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| Biofeedback | |
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| Description: |
Effective August 1, 2026, Coverage Policies 2009025 (Biofeedback as a Treatment of Urinary Incontinence in Adults), 2009026 (Biofeedback as a Treatment of Headache), 2009027 (Biofeedback as a Treatment of Chronic Pain), 2009028 (Biofeedback as a Treatment of Fecal Incontinence or Constipation), and 1998043, (Biofeedback for Miscellaneous Indications) have been combined into one policy with no change to coverage intent. Coverage Policies 2009025, 2009026, 2009027, and 2009028 have been archived.
Biofeedback is a technique intended to teach patients self-regulation of certain physiologic processes not normally considered to be under voluntary control. The technique involves the feedback of a variety of types of information not normally available to the patient, followed by a concerted effort on the part of the patient to use this feedback to help alter the physiological process in some specific way. Biofeedback has been proposed as a treatment for a variety of diseases and disorders including anxiety, headache (migraine and tension), hypertension, incontinence (fecal and urinary), and movement disorders.
The various forms of biofeedback differ mainly in the nature of the disease or disorder under treatment, the biologic variable that the individual attempts to control, and the information that is fed back to the individual. Biofeedback techniques include peripheral skin temperature feedback, blood-volume-pulse feedback (vasoconstriction and dilation), vasoconstriction training (temporalis artery), and electromyographic (EMG) biofeedback; these may be used alone or in conjunction with other therapies (e.g., relaxation, behavioral management, medication). For hypertension, blood pressure is monitored and the data reported back to the patients.
In general, EMG biofeedback is used to treat tension headaches. Feedback on achievement of a decrease in muscle tension is provided to the individual, reinforcing those activities (behaviors or thoughts) that are effective. Thermal biofeedback is commonly used for migraine headaches. In this technique a temperature sensor is placed on the finger, and the subject is taught to increase peripheral vasodilation by providing feedback on skin temperature, an effect that is mediated through sympathetic activity. The pulse amplitude recorded from the superficial temporal artery has also been used to provide feedback. Temporal pulse amplitude biofeedback has been used to treat both chronic tension type headaches and migraine headaches.
Treatment for chronic pain is often multimodal and typically includes psychological therapy. Psychological techniques vary but may include cognitive therapy, which teaches subjects the ability to cope with stressful stimuli by attempting to alter negative thought patterns and dysfunctional attitudes, and behavioral approaches to reduce muscle tension and break the pain cycle. Relaxation, using any of a variety of techniques including meditation or mental imagery, is considered a behavioral therapy that may be used alone or as a component of a cognitive-behavioral therapy program. Electromyography biofeedback has also been used for the treatment of chronic pain, on the assumption that the ability to reduce muscle tension will be improved through the feedback of data to the patient regarding the degree of muscle tension. While some consider electromyography biofeedback to be a method used to obtain relaxation, others consider biofeedback to be distinct from other relaxation techniques.
The application of biofeedback to the treatment of urinary and rectal incontinence differs somewhat from the general tenets of biofeedback in that the biofeedback is used to help the patient learn to control and coordinate the contraction of sphincter muscles, i.e., skeletal muscles, which are under voluntary control. Data from manometric studies may also be used in biofeedback for fecal incontinence. In particular, biofeedback as a treatment for urinary incontinence is often used to enhance training in pelvic floor muscle exercises (PME).
Regulatory Status
A variety of biofeedback devices are cleared for marketing by the U.S. Food and Drug Administration’s (FDA) through the 510(k) process. The FDA defines a biofeedback device as “an instrument that provides a visual or auditory signal corresponding to the status of one or more of a patient's physiological parameters (e.g., brain alpha wave activity, muscle activity, skin temperature, etc.) so that the patient can control voluntarily these physiological parameters”.
The leva Pelvic Heath system uses motion sensor technology to provide biofeedback through use of an intravaginal device worn pelvic during training with connection to a smartphone app. The device received FDA approval in 2022 for fecal incontinence, urinary incontinence, and strengthening of the pelvic muscle floor.
FDA product code: KPI; HIR.
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Policy/ Coverage: |
Biofeedback for any condition is an exclusion in the member certificate of coverage in most member benefit certificates.
For members of plans with benefit certificates without this specific contract exclusion, the following Coverage Policy applies.
Effective August 1, 2026, Coverage Policies 2009025 (Biofeedback as a Treatment of Urinary Incontinence in Adults), 2009026 (Biofeedback as a Treatment of Headache), 2009027 (Biofeedback as a Treatment of Chronic Pain), 2009028 (Biofeedback as a Treatment of Fecal Incontinence or Constipation), and 1998043, (Biofeedback for Miscellaneous Indications) have been combined into one policy with no change to coverage intent. Coverage Policies 2009025, 2009026, 2009027, and 2009028 have been archived.
Effective August 1, 2026
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Biofeedback meets member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes or for members with contracts without Primary Coverage Criteria, is considered Medically Necessary and is covered when member receives a “recommended” determination from criteria review in InterQual® for biofeedback based on diagnosis and requested service.
Click the following link to view the specific criteria in InterQual®:
https://prod.ds.interqual.com/service/connect/transparency?tid=27b0a724-ca06-4b22-846b-598b8dae52fc
See Criteria below.
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Biofeedback meets member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes or for members with contracts without Primary Coverage Criteria is considered Medically Necessary and is covered as part of the overall treatment plan for migraine and tension-type headaches.
Does Not Meet Primary Coverage Criteria Or Is Not Covered For Contracts Without Primary Coverage Criteria
Biofeedback for the treatment of cluster headaches and unsupervised home use of biofeedback for treatment of headaches does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or circumstance not described above.
For members with benefit certificates without this specific contract exclusion, biofeedback for the treatment of cluster headaches and unsupervised home use of biofeedback for treatment of headaches is considered not Medically Necessary or is investigational and is not covered for any indication or circumstance not described above. Not Medically Necessary or Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Biofeedback as a treatment of urinary incontinence in adults does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or circumstance not described above.
For members with benefit certificates without this specific contract exclusion, biofeedback as a treatment of urinary incontinence in adults is considered not Medically Necessary or is investigational and is not covered for any indication or circumstance not described above. Not Medically Necessary or Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Biofeedback for the treatment of fecal incontinence or constipation, does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or circumstance not described above.
