Poster Presentation Sydney Spinal Symposium 2022

The effectiveness of biofeedback for improving pain, disability and work ability in adults with neck pain: a systematic review and meta-analysis (#119)

Marc Campo 1 , Joshua R Zadro 2 , Evangelos Pappas 3 , Marco Monticone 4 , Claudio Secci 4 , David Scalzitti 5 , Jill L Findley 6 , Petra L Graham 7 , Giovanni Ferreira 2
  1. School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York, United States
  2. Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, NEW SOUTH WALES, Australia
  3. Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
  4. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
  5. Department of Physical Therapy, George Washington University, Washington, DC, United States
  6. Department of Rehabilitation, Shore Rehabilitation Institute, Brick, New Jersey, United States
  7. Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia

Background: Neck pain is a leading cause of disability worldwide. Biofeedback can be used to optimise muscle activation patterns in people with neck pain and may be a promising non-pharmacological treatment strategy.  

Aims: To evaluate the safety and efficacy of electromyographic and pressure biofeedback on pain (primary outcome), disability and work ability in adults with neck pain.

Design: Systematic review and meta-analysis.

Methods: We searched key databases and trial registries to September 2020, using terms synonymous with ‘neck pain’ and ‘biofeedback’. We included randomized controlled trials (RCTs) evaluating biofeedback (against any comparison) for adults with neck pain. Outcomes included pain (primary outcome), disability, work ability and adverse events. Two authors independently selected the studies, extracted data, and evaluated risk of bias. GRADE was applied to each meta-analysis. Data were pooled using random-effects models to determine the standardised mean change (SMC).

Results: We included 15 RCTs (n=990). Moderate-quality evidence suggests biofeedback has a moderate effect on reducing short-term disability (SMC=-0.42, 95%CI:-0.59 to -0.26, nine trials, n=627), and a small effect on reducing intermediate-term disability (SMC=-0.30, 95%CI:-0.53 to -0.06, five trials, n=458). Biofeedback had no effect on pain or work ability in the short- and intermediate-term (low- to moderate-quality evidence). One study reported headaches in 6.7% of participants, but headache frequency was not reported by group. 

Limitations: There were a variety of control interventions across studies. Few studies compared biofeedback with no treatment or placebo.

Conclusion: Biofeedback appears to have a small-to-moderate effect on reducing neck pain disability in the short- and intermediate-term, but no effect on pain (our primary outcome) or work ability. More trials reporting adverse events and comparing biofeedback to placebo are needed. Clinicians should communicate these findings to patients with neck pain so patients can better understand the value of biofeedback and make an informed treatment choice.