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

Musculoskeletal disorders (MSD) are a frequent reason for consultation and the main cause of disability in population. Electromyographic biofeedback or myofeedback (MF) is a promising treatment in rehabilitation, although studies supporting its benefits in MSD have declined in recent years. The objective of this review was to describe the efficacy of MF in function recovery, strength increase and muscle relaxation in MSD. Randomized clinical trials (RCTs) were identified in Pubmed, Scopus, Web of Science, Cinahl and Science Direct databases dated September 2, 2021. Four independent researchers reviewed articles titles and abstracts to determine their eligibility. Risk of bias and articles quality was assessed using Rob2 tool (Cochrane) and PEDro scale. Functionality improvement, strength increase, and muscle relaxation were considered as main outcome. Search strategy yielded 160 articles after eliminating duplicates, reducing to 26 when selection criteria were applied. Articles were classified in strengthening (n = 16) and muscle relaxation (n = 10) according to MF therapeutic aim. Eighteen articles were rated as low risk of bias (69.22%) and an average internal validity of 6 points was obtained. Studies showed improvements in functionality, strength increase and pain reduction with statistical significance when MF were complemented with therapeutic exercises or other physical agents modalities (p < 0.005). MF also showed a decrease in fear of movement, depression, and pain perception, suggesting central modulating effects. This review supports MF efficacy in MSD rehabilitation, showing improvements in functionality and pain reduction. The review allowed to establish a dosage recommendation based on articles analysis which can be considered for future RCTs.