Biofeedback therapy in poststroke rehabilitation: a meta-analysis of the randomized controlled trials.

OBJECTIVE To assess the efficacy of biofeedback therapy in poststroke rehabilitation. DESIGN A meta-analysis of the reported randomized control trials of biofeedback therapy in poststroke rehabilitation was performed. Data were analyzed using the effect size method and pooled using the Der Simonian-Laird Random Effects Model. Study quality was assessed according to the method of Chalmers. SETTING All included studies were conducted in academically based rehabilitation settings. PATIENTS Patients were in the rehabilitative phase of their illness. The timing of the intervention from the acute event did vary greatly between and within studies. INTERVENTION Biofeedback therapy was applied to a paretic limb of patients in the study group. Both treatment and control groups received standard physical therapy. MAIN OUTCOME MEASURE Change in range of motion of a joint of a paretic limb as a result of treatment was examined. This measure was chosen after the eligible studies were evaluated for combinable end points. RESULTS A total of eight studies were included in the analysis. The mean effect size for change in lower extremity range of motion as a result of biofeedback therapy was 1.50 (95% confidence interval [CI]: -0.59, 3.59). For the upper extremity the effect size was 2.30 (95% CI: -1.06, 5.66). Both results were not significant at the p < .05 level. Statistical tests showed significant heterogeneity among studies, validating the use of the Random Effects Model. CONCLUSION Results of pooling available randomized control trials do not support the efficacy of biofeedback in restoring the range of motion of hemiparetic joints. Nevertheless, because the calculated mean effect sizes were large, with associated wide confidence intervals, the possibility of a type II error masking an important clinical benefit needs to be considered in evaluating this result.