[Impact of biofeedback therapy on patients with fecal incontinence or constipation in a gastrointestinal neurophysiology unit in Bogotá, D.C.] / Impacto de la terapia de biorretroalimentación en pacientes con incontinencia fecal o constipación en una unidad de neurofisiología gastrointestinal en Bogotá, D.C.

INTRODUCTION: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. OBJECTIVE: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. MATERIALS AND METHODS: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometricfindings before and after 10 biofeedback sessions. RESULTS: 21 patients were included(71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence.Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapysignificantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. CONCLUSIONS: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipationand fecal incontinence; in our center, the response is similar to that of the world literature.

Electromyographic biofeedback training in a cerebral palsy patient undergoing pronator teres rerouting and brachioradialis to extensor carpi radialis brevis tendon transfer surgery: A case report.

Several surgical procedures are used to treat dynamic pronation position of the forearm and flexion deformity of the wrist in cerebral palsy. Postoperative results of pronator teres rerouting were explored, while specially designed postoperative physiotherapy and its outcomes were limited. Herein, we present a case in whom the outcomes of electromyographic biofeedback (EMG-BF) training were assessed after pronator teres rerouting and brachioradialis tendon to extensor carpi radialis brevis tendon transfer combined with derotation osteotomy. The peak value increased, while the resting value decreased for the muscles after the intervention. Range of motion, hand function, manual ability, functional independence, and quality of life levels were improved. In conclusion, EMG biofeedback training may have a positive effect on neuromuscular control of pronator teres and brachioradialis. Free use of the upper extremity and improved manual ability positively affect the activity and quality of life of the patients.

Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study.

BACKGROUND: Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach. OBJECTIVE: The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being. METHODS: To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV. RESULTS: In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant. CONCLUSIONS: In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.

Visual feedback improves propulsive force generation during treadmill walking in people with Parkinson disease.

Persons with Parkinson's disease experience gait alterations, such as reduced step length. Gait dysfunction is a significant research priority as the current treatments targeting gait impairment are limited. This study aimed to investigate the effects of visual biofeedback on propulsive force during treadmill walking in persons with Parkinson's. Sixteen ambulatory persons with Parkinson's participated in the study. They received real-time biofeedback of anterior ground reaction force during treadmill walking at a constant speed. Peak propulsive force values were measured and normalized to body weight. Spatiotemporal parameters were also assessed, including stride length and double support percent. Persons with Parkinson's significantly increased peak propulsive force during biofeedback compared to baseline (p <.0001, Cohen's dz = 1.69). Variability in peak anterior ground reaction force decreased across repeated trials (p <.0001, dz = 1.51). While spatiotemporal parameters did not show significant changes individually, stride length and double support percent improved marginally during biofeedback trials. Persons with Parkinson's can increase propulsive force with visual biofeedback, suggesting the presence of a propulsive reserve. Though stride length did not significantly change, clinically meaningful improvements were observed. Targeting push-off force through visual biofeedback may offer a potential rehabilitation technique to enhance gait performance in Persons with Parkinson's. Future studies could explore the long-term efficacy of this intervention and investigate additional strategies to improve gait in Parkinson's disease.

Pelvic floor muscle contraction automatic evaluation algorithm for pelvic floor muscle training biofeedback using self-performed ultrasound.

INTRODUCTION: Non-invasive biofeedback of pelvic floor muscle training (PFMT) is required for continuous training in home care. Therefore, we considered self-performed ultrasound (US) in adult women with a handheld US device applied to the bladder. However, US images are difficult to read and require assistance when using US at home. In this study, we aimed to develop an algorithm for the automatic evaluation of pelvic floor muscle (PFM) contraction using self-performed bladder US videos to verify whether it is possible to automatically determine PFM contraction from US videos. METHODS: Women aged ≥ 20 years were recruited from the outpatient Urology and Gynecology departments of a general hospital or through snowball sampling. The researcher supported the participants in their self-performed bladder US and videos were obtained several times during PFMT. The US videos obtained were used to develop an automatic evaluation algorithm. Supervised machine learning was then performed using expert PFM contraction classifications as ground truth data. Time-series features were generated from the x- and y-coordinate values of the bladder area including the bladder base. The final model was evaluated for accuracy, area under the curve (AUC), recall, precision, and F1. The contribution of each feature variable to the classification ability of the model was estimated. RESULTS: The 1144 videos obtained from 56 participants were analyzed. We split the data into training and test sets with 7894 time series features. A light gradient boosting machine model (Light GBM) was selected, and the final model resulted in an accuracy of 0.73, AUC = 0.91, recall = 0.66, precision = 0.73, and F1 = 0.73. Movement of the y-coordinate of the bladder base was shown as the most important. CONCLUSION: This study showed that automated classification of PFM contraction from self-performed US videos is possible with high accuracy.

