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Advances in Rehabilitation
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vol. 36
Review article

Efficacy of biofeedback in rehabilitation of musculoskeletal disorders: a systematic review

Hernán Andrés de la Barra Ortiz
Alexandra Meza Matamala
Francisca López Inostroza
Catalina Lobos Araya
Valeria Núñez Mondaca

Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
Advances in Rehabilitation, 2022, 36(1), 41–69
Online publish date: 2022/02/01
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1. Hawker GA. The assessment of musculoskeletal pain. Clin Exp Rheumatol. 2017; 35 Suppl 107(5): 8–12.
2. El-Tallawy SN, Nalamasu R, Salem GI, LeQuang JAK, Pergolizzi JV, Christo PJ. Management of mu-sculoskeletal pain: An update with emphasis on chronic musculoskeletal pain. Pain Ther. 2021; 10(1): 181–209.
3. Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017; 15(4): 413–21.
4. Park PW, Dryer RD, Hegeman-Dingle R, Mardekian J, Zlateva G, Wolff GG, et al. Cost burden of chronic pain patients in a large integrated delivery system in the United States. Pain Pract. 2015; 16(8): 1001–11.
5. Arendt-Nielsen L, Fernández-de-Las-Peñas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther. 2011; 19(4): 186–93.
6. Blyth FM, Noguchi N. Chronic musculoskeletal pain and its impact on older people. Best Pract Res Clin Rheumatol. 2017; 31(2): 160–8.
7. Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice ASC, et al. A new definition of neuropathic pain. Pain. 2011; 152(10): 2204–5.
8. Szok D, Tajti J, Nyári A, Vécsei L. Therapeutic approaches for peripheral and central neuropathic pain. Behav Neurol. 2019; 2019: 8685954.
9. van Griensven H, Schmid A, Trendafilova T, Low M. Central sensitization in musculoskeletal pain: Lost in translation? J Orthop Sports Phys Ther. 2020; 50(11): 592–6.
10. Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord. 2015; 16(1): 25.
11. Baliki MN, Mansour AR, Baria AT, Apkarian AV. Functional reorganization of the default mode network across chronic pain conditions. PLoS One. 2014; 9(9): e106133.
12. Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain Manag. 2015; 5(4): 297–317.
13. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): 2163–96.
14. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789–858.
15. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for mu-sculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020; 54(2): 79–86.
16. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Intern Med. 2016; 176(7): 958–68.
17. Mercadante S, Arcuri E, Santoni A. Opioid-induced tolerance and hyperalgesia. CNS Drugs. 2019; 33(10): 943–55.
18. Lin I, Wiles LK, Waller R, Goucke R, Nagree Y, Gibberd M, et al. Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review. Br J Sports Med. 2018; 52(5): 337–43.
19. Beutler A. Musculoskeletal therapies: Adjunctive physical therapy. FP Essent. 2018; 470: 16–20.
20. Hidalgo B, Detrembleur C, Hall T, Mahaudens P, Nielens H. The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. J Man Manip Ther. 2014; 22(2): 59–74.
21. Smith BE, Hendrick P, Bateman M, Holden S, Littlewood C, Smith TO, et al. Musculoskeletal pain and exercise-challenging existing paradigms and introducing new. Br J Sports Med. 2019; 53(14): 907–12.
22. Akkaya N, Ardic F, Ozgen M, Akkaya S, Sahin F, Kilic A. Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial. Clin Rehabil. 2012; 26(3): 224–36.
23. Juul-Kristensen B, Larsen CM, Eshoj H, Clemmensen T, Hansen A, Bo Jensen P, et al. Positive effects of neu-romuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome – A randomised controlled trial. J Electromyogr Kinesiol. 2019; 48: 161–8.
24. Baumueller E, Winkelmann A, Irnich D, Weigl M. Electromyogram biofeedback in patients with fibromyalgia: A randomized controlled trial. Complement Med Res. 2017; 24(1): 33–9.
25. Gálvez-Hernández CL, Rodríguez-Ortiz MD, Del Río-Portilla Y. Biofeedback treatment for acute whiplash patients. Rev Med Inst Mex Seguro Soc. 2016; 54(4): 480–9.
