The effectiveness of biofeedback for improving pain, disability and work ability in adults with neck pain: A systematic review and meta-analysis

Background: Biofeedback is used to optimise muscle activation patterns in people with neck pain. Objectives: To evaluate the safety and efficacy of electromyographic and pressure biofeedback on pain, 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 randomised controlled trials (RCTs) evaluating biofeedback (against any comparison) for adults with neck pain. Outcomes included pain, 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 or work ability. More trials reporting adverse events and comparing biofeedback to placebo are needed.