For members with benefit certificates without Primary Coverage Criteria and without this specific contract exclusion, biofeedback for the treatment of fecal incontinence or constipation is considered not Medically Necessary or is investigational and is not covered for any indication or circumstance not described above. Not Medically Necessary or Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Biofeedback for the treatment of chronic pain (including but not limited to low back pain) or any other condition does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or circumstance not described above.
For members with benefit certificates without Primary Coverage Criteria and without this specific contract exclusion, biofeedback for the treatment of chronic pain (including but not limited to low back pain) or any other condition is considered not Medically Necessary or is investigational and is not covered for any indication or circumstance not described above. Not Medically Necessary or Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Biofeedback does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or circumstance not described above, including but not limited to treatment of the following:
For members with benefit certificates without Primary Coverage Criteria, biofeedback is considered not Medically Necessary or is investigational and is not covered for any indication or circumstance not described above, including but not limited to the following. Not Medically Necessary or Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Click the following link to view the specific criteria in InterQual®:
https://prod.ds.interqual.com/service/connect/transparency?tid=27b0a724-ca06-4b22-846b-598b8dae52fc
Effective July 1, 2026 through July 31, 2026
Does Not Meet Primary Coverage Criteria Or Is Not Covered For Contracts Without Primary Coverage Criteria
Biofeedback for any condition is a specific contract exclusion in most member benefit certificates of coverage.
For members with benefit certificates without this specific contract exclusion, biofeedback does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes for any indication, including but not limited to, the treatment of the following indications:
For members with benefit certificates without Primary Coverage Criteria whose contract does not include this specific contract exclusion, biofeedback for any indication, including those listed above, is considered Not Medically Necessary or is investigational and is not covered. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Click the following link to view the InterQual® criteria:
https://prod.ds.interqual.com/service/connect/transparency?tid=27b0a724-ca06-4b22-846b-598b8dae52fc
Effective August 2021 to June 30, 2026
Does Not Meet Primary Coverage Criteria Or Is Not Covered For Contracts Without Primary Coverage Criteria
Biofeedback for any condition is a specific contract exclusion in most member benefit certificates of coverage.
For members with benefit certificates without this specific contract exclusion, biofeedback does not meet member benefit certificate Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes for any indication, including but not limited to, the treatment of the following indications:
For members with benefit certificates without Primary Coverage Criteria whose contract does not include this specific contract exclusion, biofeedback for any indication, including those listed above, is considered Not Medically Necessary or is investigational and is not covered. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Effective Prior to August 2021
Biofeedback for any condition is an exclusion in the member certificate of coverage in most member benefit certificates.
For member benefit certificates without this specific contract exclusion, biofeedback does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes a treatment of the following indications:
For member benefit certificates without this specific contract exclusion, with contracts without primary coverage criteria biofeedback for the above indications is
investigational.
Effective August 2014
Biofeedback for any condition is an exclusion in the member certificate of coverage in most member benefit certificates.
For member benefit certificates without this specific contract exclusion, biofeedback does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes a treatment of the following indications:
For member benefit certificates without this specific contract exclusion, with contracts without primary coverage criteria biofeedback for the above indications is
investigational.
Effective August 2011
Biofeedback for any condition is an exclusion in the member certificate of coverage in most member benefit certificates.
For member benefit certificates without this specific contract exclusion, biofeedback is considered investigational as a treatment of the following indications:
Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Effective Prior to August 2011
Biofeedback for any condition is an exclusion in the member certificate of coverage in most member benefit certificates.
For member benefit certificates without this specific contract exclusion, biofeedback is considered
investigational as a treatment of anxiety disorders, hypertension, insomnia, movement disorders, asthma, and Raynaud’s disease. Investigational services are not a covered benefit.
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| Rationale: |
Published literature consists of studies that evaluate biofeedback for a variety of clinical conditions. Relevant systemic reviews and key randomized or controlled trials are described.
Headache treatment
The American Headache Society identified the following treatment goals of preventive biobehavioral therapy (including biofeedback) (Ailani, 2021):
In 2021, the American Headache Society released a consensus statement on integration of new migraine treatments into clinical practice, including biobehavioral therapies (cognitive behavioral therapy, biofeedback, and relaxation) (Ailani, 2021). According to the consensus statement, "biobehavioral therapies have Grade A evidence supporting their use as preventive treatments in patients with migraine." The statement notes that biobehavioral therapies are particularly suited for the following individuals:
Martino Cinnera and others conducted a systematic review and meta-analysis of electromyographic biofeedback for headache (Martino Cinnera, 2023). A total of 29 RCTs were included in the systematic review, and 4 RCTs were included in the meta-analysis (Martino Cinnera, 2023). The headache types represented in the included studies were tension headache (69%), migraine (30%), and mixed types (1%). Risk of bias was generally low in the included studies, but about 60% of studies had concerns about potential deviations from the intended intervention. There was also high heterogeneity regarding patient demographics. The meta-analysis found no difference in headache frequency (p=.66), intensity (p=.99), or duration (p=.54) between electromyographic biofeedback and controls.
Paudel and colleagues conducted a systematic review and meta-analysis of 9 RCTs that evaluated the efficacy of biofeedback for migraine (Paudel, 2025). All of the studies included compared biofeedback to a control group that did not receive biofeedback (wait list) and 3 studies had an active comparator group. The results found that biofeedback significantly reduced headache severity (mean difference [MD], -0.68; 95% confidence interval [CI], -1.07 to -0.30) and frequency (MD, -0.20; 95% CI, -0.39 to -0.01) compared to wait list control. However, there was no difference in headache severity or frequency between biofeedback and active therapies.
Arce Saez and fellow investigators conducted a systematic review of nonpharmacologic therapy for tension-type headaches in children (Arce Saez, 2024). Meta-analysis was not performed. Among the 18 included studies, biofeedback was used in 3 studies, all of which were cohort studies. The authors concluded that all of the data for biofeedback is in patients who are also receiving concurrent therapy programs, so it is difficult to make conclusions about the effect of biofeedback alone.
In 2023, the Department of Veterans Affairs/Department of Defense updated their guideline on management of headache (VA/DoD, 2023). The guideline stated that there is insufficient evidence to recommend for or against biofeedback for the treatment or prevention of headache.
