Acute Lower Back Problems in Adults - Biofeedback

Biofeedback

Panel findings and recommendations:

• Biofeedback is not recommended for treatment of patients with acute low back problems. (Strength of Evidence = C.)

Biofeedback involves translating the physiologic activity of a patient's muscular response into a visual or auditory signal that allows the patient to try to facilitate or inhibit the muscular activity. The therapeutic objective is to reduce muscle tension and thereby reduce pain. Biofeedback has been advocated primarily for patients with chronic low back problems.

Literature Reviewed.

Of 13 articles screened for this topic, 4 reporting on 5 RCTs met criteria for review. [177] <http://text.nlm.nih.gov>– [180] <http://text.nlm.nih.gov> Other studies did not meet panel review criteria because they had fewer than 10 subjects per treatment group, but were used in a meta–analysis. [181] <http://text.nlm.nih.gov>, [182] <http://text.nlm.nih.gov> All of the studies involved patients with chronic low back pain. In most subjects, pain had persisted for several years.

Evidence on Efficacy.

Because these trials presented conflicting results, a meta–analysis was begun by the panel methodologists. Studies were assessed for quality without knowledge of the results. There were no excellent studies, one good study, [178] <http://text.nlm.nih.gov> three fair studies, [177] <http://text.nlm.nih.gov>, [180] <http://text.nlm.nih.gov>, [182] <http://text.nlm.nih.gov> and a fair study reported by Flor, Haag, Turk, et al. [179] <http://text.nlm.nih.gov> and by Flor, Haag, and Turk. [181] <http://text.nlm.nih.gov> There were no poor studies.

The studies involved comparisons of biofeedback with sham biofeedback; [178] <http://text.nlm.nih.gov>, [179] <http://text.nlm.nih.gov>, [181] <http://text.nlm.nih.gov> biofeedback combined with another treatment in comparison with the other treatment alone; [177] <http://text.nlm.nih.gov> and biofeedback alone compared with some other treatment. [179] <http://text.nlm.nih.gov>, [181] <http://text.nlm.nih.gov>, [182] <http://text.nlm.nih.gov>

The study with a good quality rating showed no benefit for biofeedback over sham biofeedback. [178] <http://text.nlm.nih.gov> Two studies reported patients in the biofeedback groups developed significantly better control of paraspinous muscle electromyographic activity. [178] <http://text.nlm.nih.gov>, [180] <http://text.nlm.nih.gov> In neither study did this reduce pain. Thus, of the five studies, two showed no benefit for biofeedback. [178] <http://text.nlm.nih.gov>, [180] <http://text.nlm.nih.gov> Two showed a benefit for biofeedback: Asfour, Khalil, Waly, et al. [177] <http://text.nlm.nih.gov> and the study reported by Flor, Haag, Turk, et al., [179] <http://text.nlm.nih.gov> and by Flor, Haag, and Turk. [181] <http://text.nlm.nih.gov> One study showed a slight benefit for biofeedback compared with a placebo condition, but reported an even better benefit for relaxation training. [182] <http://text.nlm.nih.gov> Statistical combination of results from these studies was not done because it would require requesting the original data from the authors.

Conclusions from the attempted meta–analysis were that biofeedback as a treatment for low back problems has been studied only for chronic problems, and that most of the studies are of mediocre quality and arrive at conflicting results.

Potential Harms and Costs.

The risks for biofeedback are considered low. The costs of biofeedback treatment are determined by the number of treatment visits.

Summary of Findings.

There is conflicting evidence on the effectiveness of biofeedback for treating patients with chronic low back problems. However, this technique has not been studied in patients with acute low back problems.



Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.