A Preliminary Study of Voluntary Cough Motor Performance and Learning With Skill Training and Biofeedback.

PURPOSE: Sensorimotor cough skill training (CST) has been shown to improve cough strength, as well as facilitate changes during training (i.e., motor performance) and generalization to untrained tasks (i.e., motor learning). However, there is a gap in our understanding of the effects of voluntary CST (without sensory stimuli) on motor performance and learning. Furthermore, the contribution of physiologic factors, such as lung volume, a driver of cough strength in healthy adults, and treatment-specific factors, such as biofeedback, remains unexamined. METHOD: Twenty individuals with Parkinson's disease (PD) completed pre- and post-CST single voluntary, sequential voluntary, and reflex cough testing. Participants were randomized to biofeedback or no biofeedback groups. They completed one CST session involving 25 trials of voluntary coughs, with the treatment target set 25% above baseline peak flow. Participants were instructed to "cough hard" to exceed the target. In the biofeedback group, participants received direct visualization of the target line in real time. RESULTS: Cough peak flow showed positive improvements in motor performance (ß = .02; 95% credible interval [CI]: 0.01, 0.03) and learning (ß = .26; 95% CI: 0.03, 0.47). Changes in lung volume from pre- to post-CST did not predict treatment response. No differences in treatment response were detected between the biofeedback groups. CONCLUSIONS: A single session of voluntary CST improved voluntary cough motor performance and learning. Although lung volume increased during CST, changes to lung volume did not predict treatment response. These findings demonstrate the potential of voluntary CST to improve motor performance and motor learning among individuals with PD and cough dysfunction. SUPPLEMENTAL MATERIAL AND OPEN SCIENCE FORM: https://doi.org/10.23641/asha.25447444.

A Biofeedback Based Virtual Reality Game for Pediatric Population (BioVirtualPed): A Feasibility Trial.

OBJECTIVE: This trial aims to assess the acceptability, feasibility, and safety of BioVirtualPed, a biofeedback-based virtual reality (VR) game designed to reduce pain, anxiety, and fear in children undergoing medical procedures. METHODS: An Oculus Quest 2 headset was used in the VR experience, respiratory data was captured using an ADXL354 accelerometer, and these data were integrated into the game with ArdunioUno software. The sample of this study consisted of 15 pediatric oncology patients aged 6 to 12 years between July and August 2023. BioVirtualPed's acceptability, feasibility, and safety were evaluated through child and expert feedback, alongside metrics including the System Usability Scale, Wong-Baker Pain Rating Scale, Child Fear Scale, Child Anxiety Scale-Status, Satisfaction Scoring, and various feasibility and safety parameters. RESULTS: Regarding the acceptability, the expert evaluation showed a mean score of 122.5 ± 3.53, indicating high usability for the system. All children provided positive feedback, and both children and their mothers reported high satisfaction with using BioVirtualPed. The BioVirtualPed was feasible for reducing children's pain, fear, and anxiety levels. All the children complied with the game, and no one withdrew from the trial. BioVirtualPed did not cause symptoms of dizziness, vomiting, or nausea in children and was found to be safe for children. CONCLUSION: The findings showed that BioVirtualPed meets the following criteria: feasibility, user satisfaction, acceptability, and safety. It is a valuable tool to improve children's experience undergoing port catheter needle insertion procedures. IMPLICATION FOR NURSING PRACTICE: Integration of VR interventions with BioVirtualPed into routine nursing care practices has the potential to effectively manage the pain, anxiety, and fear experienced by children undergoing medical procedures. The safety, feasibility, and acceptability results are promising for further research and integration into pediatric healthcare practice.

Heart rate and breathing effects on attention and memory (HeartBEAM): study protocol for a randomized controlled trial in older adults.