Treatment chronic of pain
Yelden and associates compared biofeedback to physiotherapist feedback in an RCT in 40 patients with chronic nonspecific low back pain (Yelden, 2024). All patients received 12 sessions of the designated therapy (3 sessions weekly for 4 weeks) and a core stabilization activity program. The primary outcome, disability as measured by the Revised Oswestry Disability Index scale was not significantly different between groups at the end of treatment. Secondary measures of visual analogue scale pain scores, muscle activity, and quality of life were also not different between groups.
Ananias and others conducted a systematic review and meta-analysis of 8 RCTs that compared the efficacy of biofeedback and standard rehabilitation in patients undergoing anterior cruciate ligament reconstruction surgery (Ananias, 2024). Four of the RCTs were included in the meta-analysis. Two RCTs showed a significant effect of biofeedback on quadriceps strength, 2 studies reported a significant difference in pain scores, 2 studies found a significant difference in knee extension deficit, and one study reported a significant difference in balance. The heterogeneity of outcomes assessed limits the interpretation of these results in this subset of studies.
Several meta-analyses have reviewed RCTs assessing psychological therapies for a variety of nonheadache chronic pain conditions. Calderone et al conducted a systematic review of biofeedback in the setting of rehabilitation for chronic pain (Calderone, 2025). A total of 25 studies were included in the review; 15 studies were RCTs and 10 studies were nonrandomized. The overall risk of bias was moderate for almost all of the included studies. A meta-analysis was not performed, but the authors concluded that the data supports the efficacy of biofeedback as adjunctive therapy for chronic pain. A limitation of this analysis is that some studies used biofeedback techniques other than EMG biofeedback.
Urinary Incontinence
In a Cochrane systematic review, Herderschee and others assessed RCTs on feedback or biofeedback in conjunction with PFMT for treating urinary incontinence in women (Herderschee, 2011). Feedback was defined as verbal feedback by a clinician, whereas biofeedback involved the use of an instrument or device. After examining 36 full-text articles, 24 trials met reviewers' eligibility criteria, and 17 contributed data to the analysis of at least 1 primary outcome measure. Sixteen of the 24 trials compared PFMT plus biofeedback with PFMT alone; 9 of them included the same PFMT programs in both groups. The primary outcomes of the review were quality of life and improvement or cure. Nine trials used one of several validated quality of life instruments; however, only 4 of them reported data in a form amenable to meta-analysis. Thus, the quality of life results were not pooled. Data were pooled for the other primary outcome (improvement or cure), but there was a sufficient number of studies only for comparing PFMT with and without biofeedback. In a pooled analysis of 7 studies, there was a significant reduction in the proportion of women reporting "no improvement or cure" when biofeedback was added to muscle exercise (relative risk, 0.75; 95% CI, 0.66 to 0.86). Reviewers noted there may have been other differences between groups, such as more frequent contact with a health care professional or a greater number of treatment sessions, which might partially explain the difference between the improvement or cure rates in women who did or did not receive biofeedback. Moreover, when only the outcome "no cure" was examined, there was no significant difference between groups that did and did not receive biofeedback (5 studies; relative risk, 0.92; 95% CI, 0.81 to 1.05). Among secondary outcomes, a pooled analysis of 7 trials did not find a significant difference in leakage episodes in a 24-hour period after treatment (mean difference, -0.01; 95% CI, -0.21 to 0.01). For the outcomes frequency and nocturia, data could not be combined but reviewers reported that the pattern was one of no difference between groups. This Cochrane review was updated in 2025 by Fernandes et al, with updated findings on the comparison between PFMT with biofeedback versus PFMT alone (Fernandes, 2025). The updated review included 33 RCTs assessing this comparison, with 30 contributing data to meta-analyses. For the primary outcome of lower urinary tract symptom-specific quality of life, data from 11 studies found little difference between PFMT with biofeedback and PFMT alone (standardized mean difference, 0.07; 95% CI, 0.18 to 0.05). Regarding leakage episodes in a 24-hour period, a pooled analysis of 12 studies demonstrated a statistically significant reduction favoring biofeedback, though the clinical significance is unclear (mean difference, -0.29; 95% CI, -0.42 to -0.16). Subjective perception of cure or improvement was analyzed in 14 studies, yielding an odds ratio of 1.26 (95% CI, 1.00 to 1.58), suggesting little to no difference between groups. However, satisfaction with treatment outcomes, analyzed in 6 studies, favored PFMT with biofeedback (odds ratio, 2.41; 95% CI, 1.56 to 3.70).
Wang and colleagues published a multicenter (China), assessor-blinded RCT evaluating the efficacy of pressure-mediated biofeedback combined with PFMT versus PFMT alone in postpartum women with stress urinary incontinence (Wang, 2024). A total of 452 participants (median age, 34 years; median time since delivery, 50 days) were randomized to receive 3 months of supervised PFMT either with a home-based pressure-mediated biofeedback device (n=223) or without it (n=229). The primary outcome was the severity of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Secondary outcomes included cure and improvement rates, pelvic floor muscle strength, quality of life, self-efficacy, and adherence. The intervention group showed significantly greater improvement in ICIQ-UI SF scores (median reduction 3.00 vs 2.00 points; p=.002), higher cure rates (20.2% vs 8.7%; p=.001), and improvement rates (59.2% vs 44.5%; p=.002). Objective pelvic floor muscle strength was significantly higher in the intervention group (p=.02), and self-efficacy scores were greater (p=.02). No serious device-related adverse events were reported.
Brea-Gomez and others published a systematic review evaluating the efficacy of PFMT with preoperative biofeedback in reducing urinary incontinence postprostatectomy (Brea-Gomez, 2024). Fourteen RCTs (N=1246) were included in the systematic review, and 13 were included in a meta-analysis. PFMT with preoperative biofeedback was compared against no intervention/placebo, usual care (postoperative PFMT), or PFMT with postoperative biofeedback. The primary outcome was urinary incontinence, assessed at up to 3 months, 3 to less than 6 months, and 6 to less than 12 months after radical prostatectomy. At up to 3 months, PFMT with preoperative biofeedback significantly reduced incontinence rates when compared to control groups consisting of no intervention, placebo, or usual care (n=485; odds ratio, 0.51; 95% CI, 0.28 to 0.92; p=.02). Similar benefits were observed at 3 to less than 6 months (n=436; odds ratio, 0.40; 95% CI, 0.20 to 0.79; p=.008) and at 6 to less than 12 months (n=409; odds ratio, 0.29; 95% CI, 0.10 to 0.85; p=.02). No significant differences were found when comparing incontinence rates for groups that received preoperative versus postoperative biofeedback. Quality of life outcomes showed no statistically significant differences between groups at any time point. The overall certainty of evidence was rated low to very low due to risk of bias, inconsistency, and imprecision.
