Biofeedback Utilization in Clinical Treatments

In a technologically advancing world, the use of technology is increasingly apparent in the field of medicine. Biofeedback is a self-regulation method for patients to learn mind-body techniques that contribute to their health. The goal of biofeedback methods is to turn voluntary control into involuntary body processes. (1) Since biofeedback incorporates real-time data, patients get feedback instantly and improve how they regulate their physiology. Using biofeedback is uniquely beneficial because it is non-invasive, safe, and cost-effective. (2,3) It is shown to be a promising tool in managing many clinical diseases including headaches, anxiety, and asthma. (5,7,12)

Of those suffering from migraines, 18% of women and 6% of men go undiagnosed and untreated. (4) There is strong evidence suggesting biofeedback therapy methods, such as thermal biofeedback and electromyographic biofeedback, are effective for treating migraines. In a study testing the efficacy of different types of biofeedback, 37 migraine patients underwent 40 neurofeedback sessions combined with thermal biofeedback. 26 out of the 37 patients, experienced at least a 50% reduction in the frequency of their headaches which was managed for 14.5 months on average after treatment. During pre-treatment, the average frequency of migraines per month was 7.6; post-treatment the average dropped to 2.9 migraines per month. (5) Another study tested 61 migraine patients to see the effects of biofeedback therapy in combination with pharmacologic therapy. The results showed that a combination of pharmacologic and biofeedback treatment was more effective than pharmacologic therapy alone in managing migraines. (6)

Biofeedback is also widely used to treat anxiety. It has the ability to train patients to regulate their emotions when elicited by negative stimuli. The autonomic nervous system becomes activated when a patient experiences stress or anxiety. The heart rate is most sensitive during the activation of the autonomic nervous system, and restoring a normal, stable heart rate is a crucial part of alleviating anxiety. (8) Studies have tested heart rate variability (HRV) biofeedback for effectiveness in lowering anxiety. A group of 40 graduate students under the age of 35, who scored an upper 40% of trait anxiety, were studied for the effectiveness of biofeedback. With 4 sessions of HRV biofeedback and relaxation training, there was a significantly reduced trait anxiety compared to the control group. The biofeedback group had a post-treatment trait anxiety score of 39.40 compared to the control group score of 49.80. (7) This was a significant change showing the advantages HRV biofeedback therapy over the methods in clinical guidelines. Another study tested patients undergoing coronary angiography. Preoperative anxiety has been identified as a cardiovascular risk factor when undergoing cardiac surgery. (9) A study report of 212 patients undergoing coronary angioplasty was split into two groups. One group was offered psychological support with respiratory-sinus-arrhythmia biofeedback training before the procedure. Compared to the second (control) group, the psychological support and biofeedback group was shown to have lower state anxiety after the coronary angiography and had significantly lower blood pressure. (10) These studies show the clear physiological and psychological benefits of biofeedback therapy utilization in clinical treatments.  

Another effective use of biofeedback is in asthma patients. A common problem among patients using inhalers is the misuse and lack of education in administering them. (11) Out of $25 billion spent on inhalers, $5-7 billion is wasted due to misuse. (11) A 2019 study tested the impact of biofeedback intervention compared to usual consultation with the use of a digital inhaler device. Out of 152 participants (72 in the biofeedback group, 56 in the demonstration group and 22 in the control group), the biofeedback group had 14% higher adherence than the demonstration group and 31% higher than the control group over the course of 6 months. The biofeedback group had significantly improved respiratory symptoms. (12) This study shows that using biofeedback in clinical tasks like treating asthma has the opportunity to not only improve physical wellbeing but also to improve patient education and reduce unnecessary healthcare spending.

With more studies examining the efficacy of biofeedback therapy, this method of therapy is increasingly becoming a useful clinical tool. Biofeedback therapy is shown to improve healthcare adherence through training patients to manage their symptoms. (1,12) At Esurgi, we are creating an automated pressure biofeedback unit, the Biostabilizer, that provides real-time feedback while users perform rehabilitation exercises. The Biostabilizer targets spinal stabilization and lower back pain. Physical therapists are provided with information on a patient’s exercise instantly, reducing the amount of time spent on ineffective exercises and increasing the impact of effective exercises. The Biostabilizer provides a graphical representation of a patient’s session and audible alerts to indicate an exercise carrying forces outside the suitable range, increasing the safety of performing exercises.

How could using biofeedback enhance your practice? 

Citations:

1. Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback in medicine: who, when, why and how?. Mental health in family medicine, 7(2), 85–91.
2. “Biofeedback.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Feb. 2019, www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664. 
3. Haines, T., & Bowles, K. A. (2017). Cost-effectiveness of using a motion-sensor biofeedback treatment approach for the management of sub-acute or chronic low back pain: economic evaluation alongside a randomised trial. BMC musculoskeletal disorders, 18(1), 18. https://doi.org/10.1186/s12891-016-1371-6
4. Silberstein, S. D. “Practice Parameter: Evidence-Based Guidelines for Migraine Headache (an Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology.” Neurology, vol. 55, no. 6, 2000, pp. 754–762., doi:10.1212/wnl.55.6.754. 
5. Stokes, D. A., & Lappin, M. S. (2010). Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study. Behavioral and brain functions : BBF, 6, 9. https://doi.org/10.1186/1744-9081-6-9
6. Grazzi, L., Andrasik, F., D’Amico, D., Leone, M., Usai, S., Kass, S. J., & Bussone, G. (2002). Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Headache, 42(6), 483–490. https://doi.org/10.1046/j.1526-4610.2002.02123.x
7. Lee, J., Kim, J. K., & Wachholtz, A. (2015). The benefit of heart rate variability biofeedback and relaxation training in reducing trait anxiety. Han’guk Simni Hakhoe chi. Kon’gang = The Korean journal of health psychology, 20(2), 391–408. https://doi.org/10.17315/kjhp.2015.20.2.002
8. Peira, N., Pourtois, G., & Fredrikson, M. (2013). Learned cardiac control with heart rate biofeedback transfers to emotional reactions. PloS one, 8(7), e70004. https://doi.org/10.1371/journal.pone.0070
9. Kumar, A., Dubey, P. K., & Ranjan, A. (2019). Assessment of Anxiety in Surgical Patients: An Observational Study. Anesthesia, essays and researches, 13(3), 503–508. https://doi.org/10.4103/aer.AER_59_19
10. Mikosch, P., Hadrawa, T., Laubreiter, K., Brandl, J., Pilz, J., Stettner, H., & Grimm, G. (2010). Effectiveness of respiratory-sinus-arrhythmia biofeedback on state-anxiety in patients undergoing coronary angiography. Journal of advanced nursing, 66(5), 1101–1110. https://doi.org/10.1111/j.1365-2648.2010.05277.x
11. Fink , James B, and Bruce K Rubin. Problems With Inhaler Use: A Call for Improved Clinician and Patient Education. Respiratory Care , Sept. 2005, rc.rcjournal.com/content/respcare/50/10/1360.full.pdf. 
12. O’Dwyer, Susan, et al. “Personalized Biofeedback on Inhaler Adherence and Technique by Community Pharmacists: A Cluster Randomized Clinical Trial.” The Journal of Allergy and Clinical Immunology: In Practice, Elsevier, 27 Sept. 2019, www.sciencedirect.com/science/article/abs/pii/S221321981930786X?via=ihub.