BACKGROUND: In healthy people, the "fight-or-flight" sympathetic system is counterbalanced by the "rest-and-digest" parasympathetic system. As we grow older, the parasympathetic system declines as the sympathetic system becomes hyperactive. In our prior heart rate variability biofeedback and emotion regulation (HRV-ER) clinical trial, we found that increasing parasympathetic activity through daily practice of slow-paced breathing significantly decreased plasma amyloid-ß (Aß) in healthy younger and older adults. In healthy adults, higher plasma Aß is associated with greater risk of Alzheimer's disease (AD). Our primary goal of this trial is to reproduce and extend our initial findings regarding effects of slow-paced breathing on Aß. Our secondary objectives are to examine the effects of daily slow-paced breathing on brain structure and the rate of learning. METHODS: Adults aged 50-70 have been randomized to practice one of two breathing protocols twice daily for 9 weeks: (1) "slow-paced breathing condition" involving daily cognitive training followed by slow-paced breathing designed to maximize heart rate oscillations or (2) "random-paced breathing condition" involving daily cognitive training followed by random-paced breathing to avoid increasing heart rate oscillations. The primary outcomes are plasma Aß40 and Aß42 levels and plasma Aß42/40 ratio. The secondary outcomes are brain perivascular space volume, hippocampal volume, and learning rates measured by cognitive training performance. Other pre-registered outcomes include plasma pTau-181/tTau ratio and urine Aß42. Recruitment began in January 2023. Interventions are ongoing and will be completed by the end of 2023. DISCUSSION: Our HRV-ER trial was groundbreaking in demonstrating that a behavioral intervention can reduce plasma Aß levels relative to a randomized control group. We aim to reproduce these findings while testing effects on brain clearance pathways and cognition. TRIAL REGISTRATION: ClinicalTrials.gov NCT05602220. Registered on January 12, 2023.

Biobehavioral treatments of migraine.

Pharmacotherapies are the mainstays of migraine management, though it is not uncommon for them to be poorly tolerated, contraindicated, or only modestly effective. There is a clear need for nonpharmacologic migraine therapies, either employed alone or in combination with pharmacotherapies. Behavioral and psychosocial factors known to contribute to the onset, exacerbation, and persistence of primary headache disorders (e.g., stress, sleep, diet) serve as targets within a self-management model for migraine-a model that features headache pharmacotherapies, behavioral skills training, medication adherence facilitation, relevant lifestyle changes, and techniques to limit headache-related impairment. Behavioral self-management interventions for migraine with the strongest empirical validation (e.g., relaxation training, biofeedback training, cognitive-behavior therapies) presently are available in specialty headache treatment centers and routinely show promise for reducing headache pain frequency/severity and related impairment, reducing reliance on pharmacotherapies, enhancing personal control over headache activity, and reducing headache-related distress and symptoms. These approaches may be particularly well-suited among patients for whom pharmacotherapies are unwanted, poorly tolerated, or contraindicated. Though underutilized, clinical trials indicate that new and well-established behavioral therapies are similarly effective to migraine medications for migraine prevention among adults and can be successfully employed in various settings.

Effectiveness of a Biofeedback Intervention Targeting Mental and Physical Health Among College Students Through Speech and Physiology as Biomarkers Using Machine Learning: A Randomized Controlled Trial.

Biofeedback therapy is mainly based on the analysis of physiological features to improve an individual's affective state. There are insufficient objective indicators to assess symptom improvement after biofeedback. In addition to psychological and physiological features, speech features can precisely convey information about emotions. The use of speech features can improve the objectivity of psychiatric assessments. Therefore, biofeedback based on subjective symptom scales, objective speech, and physiological features to evaluate efficacy provides a new approach for early screening and treatment of emotional problems in college students. A 4-week, randomized, controlled, parallel biofeedback therapy study was conducted with college students with symptoms of anxiety or depression. Speech samples, physiological samples, and clinical symptoms were collected at baseline and at the end of treatment, and the extracted speech features and physiological features were used for between-group comparisons and correlation analyses between the biofeedback and wait-list groups. Based on the speech features with differences between the biofeedback intervention and wait-list groups, an artificial neural network was used to predict the therapeutic effect and response after biofeedback therapy. Through biofeedback therapy, improvements in depression (p = 0.001), anxiety (p = 0.001), insomnia (p = 0.013), and stress (p = 0.004) severity were observed in college-going students (n = 52). The speech and physiological features in the biofeedback group also changed significantly compared to the waitlist group (n = 52) and were related to the change in symptoms. The energy parameters and Mel-Frequency Cepstral Coefficients (MFCC) of speech features can predict whether biofeedback intervention effectively improves anxiety and insomnia symptoms and treatment response. The accuracy of the classification model built using the artificial neural network (ANN) for treatment response and non-response was approximately 60%. The results of this study provide valuable information about biofeedback in improving the mental health of college-going students. The study identified speech features, such as the energy parameters, and MFCC as more accurate and objective indicators for tracking biofeedback therapy response and predicting efficacy. Trial Registration ClinicalTrials.gov ChiCTR2100045542.