Fecal Incontinence or Constipation
In 2015, the American Society of Colon and Rectal Surgeons (ASCRS) updated its guideline on the treatment of fecal incontinence (Parquette, 2015). Those guidelines were updated in 2023 (Bordeianou, 2023). Biofeedback is no longer considered first line but may still be considered for patients with fecal incontinence (conditional recommendation, low quality of evidence
Gordon and colleagues conducted a systematic review of treatments for intractable functional constipation in children (Gordon, 2024). Ten RCTs were included, 6 of which had a high concern for bias. Only one study evaluated biofeedback, and that study was considered a low certainty of evidence due to concern for bias and a small sample size. Symptom resolution was improved with biofeedback compared to no intervention (risk ratio, 2.50; 95% CI, 1.08 to 5.79) but the conclusion of efficacy was uncertain.
Pun and fellow investigators conducted a systematic review and meta-analysis of 10 RCTs that assessed physiotherapy interventions on fecal incontinence following colorectal surgery (Pun, 2024). Biofeedback was more effective than usual care in measures of rectal muscle strength (all p less than .05), and biofeedback combined with pelvic floor muscle training was more effective than pelvic floor training alone (all p less than .05). The effect of biofeedback on constipation symptoms was not reported. These results are limited by a high risk of bias and heterogeneity of the included trials.
In 2024, the American Society of Colon and Rectal Surgeons (ASCRS) published a guideline on the evaluation and management of chronic constipation (Alavi, 2024). The guideline stated that biofeedback therapy is a first-line treatment for symptomatic pelvic floor dyssynergia (strong recommendation, moderate quality of evidence).
Hao and others conducted a systematic review and meta-analysis of physical therapy-based treatments for functional constipation in children (Hao, 2025). Of the 13 RCTs included in the analysis, 3 evaluated biofeedback (2 of which overlapped with studies in the Wegh and colleagues review). All 3 trials were unblinded. The meta-analysis found no difference in treatment success between biofeedback and control (risk ratio, 0.91; 95% CI, 0.50 to 1.68; p=.01; I2=78%).
Hypertension
A systematic review of studies on biofeedback for hypertension was published by Greenhalgh and colleagues in 2010 (Greenhalgh, 2010). The investigators searched for RCTs that included adults with essential hypertension (defined as at least 140/90 mm Hg) and that compared biofeedback interventions, alone or in combination with other therapies, to medication, sham biofeedback, no treatment, or another behavioral intervention. A total of 36 trials (n=1,660) met inclusion criteria. Trials generally had small sample sizes; only 4 included more than 100 patients. All were single-center, and most were conducted in the United States. Trials used a variety of biofeedback techniques including thermal biofeedback, galvanized skin response, pulse wave velocity, and heart rate variability; some trials used more than 1 modality. Twenty studies evaluated biofeedback alone, fifteen evaluated biofeedback combined with another intervention, and 1 had multiple arms and evaluated both types of interventions; only 4 trials included a sham biofeedback comparison group. The authors stated that they did not pool study findings due to differences in interventions and outcomes and the generally poor quality of the studies.
The investigators reported that trials comparing biofeedback alone versus no treatment or another behavioral intervention did not provide convincing evidence of the superiority of biofeedback. Only 1 of 5 trials that compared a biofeedback combination intervention (most commonly combined with relaxation) to a different behavioral treatment found the biofeedback intervention to be superior. Approximately half of the trials comparing a biofeedback combination to no treatment found a significant benefit to the biofeedback combination, but the specific effects of biofeedback cannot be determined from this analysis. Only 1 trial was identified that compared a biofeedback combination intervention to sham biofeedback, and this study did not find a significant difference in the efficacy of the 2 interventions. Four studies on biofeedback alone and another 4 on a combined biofeedback intervention reported data beyond 6 months; most of these found no significant differences in efficacy between the biofeedback and control groups. Greenhalgh and colleagues concluded, “…we found no convincing evidence that consistently demonstrates the effectiveness of the use of any particular biofeedback treatment in the control of essential hypertension when compared with pharmacotherapy, placebo, no intervention or other behavioral therapies.”
Wang and colleagues published an RCT evaluating the effect of direct blood pressure biofeedback on patients with prehypertension or stage I hypertension (Wang, 2016). A trained nurse instructed patients in blood pressure self-regulation by using slow diaphragmatic breathing and passive attitude. During the 8-week training (1 session per week), patients in the treatment group received real-time blood pressure feedback signals (n=29) and controls received pseudo-feedback signals (n=28). Outcomes were systolic and diastolic blood pressure, measured at baseline and 1 and 8 weeks after training. Both groups significantly decreased blood pressure following training. The decreases were equal in magnitude, suggesting that blood pressure self-regulation training can effectively lower blood pressure, regardless of the type of feedback signal.
The American College of Cardiology/American Heart Association Task Force (2017) guidelines on hypertension in adults states that "behavioral therapies, including....biofeedback, lack strong evidence for their long-term BP-lowering effect (Whelton, 2018).”
Mengden and others published a randomized cohort study evaluating the effect of device-guided slow breathing with biofeedback of pulse wave velocity in patients with hypertension (Mengden, 2023). Patients (N=44) were trained to perform unattended device-guided slow breathing exercises for 10 minutes daily over 5 days. At the time of initial screening, office-measured blood pressure was median 137/83 mmHg. After the first 10-minute daily exercise, a significant increase (p<.05) in pulse wave velocity of 5 ms on average was observed. Additionally, between the initial baseline collection of blood pressure and self-assessment before beginning the breathing assessment, there was a significant decrease of 6 mmHg (p<.001) in systolic blood pressure, possibly accounting for white coat effect. Another significant 5 mmHg (p<.001) decrease in systolic blood pressure occurred post-assessment. Similar changes were seen daily after each biofeedback session. However, there were no significant changes between day 1 values and day 5 values.
