
For the majority of conditions, including Raynaud’s disease, fibromyalgia, sleep bruxism, knee osteoarthritis, intradialytic hypotension, dysphagia, Bell’s palsy, and chronic idiopathic constipation, there was insufficient evidence to allow conclusive determination of an effect of biofeedback. In these areas, more research is needed to examine the potential effect of biofeedback interventions. Such endeavors should involve head-to-head trials of different biofeedback treatment modalities and subgroup analyses.
Study limitations include a lack of discrimination between the types of biofeedback used.
“There are several potentially promising areas…[that] are good targets for further research including as follows: balance and gait training, fibromyalgia, and intradialytic hypotension,” noted the review authors.
Kondo K, Noonan KM, Freeman M, Ayers C, Morasco BJ, Kansagara D. Efficacy of biofeedback for medical conditions: an evidence map [published online August 14, 2019]. J Gen Intern Med. doi:10.1007/s11606-019-05215-z