26. Narayanan SP, Bharucha AE. A practical guide to biofeedback therapy for pelvic floor disorders. Curr Gastroenterol Rep. 2019; 21(5): 21.
27. Dost Sürücü G, Tezen Ö. The effect of EMG biofeedback on lower extremity functions in hemiplegic patients. Acta Neurol Belg. 2021; 121(1): 113–8.
28. Robinson AJ, Snyder-Mackler L, editors. Clinical Electrophysiology: Electrotherapy and Electrophy-siologic Testing. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2007.
29. Avanzino L, Pelosin E, Vicario CM, Lagravinese G, Abbruzzese G, Martino D. Time processing and motor control in movement disorders. Front Hum Neurosci. 2016; 10: 631.
30. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339: b2535.
31. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1).
32. Albanese E, Bütikofer L, Armijo-Olivo S, Ha C, Egger M. Construct validity of the Physiotherapy Evidence Database (PEDro) quality scale for randomized trials: Item response theory and factor analyses. Res Synth Methods. 2020; 11(2): 227–36.
33. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l 4898.
34. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021; 12(1): 55–61.
35. Oravitan M, Avram C. The effectiveness of electromyographic biofeedback as part of a meniscal repair rehabilitation programme. J Sports Sci Med. 2013; 12(3): 526–32.
36. Huang H-Y, Lin J-J, Guo YL, Wang WT-J, Chen Y-J. EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement. J Electromyogr Kinesiol. 2013; 23(1): 267–74.
37. Ng GYF, Zhang AQ, Li CK. Biofeedback exercise improved the EMG activity ratio of the medial and lateral vasti muscles in subjects with patellofemoral pain syndrome. J Electromyogr Kinesiol. 2008; 18(1): 128–33.
38. Draper V, Ballard L. Electrical stimulation versus electromyographic biofeedback in the recovery of quadriceps femoris muscle function following anterior cruciate ligament surgery. Phys Ther. 1991; 71(6): 455–61.
39. Anwer S, Quddus N, Miraj M, Equebal A. Effectiviness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee. Hong Kong Physiother J. 2011; 29(2): 86–93.
40. Dursun N, Dursun E, Kiliç Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001; 82(12): 1692–5.
41. Choi YL, Kim BK, Hwang YP, Moon OK, Choi WS. Effects of isometric exercise using biofeedback on maximum voluntary isometric contraction, pain, and muscle thickness in patients with knee osteoarthritis. J Phys Ther Sci. 2015; 27(1): 149–53.
42. Yilmaz OO, Senocak O, Sahin E, Baydar M, Gulbahar S, Bircan C, et al. Efficacy of EMG-biofeedback in knee osteoarthritis. Rheumatol Int. 2010; 30(7): 887–92.
43. Durmuş D, Alayli G, Cantürk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007; 26(5): 674–8.
44. Christanell F, Hoser C, Huber R, Fink C, Luomajoki H. The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial. Sports Med Arthrosc Rehabil Ther Technol. 2012; 4(1): 41.
45. Sardaru DP, Matei D, Zaharia-Kezdi D, Pendefunda L. Effects of biofeedback versus switch-triggered func-tional electrical stimulation on sciatica-related foot drop. J Back Musculoskelet Rehabil. 2018; 31(2): 239–45.
46. Kirnap M, Calis M, Turgut AO, Halici M, Tuncel M. The efficacy of EMG-biofeedback training on quadriceps muscle strength in patients after arthroscopic meniscectomy. N Z Med J. 2005; 118(1224): U1704.
47. Levitt R, Deisinger JA, Remondet Wall J, Ford L, Cassisi JE. EMG feedback-assisted postoperative rehabilitation of minor arthroscopic knee surgeries. J Sports Med Phys Fitness. 1995; 35(3): 218–23.
48. Raeissadat SA, Rayegani SM, Sedighipour L, Bossaghzade Z, Abdollahzadeh MH, Nikray R, et al. The efficacy of electromyographic biofeedback on pain, function, and maximal thickness of vastus medialis oblique muscle in patients with knee osteoarthritis: a randomized clinical trial. J Pain Res. 2018; 11: 2781–9.
49. Ehrenborg C, Archenholtz B. Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain – a randomized controlled trial. Clin Rehabil. 2010; 24(8): 715–26.