Jenkins and associates published a systematic review and meta-analysis of biofeedback in patients with hypertension (Jenkins, 2024). Twenty studies (N=988 patients) met the inclusion criteria, which represented 6 methods of providing biofeedback. The number of sessions ranged from 4 to 48 and follow-up ranged from 2 weeks to 12 months. There was a significant effect on both systolic (mean, -4.52 mm Hg) and diastolic blood pressure (mean, -5.19 mm Hg) with biofeedback (p=.02 and p=.0004, respectively). Limitations of this analysis include heterogeneity in the included studies.
The 2025 American College of Cardiology/American Heart Association Task Force, guideline on management of high blood pressure in adults does not include any comments about biofeedback or other behavioral therapies (Jones, 2025).
Motor function after stroke, injury, or lower-limb surgery
A Cochrane review assessed electromyographic (EMG) biofeedback for the recovery of motor function after stroke was published in 2007 (Woodford, 2007). It included 13 randomized or quasi-randomized studies with a total of 269 patients. All of the trials compared EMG biofeedback plus standard physiotherapy to standard physiotherapy; in addition to standard physiotherapy, several studies also included a sham biofeedback group. The studies tended to be small and poorly designed. The authors did not find support for EMG biofeedback to improve motor power, functional recovery, or gait quality when compared to physiotherapy alone.
A systematic review by Zijlstra and colleagues, published in 2010, searched for studies evaluating biofeedback-based training to improve mobility and balance in adults older than 60 years of age (Zijlstra, 2010). Although the review was not limited to studies on motor function after stroke, more than half of the studies included older adults post-stroke. For inclusion in this review, studies needed to include a control group of patients who did not receive biofeedback and to assess at least 1 objective outcome measure. A total of 97 potentially relevant articles were identified, and 21 (22%) studies, including 17 RCTs, met the selection criteria. Twelve of the 21 (57%) studies included individuals post-stroke, 3 included older adults who had lower-limb surgery, and 6 included frail older adults without a specific medical condition. Individual studies were small; sample sizes ranged from 5 to 30 patients. The added benefit of using biofeedback could be evaluated in 13 of 21 (62%) studies. Nine of the 13 studies found a significantly greater benefit with interventions that used biofeedback compared to control interventions. However, the outcomes assessed were generally not clinical outcomes but were laboratory-based measures related to executing a task, e.g., moving from sitting to standing in a laboratory setting and platform-based measures of postural sway. The applicability of improvements in these types of measures to clinical outcomes such as the ability to perform activities of daily living or the rate of falls, is unknown. Only 1 study cited in this review reported an improvement in fall rates, and this trial could not isolate the effect of biofeedback from other components of treatment. In addition, only 3 studies reported long-term outcomes, and none of these reported a significant effect of biofeedback. Conclusions about the efficacy of biofeedback for improving mobility and balance in older adults cannot be drawn from these data due to the lack of evidence on clinical outcomes. Other methodologic limitations include limited data on the durability of effects and the inability to isolate the effect of biofeedback in many studies.
Numerous RCTs and several systematic reviews of RCTs have been published. Systematic reviews have noted that RCTs tended to have relatively small sample sizes and only small RCTs were identified in policy updates (Rayegani, 2014).
Systematic Reviews
Stanton and others updated a systematic review and meta-analysis published in 2011 (see below) which evaluated the effect of biofeedback on lower-limb activities in patients who have had a stroke (Stanton, 2017). Only high-quality RCTs or quasi-RCTs with Physiotherapy Evidence Database (PEDro) scores greater than 4 were included. The literature search, conducted through September 2015, identified 18 trials (total N=429 patients) for inclusion. Training activities were walking (9 trials), standing (8 trials), and standing up (1 trial). Trials were small, with study populations ranging from 12 to 50 patients. Biofeedback techniques included weight distribution from a force platform or sensor (11 trials), muscle activity from EMG (3 trials), linear gait parameters (3 trials), and joint angle from a goniometer (1 trial). Visual feedback was used in 7 trials, auditory in 7 trials, and a combination of visual/auditory in 4 trials. Pooled standardized mean difference of the short-term effect of biofeedback from 17 trials (n=417) was significant (0.50; 95% confidence interval [CI], 0.3 to 0.7). Long-term effects could not be calculated because only 4 trials provided that information.
A systematic review and meta-analysis by Stanton and associates was updated in 2017 (Stanton, 2011). A total of 22 trials with 591 participants met inclusion criteria; in the update, reviewers only included high-quality trials (see above).
Randomized Controlled Trials
Kim published an RCT on the effect of EMG on upper-extremity functions in patients who have had a stroke (Kim, 2017). Patients were randomized to traditional rehabilitation therapy (n=15) or traditional rehabilitation therapy plus EMG biofeedback training (n=15). Upper-limb function was measured by Fugl-Meyer Assessment (FMA) and Manual Function Test (MFT), and activities of daily living were measured using the FIM instrument. Both FMA and MFT scores improved significantly more in the patients receiving EMG biofeedback. However, there was not a significant difference in FIM score improvement between groups.
In a case series, Pellegrino and colleagues tested the use of visual biofeedback in reducing postural control deficits on 11 chronic stroke survivors (Pellegrino, 2017). Each participant was assessed using the Berg Balance Scale, Trunk Impairment Scale, and the Nottingham Sensory Assessment Scale for trial inclusion. The test method involved seating each participant on a custom-built force platform and mapping their initial center of pressure positions. The trial had 4 phases: familiarization, training, and pre- and post-training tests. After familiarization and training, subjects were tested to observe if and to what extent they could transfer performance improvement obtained with visual feedback training to the conditions where they have to move (1) without visual feedback, (2) in different directions, and (3) respond to different displacement amplitudes. The study found that most stroke survivors were able to perform the required task and improve task performance during the training phase when provided visual feedback, however, without visual feedback, most showed no improvement on pre-training performance. The authors concluded that postural training based exclusively on continuous visual feedback provided limited benefits. The small sample size and design limit conclusions to be drawn from the study results.
Practice Guidelines and Position Statements
American Academy of Neurology
As of September 2019, the American Academy of Neurology has made no recommendations regarding the use of biofeedback for multiple sclerosis, Bell palsy, or orthostatic hypotension due to spinal cord injury.
