Stroke: biofeedback therapy had no clear effect

Clinical bottom line (level 1b-)

  1. Patients who had a stroke and required rehabilitation who were given biofeedback therapy, had no clear difference in change in range of motion than those not given it.
Glanz et al: Archives of Physical Medicine and Rehabilitation 1995; 76: 508-515
Expires November 2002

The study

Systematic review of randomised controlled trials of
  • Patients: stroke
  • Intervention: biofeedback therapy compared with no biofeedback therapy
  • Outcome: change in range of motion of a joint of a paretic limb


    • Articles found in ? using MEDLINE, ? (search terms: cerebrovascular disease and rehabilitation, hemiplegia and rehabilitation ) and Review articles, articles suggested by experts in the field and studies extracted from the bibliographies of these articles.

    Selection criteria: as above and the availability of extractable data
    Appraisal criteria: detailed in text
    Articles excluded if: dissimilar end points

    Eight studies were included (five of lower-extremity range of motion and three of upper-extremity range of motion).
    • Unpublished data was not included.
    Significant heterogeneity was found.

    The evidence

    • The effect size of the pooled change in range of movement for lower-extremity paresis (biofeedback versus no biofeedback) is 1.50 (95% CI -0.59 to 3.59).
    • The effect size of the pooled change in range of movement for upper-extremity paresis (biofeedback versus no biofeedback) is 2.30 (95% CI -1.06 to 5.66).

    Comments

    1. The use fo different continuous outcome measures for assessment make overall estimation of benefits or harms very difficuly.
    2. Quality of the studies included was low due inadequate description of the randomisation process, absent or undocumented blinding of both patients, providers and observers to the actual treatment received.

    Citation

    1. Glanz M, Klawanskey S, Stason W, et al: Biofeedback therapy in poststroke rehabilitation: A meta-analysis of the randomized controlled trials. Archives of Physical Medicine and Rehabilitation 1995; 76: 508-515
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure biofeedback therapy
    Comparison no biofeedback therapy
    Outcome change in range of motion of a joint of paretic limb