50. Dellve L, Ahlstrom L, Jonsson A, Sandsjö L, Forsman M, Lindegård A, et al. Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial. Int Arch Occup Environ Health. 2011; 84(3): 335–46.
51. Voerman GE, Vollenbroek-Hutten MMR, Hermens HJ. Changes in pain, disability, and muscle activation patterns in chronic whiplash patients after ambulant myofeedback training. Clin J Pain. 2006; 22(7): 656–63
52. Atteya AA. Biofeedback traction versus conventional traction in cervical radiculopathy. Neurosciences (Riyadh). 2004; 9(2): 91–3.
53. Eslamian F, Jahanjoo F, Dolatkhah N, Pishgahi A, Pirani A. Relative effectiveness of electroacupuncture and biofeedback in the treatment of neck and upper back myofascial pain: A randomized clinical trial. Arch Phys Med Rehabil. 2020; 101(5): 770–80.
54. Newton-John TR, Spence SH, Schotte D. Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. Behav Res Ther. 1995; 33(6): 691–7.
55. Kosterink SM, Huis in ’t Veld RMHA, Cagnie B, Hasenbring M, Vollenbroek-Hutten MMR. The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial. J Telemed Telecare. 2010; 16(6): 316–21.
56. Spence SH, Sharpe L, Newton-John T, Champion D. Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders. Pain. 1995; 63(2): 199–206.
57. Stovold E, Beecher D, Foxlee R, Noel-Storr A. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Syst Rev. 2014; 3(1): 54.
58. Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, et al. Arthrogenic muscle inhi-bition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. 2019; 53(5): 289–98.
59. Struyf F, Nijs J, Mollekens S, Jeurissen I, Truijen S, Mottram S, et al. Scapular-focused treatment in pa-tients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol. 2013; 32(1): 73–85.
60. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am. 2004; 86(6): 1139–45.
61. Ebrahimi N, Jalaie S, Salsabili N, Ansari NN, Naghdi S. Knee Injury and Osteoarthritis Outcome Score in patients with isolated meniscus injury; Validity and reliability. J Res Med Sci. 2017; 22(1): 55.
62. Raven EEJ, Haverkamp D, Sierevelt IN, van Montfoort DO, Pöll RG, Blankevoort L, et al. Construct validity and reliability of the disability of arm, shoulder, and hand questionnaire for upper extremity complaints in rheumatoid arthritis. J Rheumatol. 2008; 35(12): 2334–8.
63. van der Linde JA, van Kampen DA, van Beers LWAH, van Deurzen DFP, Terwee CB, Willems WJ. The Oxford Shoulder Instability Score; validation in Dutch and first-time assessment of its smallest detectable change. J Orthop Surg Res. 2015; 10(1): 146.
64. Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS) – validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003; 1(1): 17.
65. Cano-de-la-Cuerda R, Molero-Sánchez A, Carratalá-Tejada M, Alguacil-Diego IM, Molina-Rueda F, Mian-golarra-Page JC, et al. Teorías y modelos de control y aprendizaje motor. Aplicaciones clínicas en neurorre-habilitación. Neurologia. 2015; 30(1): 32–41.
66. Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. J Pain. 2013; 14(10): 1019–30.
67. Roy M, Lebuis A, Peretz I, Rainville P. The modulation of pain by attention and emotion: a dissociation of perceptual and spinal nociceptive processes. Eur J Pain. 2011; 15(6): 641.e1-10.
68. Bi Y, Wei Z, Kong Y, Hu L. Supraspinal neural mechanisms of the analgesic effect produced by transcutaneous electrical nerve stimulation. Brain Struct Funct. 2021; 226(1): 151–62.
69. Johnson DS. The spasm-pain-spasm cycle. Pain Med. 2012; 13(4): 615.
70. Sembrano JN, Yson SC, Kanu OC, Braman JP, Santos ERG, Harrison AK, et al. Neck-shoulder crossover: how often do neck and shoulder pathology masquerade as each other? Am J Orthop (Belle Mead NJ). 2013; 42(9): E76-80.
71. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009; 39(5): 400–17.
72. de Zwart BCH, Frings-Dresen MHW, van Duivenbooden JC. Test-retest reliability of the Work Ability Index questionnaire. Occup Med (Lond). 2002; 52(4): 177–81.
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