Ambrosini and colleagues published an RCT on the effect of visual biofeedback on gait and walking ability in patients who have had a first-time stroke (Ambrosini, 2020). Patients were randomized to receive 20 minutes of visual biofeedback training and 70 minutes of usual rehabilitation care (n=34) or 90 minutes of usual rehabilitation care (n=34). Groups experienced similar improvements in gait speed, 6-minute walking test, Functional Independence Measure scores, and Berg Balance Test scores, with no significant differences between groups observed. Outcomes were reported at the end of 6 weeks of treatment; although follow-up was attempted at 6 months, over half of the patients were unavailable for follow-up assessments, so longer term effects of biofeedback training could not be assessed.
Ghanbari Ghoshchi and others published an RCT on the effects of technological rehabilitation (using audio or visual biofeedback) on activities of daily living and return to work among 48 patients who have had a stroke (Ghanbari Ghoshchi, 2020). All patients attended 3 rehabilitation sessions per day on 3 days per week for 1 month; each session was 40 minutes in length. Patients randomized to the technological rehabilitation group had 400 minutes of audio or visual biofeedback training included in their rehabilitation sessions. Ability to perform activities of daily living was measured using the modified Barthel Index. No significant between-group differences were observed 6 months after therapy was completed. Return to work may have been influenced by other factors, including patient age, economic status, and previous occupation.
Raynaud’s disease
A 2009 systematic review on complementary and alternative medicine in the treatment of Raynaud’s disease included an examination of the literature on biofeedback (Malenfant, 2009). The authors identified 5 trials, and these reported a variety of outcomes. A pooled analysis of findings from 4 trials (total n=110) on the change in frequency of attacks favored the sham control group over the biofeedback group (weighted mean difference: -1.21; 95% confidence interval [CI]: -1.68 to -0.73; p<0.00001). Several trials had more than 2 arms; in the preceding analysis, only the arms comparing active and sham biofeedback were included.
The trial that was given the highest quality rating by the authors of the systematic review and had the largest sample size was the Raynaud’s Treatment Study, published in 2000 (Raynaud’s Treatment Study Investigators, 2000). This was a randomized comparison of sustained release nifedipine and thermal biofeedback in 313 patients with primary Raynaud’s disease. In addition to these 2 treatment groups, there were 2 control treatments: pill placebo and EMG biofeedback. EMG biofeedback was chosen as a control because it did not address the physiologic mechanism of Raynaud’s disease. The mean attack rate at 1 year, the primary study outcome, was 0.16 in the thermal biofeedback group, 0.23 in the EMG biofeedback group, 0.07 in the nifedipine group, and 0.21 in the placebo group. Nifedipine significantly reduced Raynaud’s attacks compared with placebo (p<0.002), but thermal feedback did not differ significantly from EMG biofeedback (0 37). There was not a significant difference in attack rates in the nifedipine and thermal biofeedback groups for the primary outcome (p=0.08). However, several secondary outcomes including all attacks and verified attacks at 2 months significantly favored nifedipine over thermal biofeedback.
Multiple Sclerosis
A crossover study by van der Logt evaluated the effect of vibrotactile biofeedback for trunk sway on balance control in patients with multiple sclerosis (Logt, 2016). Ten patients performed a series of stance and gait tasks while trunk sway was measured using a SwayStar device attached to the waist. Patients underwent the series of tasks with and without an add-on to the SwayStar device, which provided patients with direction-specific vibrotactile feedback during the tasks. When patients performed the tasks with vibrotactile biofeedback, there was a general reduction in trunk sway, though not all the reductions differed significantly with trunk sway when performing the tasks without vibrotactile biofeedback. Studies with larger sample sizes are needed.
Sleep Bruxism
One small, randomized study (n=57) examined changes in sleep bruxism following treatment with a cognitive behavioral therapy program consisting of problem-solving, progressive muscle relaxation, nocturnal biofeedback, and training of recreation and enjoyment (Ommerborn, 2007). Similar improvements were observed for the occlusal splint group as for the multicomponent cognitive behavioral program. The effects of biofeedback were not isolated in this study and thus conclusions cannot be drawn about its effectiveness compared to occlusal splinting.
Sato and colleagues published a study on the use of EMG biofeedback training for daytime clenching and its effect on sleep bruxism (Sato, 2015). Patients were monitored for 5 hours of daytime and night time and were randomized to EMG biofeedback (n=7) or to a control group (n=5). Patients in the biofeedback group received a small auditory signal in the daytime when clenching activity was detected. There were significant decreases in EMG events during weeks 2 and 3 in the biofeedback group during the daytime, and the decreases in events carried over into the night time. There were no decreases in EMG events in the control group.
Jokubauskas and associates updated the systematic review by Wang on the management of sleep bruxism with biofeedback (Jokubauskas, 2018). Five databases were searched for literature published after the original 2012 search. Six relevant publications were included (total N=86 adults), and of these studies, 4 were RCTs and 2 were uncontrolled before-after studies. For the quantitative synthesis, 2 additional studies were included from the original Wang review. Contingent electrical stimulation, audio feedback, and a maxillary biofeedback splint were among the biofeedback techniques investigated, and all studies measured sleep bruxism with EMG with the exception of one, which used a mini wireless biofeedback device that analyzed bite force. The primary outcome of the analysis was the number of sleep bruxism episodes per hour detected by EMG recording. Secondary outcomes of sleep quality and pain-related outcomes were also investigated in the studies, and 1 study reported on patient-perceived symptom change. Overall, the quality of these studies was assessed as low to moderate due to imprecision and inconsistency between studies, and risk of bias was graded as high to moderate. Despite limitations of the studies, the use of biofeedback to treat sleep bruxism has shown some effectiveness and is relatively safe and noninvasive.
Anxiety Disorders
Chen and others published an RCT comparing diaphragmatic breathing relaxation (DBR) with routine respiration activities in the treatment of 46 patients with anxiety (Chen, 2016). DBR is a technique that uses diaphragm muscle contractions to force air downward into the body, increasing diaphragm length and breathing efficiency. Outcomes were anxiety level, measured by Beck Anxiety Inventory, and 4 physiological measures (skin conductivity, peripheral blood flow, heart rate, breathing rate). All patients participated in an individualized 8-week course in breathing relaxation, but only 30 completed it. Fifteen were randomized to DBR training and 15 to routine breathing relaxation training. Researchers and patients were blinded to randomization, with only the trainer being aware of group allocation. After 8 weeks, the DBR group experienced statistically significant decreases in Beck Anxiety Inventory scores compared with baseline, while the control group did not experience significant decreases from baseline. The DBR group also experienced significant improvements in all 4 physiological measurements, while the control group did not.