Rhesus monkeys learn to control a directional-key inspired brain machine interface via bio-feedback.

Brain machine interfaces (BMI) connect brains directly to the outside world, bypassing natural neural systems and actuators. Neuronal-activity-to-motion transformation algorithms allow applications such as control of prosthetics or computer cursors. These algorithms lie within a spectrum between bio-mimetic control and bio-feedback control. The bio-mimetic approach relies on increasingly complex algorithms to decode neural activity by mimicking the natural neural system and actuator relationship while focusing on machine learning: the supervised fitting of decoder parameters. On the other hand, the bio-feedback approach uses simple algorithms and relies primarily on user learning, which may take some time, but can facilitate control of novel, non-biological appendages. An increasing amount of work has focused on the arguably more successful bio-mimetic approach. However, as chronic recordings have become more accessible and utilization of novel appendages such as computer cursors have become more universal, users can more easily spend time learning in a bio-feedback control paradigm. We believe a simple approach which leverages user learning and few assumptions will provide users with good control ability. To test the feasibility of this idea, we implemented a simple firing-rate-to-motion correspondence rule, assigned groups of neurons to virtual "directional keys" for control of a 2D cursor. Though not strictly required, to facilitate initial control, we selected neurons with similar preferred directions for each group. The groups of neurons were kept the same across multiple recording sessions to allow learning. Two Rhesus monkeys used this BMI to perform a center-out cursor movement task. After about a week of training, monkeys performed the task better and neuronal signal patterns changed on a group basis, indicating learning. While our experiments did not compare this bio-feedback BMI to bio-mimetic BMIs, the results demonstrate the feasibility of our control paradigm and paves the way for further research in multi-dimensional bio-feedback BMIs.

A Comparison Between Pre-Sleep Heart Rate Variability Biofeedback and Electroencephalographic Biofeedback Training on Sleep in National Level Athletes with Sleep Disturbances.

The current study compared the effects of heart rate variability biofeedback (HRV-BF) and electroencephalographic biofeedback (EEG-BF) on sleep, mood, and reaction time. Fourteen highly trained male athletes with sleep disturbances participated in this randomised crossover study. Participants took part in HRV-BF and EEG-BF training, with each condition consisting of eight sessions over 15 days. Polysomnography (PSG) and the Pittsburgh sleep quality index (PSQI) were used to assess sleep quality, the profile of mood states (POMS) questionnaire to monitor mood, and reaction time to measure performance pre and post intervention. HRV-BF training improved PSG sleep efficiency (SE) (P = 0.022, d = 0.35, 95% CI 0.01 to 0.16) and subjective sleep duration (P = 0.011, ES = 0.40) when compared to EEG-BF. Only HRV-BF reduced reaction time pre to post biofeedback training (P = 0.020, d = 0.75, 95% CI 0.006 to 0.059). The PSQI showed that both HRV-BF (P = 0.025, ES = 0.31) and EEG-BF (P = 0.003, ES = 0.32) resulted in improved global PSQI scores. Total mood disturbance was also reduced though HRV-BF (P = 0.001, ES = 0.40) and EEG-BF (P = 0.001, ES = 0.30). HRV-BF and EEG-BF enhanced some subjective parameters of sleep and mood. HRV-BF increased PSG SE and subjective sleep duration more than EEG-BF in highly trained athletes with sleep disturbances.

Defecation Symptoms in Relation to Stool Consistency Significantly Reflect the Dyssynergic Pattern in High-resolution Anorectal Manometry in Constipated Patients.

GOALS: To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC). BACKGROUND: DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value. STUDY: Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed. RESULTS: Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group ( P =0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group ( P =0.032). Hard stool was a discriminator for non-DP ( P =0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%. CONCLUSIONS: The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.

Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial.

OBJECTIVE: to assess the effect of cardiovascular biofeedback on nursing staff stress when compared to an activity without self-monitoring. METHOD: a randomized controlled clinical trial, carried out with nursing professionals from a university hospital. The intervention group (n=58) performed cardiovascular biofeedback, and the control (n=57) performed an online puzzle without self-monitoring, totaling nine meetings over three weeks. The outcome was assessed using the Stress Symptoms and Work-Related Stress scales, and the biological marker heart rate variability. The generalized estimating equations method was used. RESULTS: the intervention had no effect on self-reported instruments (p>0.050). However, there was an effect of time (p<0.050) on all heart rate variability indicators, demonstrating changes over the sessions. CONCLUSION: cardiovascular biofeedback showed promising results in the biological marker, suggesting that it can be used in nursing staff as a complementary therapy by promoting better autonomic nervous system regulation.

[Application of the biofeedback method in the therapy of depression]. / Primenenie metoda biologicheskoi obratnoi svyazi v terapii depressii.

In order to systematize the modern literature data on the effectiveness of biofeedback in the treatment of patients with depressive disorders, clinical efficacy and prospects for use in psychiatric practice, publications in the MEDLINE / PubMed, eLibrary databases from 2013 to 2023, as well as relevant references in the reference lists of the analyzed articles, were selected by the keywords «biofeedback¼, «depression¼, «depression therapy¼, «electroencephalogram¼, «non-drug treatments for depression¼. The analysis of data has shown that the biofeedback method demonstrates a certain therapeutic potential in the treatment of depression. It can be used to augment therapy in case of insufficient therapeutic effect, with low patient compliance, as well as poor tolerability of psychopharmacotherapy and in the presence of residual symptoms after pharmacological treatment. The method allows the correction of the psycho-emotional state, improves the balance between the parasympathetic and sympathetic divisions of the autonomic nervous system, and contributes to a more stable clinical effect. At the same time, further studies are needed, with the inclusion of large samples of patients from various nosological groups and with an analysis of the comparability of the effects of various biofeedback protocols.

[Current status and prospects of non-surgical treatment for fecal incontinence].

Fecal incontinence is a refractory disease in colorectal surgery. The main clinical manifestation is that patients cannot control the discharge of gas, solid or liquid feces in the rectum autonomously. It is easy to bring shame to patients and seriously affect their physical and mental health. Reducing the frequency of fecal incontinence, restoring anal sphincter function, and improving patient quality of life are important goals for treating fecal incontinence. With the development of medical technology and the improvement of treatment plans for fecal incontinence, patients with fecal incontinence usually undergo conservative treatment first, and if conservative treatment is ineffective, surgery can be chosen. Non-surgical treatment methods commonly used in clinical practice include biofeedback therapy, magnetic stimulation therapy, pelvic floor muscle training, anal sphincter training, Kegel training, and other rehabilitation treatments. This article discusses the non-surgical treatment methods for fecal incontinence, hoping to provide a choice for clinical treatment of fecal incontinence.

The effectiveness of a 6-week biofeedback gait retraining programme in people with knee osteoarthritis: protocol for a randomised controlled trial.

BACKGROUND: Gait retraining is a common therapeutic intervention that can alter gait characteristics to reduce knee loading in knee osteoarthritis populations. It can be enhanced when combined with biofeedback that provides real-time information about the users' gait, either directly (i.e. knee moment feedback) or indirectly (i.e. gait pattern feedback). However, it is unknown which types of biofeedback are more effective at reducing knee loading, and also how the changes in gait affect pain during different activities of daily living. Therefore, this study aims to evaluate the acute (6 weeks of training) and chronic (1 month post training) effects of biofeedback based on personalised gait patterns to reduce knee loading and pain in people with knee osteoarthritis, as well as examine if more than one session of knee moment feedback is needed to optimise the gait patterns. METHODS: This is a parallel group, randomised controlled trial in a symptomatic knee osteoarthritis population in which participants will be randomised into either a knee moment biofeedback group (n = 20), a gait pattern biofeedback group (n = 20) or a control group (n = 10). Supervised training sessions will be carried out weekly for six continuous weeks, with real-time biofeedback provided using marker-based motion capture and an instrumented treadmill. Baseline, post-intervention and 1-month follow-up assessments will be performed to measure knee loading parameters, gait pattern parameters, muscle activation, knee pain and functional ability. DISCUSSION: This study will identify the optimal gait patterns for participants' gait retraining and compare the effectiveness of gait pattern biofeedback to a control group in reducing knee loading and index knee pain. Additionally, this study will explore how many sessions are needed to identify the optimal gait pattern with knee moment feedback. Results will be disseminated in future peer-reviewed journal articles, conference presentations and internet media to a wide audience of clinicians, physiotherapists, researchers and individuals with knee osteoarthritis. TRIAL REGISTRATION: This study was retrospectively registered under the International Standard Randomised Controlled Trial Number registry on 7th March 2023 (ISRCTN28045513).

