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Efficacy of Biofeedback for Medical Conditions: an Evidence Map

  • Karli KondoEmail author
  • Katherine M. Noonan
  • Michele Freeman
  • Chelsea Ayers
  • Benjamin J. Morasco
  • Devan Kansagara
Review

Abstract

Background

Biofeedback is increasingly used to treat clinical conditions in a wide range of settings; however, evidence supporting its use remains unclear. The purpose of this evidence map is to illustrate the conditions supported by controlled trials, those that are not, and those in need of more research.

Methods

We searched multiple data sources (MEDLINE, PsycINFO, CINAHL, Epistemonikos, and EBM Reviews through September 2018) for good-quality systematic reviews examining biofeedback for clinical conditions. We included the highest quality, most recent review representing each condition and included only controlled trials from those reviews. We relied on quality ratings reported in included reviews. Outcomes of interest were condition-specific, secondary, and global health outcomes, and harms. For each review, we computed confidence ratings and categorized reported findings as no effect, unclear, or insufficient; evidence of a potential positive effect; or evidence of a positive effect. We present our findings in the form of evidence maps.

Results

We included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud’s. Biofeedback was not beneficial for urinary incontinence in women, nor for hypertension management, but these conclusions are limited by small sample sizes and methodologic limitations of these studies.

Discussion

Available evidence suggests that biofeedback is effective for improving urinary incontinence after prostatectomy and headache, and may provide benefit for fecal incontinence and balance and stroke recovery. Further controlled trials across a wide range of conditions are indicated.

KEY WORDS

biofeedback neurofeedback complementary and alternative medicine (CAM) evidence map 

Notes

Acknowledgments

The authors wish to thank Robin Paynter for developing the search strategy and running electronic searches and Jessica Montgomery for assisting with data abstraction.

Funding

This research was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The findings and conclusions in this document are those of the authors who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Supplementary material

11606_2019_5215_MOESM1_ESM.docx (116 kb)
ESM 1 (DOCX 116 kb)
11606_2019_5215_MOESM2_ESM.docx (91 kb)
ESM 2 (DOCX 91 kb)

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Copyright information

© Society for General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  1. 1.Evidence Synthesis ProgramVA Portland Health Care SystemPortlandUSA
  2. 2.Research Integrity OfficeOregon Health & Science UniversityPortlandUSA
  3. 3.Physical Medicine and RehabilitationVA Portland Health Care SystemPortlandUSA
  4. 4.Center to Improve Veteran Involvement in CareVA Portland Health Care SystemPortlandUSA
  5. 5.Department of PsychiatryOregon Health & Science UniversityPortlandUSA
  6. 6.Department of MedicineOregon Health & Science UniversityPortlandUSA

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