In 2017, the Canadian Agency for Drugs and Technology in Health published an update to their rapid response report on biofeedback for treating mood and anxiety disorders (Banerjee, 2017). This systematic review of the literature did not identify any health technology assessments, systematic reviews, meta-analyses, RCTs, or nonrandomized studies evaluating biofeedback for the treatment of generalized anxiety disorder.
Zhao and others conducted an RCT that assessed biofeedback in patients with rectal cancer and concurrent symptoms of anxiety (Zhao, 2025). Patients were randomized to receive either 16 sessions of electroencephalographic biofeedback over 8 weeks (n=75) or standard care (n=75). Anxiety symptoms were assessed at 8 weeks, 3 months, 6 months, and 12 months using the State-Trait Anxiety Inventory. At all time points post-randomization, both state anxiety (p less than .001) and trait anxiety (p less than .001) were lower in the biofeedback group than the control group. Quality of life (p less than .001) and sleep quality (p less than .001) were also significantly better in the biofeedback group compared to the standard care group at all time points.
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Ambrosini E, Peri E, Nava C, et al.(2020) A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med. Feb 2020; 56(1): 24-33. PMID 31556542
American Psychological Association (APA).(2025) APA CLINICAL PRACTICE GUIDELINE for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. February 2025. https://www.apa.org/ptsd-guideline. Accessed October 3, 2025. Bergmann A, Edelhoff D, Schubert O, et al.(2020) Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial. Clin Oral Investig. Nov 2020; 24(11): 4005-4018. PMID 32430774 Bradley L, Hart BB, Mandana S et al.(1998) Electromyographic biofeedback for gait training after stroke. Clin Rehabil 1998; 12(1):11-22. Cardoso JR, Teixeira EC, Moreira MD et al.(2008) Effects of exercises on Bell's palsy: systematic review of randomized controlled trials. Otol Neurotol 2008; 29(4):557-60. Chen YF, Huang XY, Chien CH, et al.(2016) The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspect Psychiatr Care. Aug 23 2016. PMID 27553981 Coben R, Myers TE.(2010) The relative efficacy of connectivity guided and symptom based EEG biofeedback for autistic disorders. Appl Psychophysiol Biofeedback 2010; 35(1):13-23. Geiger RA, Allen JB, O'Keefe J et al.(2001) Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Phys Ther 2001; 81(4):995-1005. Ghanbari Ghoshchi S, De Angelis S, Morone G, et al.(2020) Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation. Int J Environ Res Public Health. Jul 20 2020; 17(14). PMID 32698430 Ghomashchi H.(2016) Investigating the effects of visual biofeedback therapy on recovery of postural balance in stroke patients using a complexity measure. Top Stroke Rehabil. Jun 2016;23(3):178-183. PMID 27077976 Gillis DJ, Wouda M, Hjeltnes N.(2008) Non-pharmacological management of orthostatic hypotension after spinal cord injury: a critical review of the literature. Spinal Cord 2008; 46(10):652-9. Global Initiative for Asthma.(2021) Global Strategy for Asthma Management and Prevention. 2021; https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf Accessed September 28, 2021 Greenhalgh J, Dickson R, Dundar Y.(2010) Biofeedback for hypertension: a systematic review. J Hypertension 2010; 28(4):644-52. Henderson RJ, Hart MG, Lal SK et al.(1998) The effect of home training with direct blood pressure biofeedback of hypertensives: a placebo-controlled study. J Hypertens 1998; 16(6):771-8. Hunyor SN, Henderson RJ, Lal SK et al.(1997) Placebo-controlled biofeedback blood pressure effect in hypertensive humans. Hypertension 1997; 29(6):1225-31. Improving function after knee arthroplasty with weight-bearing biofeedback (RELOAD) (NCT001333189). Sponsored by the University of Colorado, Denver. Last updated April 8, 2011. Available online at www.clinicaltrials.gov. Last accessed June 2011. Jenkins S, Cross A, Osman H, et al.(2024) The psychological and physiological effects of integrated cognitive-behavioral and biofeedback therapy on panic disorder: A randomized controlled trial. J Hum Hypertens. Oct 2024; 38(10): 719-727. PMID 3913835 Jokubauskas L, Baltrusaityte A.(2018) Efficacy of biofeedback therapy on sleep bruxism: A systematic review and meta-analysis. J Oral Rehabil. Jun 2018;45(6):485-495. PMID 29577362 Jones DW, Ferdinand KC, Taler SJ, et al.(2025) AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for Prevention, Detection, Evaluation & Management of High Blood Pressure in Adults: Report of the ACC/AHA Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. Nov 04 2025; 86(18): 1567-1678. PMID 40815242 Jonsdottir J, Cattaneo D, Recalcati M et al.(2010) Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach. Neurorehab Neural Repair 2010; 24(5):478-85. Kenemore J, Benham G, Charak R, et al.(2024) Heart Rate Variability Biofeedback as a Treatment for Military PTSD: A Meta-Analysis. Mil Med. Aug 30 2024; 189(9-10): e1903-e1909. PMID 38287778 Kim JH.(2017) The effects of training using EMG biofeedback on stroke patients upper extremity functions. J Phys Ther Sci. Jun 2017;29(6):1085-1088. PMID 28626331 Kohlmeyer KM, Hill JP, Yarkony GM et al.(1996) Electrical stimulation and biofeedback effect on recovery of tenodesis grasp: a controlled study. Arch Phys Med Rehabil 1996; 77(7):702-6. Lehrer PM, Irvin CG, Lu SE, et al.(2018) Heart rate variability biofeedback does not substitute for asthma steroid controller medication. Appl Psychophysiol Biofeedback. Mar 2018;43(1):57-73. PMID 29124506 Ma CH, Chang HY, Lee HC, et al.(2023) The psychological and physiological effects of integrated cognitive-behavioral and biofeedback therapy on panic disorder: A randomized controlled trial. J Formos Med Assoc. Dec 2023; 122(12): 1305-1312. PMID 37453901 Mackay AM, Buckingham R, Schwartz RS, et al.