Headaches treatment with EMG biofeedback: a focused systematic review and meta-analysis.

INTRODUCTION: The aim of this paper was to present an up-to-date evaluation of the efficacy of EMG-biofeedback (EMG-BFB) for primary headaches and to address possible mediators of outcome. EVIDENCE ACQUISITION: PubMed, Scopus, Embase and Pedro databases were searched from inception to May 1, 2023. All randomized controlled trials (RCT) studies using an EMG-BFB to treat headache have been included in this systematic review. The current systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database (CRD42022312827). Methodological quality was assessed through the Risk of Bias tool 2 (RoB 2). The effect sizes and 95% confidence interval (CI) were calculated by random-effect models on frequency, intensity, and duration variables. Egger regression and the Begg-Mazumdar rank correlation test were used for publication bias. EVIDENCE SYNTHESIS: A total of 3059 articles were identified through the database searches. 29 articles, involving 1342 participants, met the inclusion criteria for the systematic review; of them, 4 were included in the meta-analysis. Ten studies reported a significant improvement in the EMG-BFB group with respect to the control group. Meta-analyses show a reduction in the intensity of attacks in patients subjected to EMG-BFB (ES 0.21 [(95% CI=-0.02; 0.44), P value=0.07] based on 293 patients). CONCLUSIONS: EMG-BFB represents a non-pharmacological approach to headache treatment as shown via qualitative synthesis, despite not impressive results, this technique can be particularly useful in paediatric or in adult patients who cannot undergo drug therapies. Quantitative synthesis revealed a promising effect in the intensity of headaches attacks. Moreover, no significant effect was found about the effectiveness of EMG-BFB in the reduction of frequency and durations of headache attacks. Future studies with new multimodal technologic assessment and following RCT guidelines can unmask the potentiality of EMG-BFB in the treatment of headache.

Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: A randomized controlled trial.

AIM: The aim was to determine whether specialist-led habit training using Habit Training with Biofeedback (HTBF) is more effective than specialist-led habit training alone (HT) for chronic constipation and whether outcomes of interventions are improved by stratification to HTBF or HT based on diagnosis (functional defaecation disorder vs. no functional defaecation disorder) by radio-physiological investigations (INVEST). METHOD: This was a parallel three-arm randomized single-blinded controlled trial, permitting two randomized comparisons: HTBF versus HT alone; INVEST- versus no-INVEST-guided intervention. The inclusion criteria were age 18-70 years; attending specialist hospitals in England; self-reported constipation for >6 months; refractory to basic treatment. The main exclusions were secondary constipation and previous experience of the trial interventions. The primary outcome was the mean change in Patient Assessment of Constipation Quality of Life score at 6 months on intention to treat. The secondary outcomes were validated disease-specific and psychological questionnaires and cost-effectiveness (based on EQ-5D-5L). RESULTS: In all, 182 patients were randomized 3:3:2 (target 384): HT n = 68; HTBF n = 68; INVEST-guided treatment n = 46. All interventions had similar reductions (improvement) in the primary outcome at 6 months (approximately -0.8 points of a 4-point scale) with no statistically significant difference between HT and HTBF (-0.03 points; 95% CI -0.33 to 0.27; P = 0.85) or INVEST versus no-INVEST (0.22; -0.11 to 0.55; P = 0.19). Secondary outcomes showed a benefit for all interventions with no evidence of greater cost-effectiveness of HTBF or INVEST compared with HT. CONCLUSION: The results of the study at 6 months were inconclusive. However, with the caveat of under-recruitment and further attrition at 6 months, a simple, cheaper approach to intervention may be as clinically effective and more cost-effective than more complex and invasive approaches.