(2015) The Effect of Biofeedback as a Psychological Intervention in Multiple Sclerosis: A Randomized Controlled Study. Int J MS Care. May-Jun 2015;17(3):101-108. PMID 26052255 Malenfant D, Catton M, Pope JE.(2009) The efficacy of complementary and alternative medicine in the treatment of Raynaud’s phenomenon: a literature reveiw and meta-analysis. Rheumatology 2009; 48(7):791-5. Maynart WHDC, Albuquerque MCDS, Santos RCS, et al.(2021) The use of biofeedback intervention in the improvement of depression levels: a randomised trial. Acta Neuropsychiatr. Jun 2021; 33(3): 126-133. PMID 33427129 Miri M, Tahami E, Veisi G.(2025) Assessing the effectiveness of EMG-biofeedback on an isometric strengthening program in individuals with multiple sclerosis. Mult Scler Relat Disord. Jan 2025; 93: 106193. PMID 39667127 Nakao M, Yano E, Nomura S et al.(2003) Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res 2003; 26(1):37-46. Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of the Clinical Evidence and Guidelines - An Update. Ottawa ON: 2014 Canadian Agency for Drugs and Technologies in Health.; 2014. Ommerborn MA, Schneider C, Giraki M et al.(2007) Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity. Eur J Oral Sci 2007; 115(1):7-14. Park SM, Jung HY.(2020) Respiratory sinus arrhythmia biofeedback alters heart rate variability and default mode network connectivity in major depressive disorder: A preliminary study. Int J Psychophysiol. Dec 2020; 158: 225-237. PMID 33148502 Pellegrino L, Giannoni P, Marinelli L, et al.(2017) Effects of continuous visual feedback during sitting balance training in chronic stroke survivors. J Neuroeng Rehabil. Oct 16 2017;14(1):107. PMID 29037206 Rayegani SM, Raeissadat SA, Sedighipour L, et al.(2014) Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients. Top Stroke Rehabil. Mar-Apr 2014;21(2):137-151. PMID 24710974 Raynaud's Treatment Study Investigators.(2000) Comparison of sustained-release nifedipine and temperature biofeedback for treatment of primary Raynaud phenomenon. Results from a randomized clinical trial with 1-year follow-up. Arch Intern Med 2000; 160(8):1101-8. Sato M, Iizuka T, Watanabe A, et al.(2015) Electromyogram biofeedback training for daytime clenching and its effect on sleep bruxism. J Oral Rehabil. Feb 2015;42(2):83-89. PMID 25256380 Siepmann M, Hennig UD, Siepmann T, et al.(2014) The effects of heart rate variability biofeedback in patients with preterm labour. Appl Psychophysiol Biofeedback. Mar 2014;39(1):27-35. PMID 24271650 Silkman C, McKeon J.(2010) The effectiveness of electromyographic biofeedback supplementation during knee rehabilitation after injury. J Sports Rehabil 2010; 19(3):343-51. Stanton R, Ada L, Dean CM, et al.(2017) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. J Physiother. Jan 2017;63(1):11-16. PMID 27989731 Taghizadeh N, Eslaminejad A, Raoufy MR.(2019) Protective effect of heart rate variability biofeedback on stress-induced lung function impairment in asthma. Respir Physiol Neurobiol, 2019 Jan 30;262:49-56. PMID 30695733 U.S. Department of Veterans Affairs.(2024) VA/DoD Clinical Practice Guidelines for the management of stroke rehabilitation. 2024; https://www.healthquality.va.gov/guidelines/Rehab/stroke/VADOD-2024-Stroke-Rehab-CPG-Full-CPG_final_508.pdf Accessed September 26, 2024. van der Logt RP, Findling O, Rust H, et al.(2016) The effect of vibrotactile biofeedback of trunk sway on balance control in multiple sclerosis. Mult Scler Relat Disord. Jul 2016;8:58-63. PMID 27456875 Wahbeh H, Senders A, Neuendorf R, et al.(2014) Complementary and Alternative Medicine for Posttraumatic Stress Disorder Symptoms: A Systematic Review. J Evid Based Complementary Altern Med. Mar 27 2014;19(3):161-175. PMID 24676593 Wang MY, Chang NC, Hsieh MH, et al.(2016) Effect of feedback signal on blood pressure self-regulation capability in individuals with prehypertension or stage I hypertension: a randomized controlled study. J Cardiovasc Nurs. Mar- Apr 2016;31(2):166-172. PMID 25774838 Weise C, Heinecke K, Rief W.(2008) Biofeedback-based behavioral treatment for chronic tinnitus: results of a randomized controlled trial. J Consult Clin Psychol 2008; 76(6):1046-57. Whelton PK, Carey RM, Aronow WS et al.(2018) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.. Circulation, 2018 Oct 26;138(17). PMID 30354655 Winstein CJ, Stein J, Arena R, et al.(2016) Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. Jun 2016; 47(6): e98-e169. PMID 27145936 Wong AM, Lee MY, Kuo JK et al.(1997) The development and clinical evaluation of a standing biofeedback trainer. J Rehabil Res Dev 1997; 34(3):322-7. Woodford H, Price C.(2007) EMG biofeedback for the recovery of motor function after stroke. Cochrane Database Syst Rev 2007; (2):CD004585. Xie YJ, Wang S, Gong QJ, et al.(2021) Effects of electromyography biofeedback for patients after knee surgery: A systematic review and meta-analysis. J Biomech. May 07 2021; 120: 110386. PMID 33794414 Yang DJ.(2016) Influence of biofeedback weight bearing training in sit to stand to sit and the limits of stability on stroke patients. J Phys Ther Sci. Nov 2016;28(11):3011-3014. PMID 27942111 Yorke J, Fleming S, Shuldham C, et al.(2015) Nonpharmacological interventions aimed at modifying health and behavioural outcomes for adults with asthma: a critical review. Clin Exp Allergy. Dec 2015;45(12):1750-1764. PMID 25675860 Zhao E, Li Z, Zhang J, et al.(2025) The Effect of Electroencephalographic Biofeedback Therapy on Anxiety and Overall Well-being in Patients with Rectal Cancer. Appl Psychophysiol Biofeedback. Sep 2025; 50(3): 395-402. PMID 40072794 Zijlstra A, Mancini M, Chiari L et al.(2010) Biofeedback for training balance and mobilitity tasks in older adults: a systematic review. J Neuroeng Rehabil 2010; 7:58. |
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