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Panel findings and recommendations: 
 -   Biofeedback is not recommended for treatment of patients with low back problems.  (Strength of Evidence = C.) 
  Biofeedback involves translating the physiologic activity of a patient's muscular response into a visual or auditory signal that allows the patient to try to facilitate or inhibit the muscular activity.  The therapeutic objective is to reduce muscle tension and thereby reduce pain.  Biofeedback has been advocated primarily for patients with chronic low back problems. 
Literature Reviewed     Evidence on Efficacy       Potential Harms and Costs   Summary of Findings    Author's Example 
  Literature Reviewed.  Of 13 articles screened for this topic, 4 reporting on 5 RCTs met criteria for review. 
177, 178, 179, 180  Other studies did not meet panel review criteria because they had fewer than 10 subjects per treatment group, but were used in a meta-analysis. 181, 182 All of the studies involved patients with chronic low back pain.  In most subjects, pain had persisted for several years. 
  Evidence on Efficacy.    Because these trials presented conflicting results, a meta-analysis was begun by the panel methodologists.  Studies were assessed for quality without knowledge of the results.  There were no excellent studies, one good study,178 three fair studies, 177,180,  182 and a fair study reported by Flor, Haag, Turk, et al.179 and by Flor, Haag, and Turk.181  There were no poor studies. 
  The studies involved comparisons of biofeedback with sham biofeedback; 178, 179,181 biofeedback combined with another treatment in comparison with the other treatment alone; 177 and biofeedback alone compared with some other treatment.179,181,182 
  The study with a "good" quality rating showed no benefit for biofeedback over sham biofeedback.178  Two studies reported patients in the biofeedback groups developed significantly better control of paraspinous muscle electromyographic activity.178, 180  In neither study did this reduce pain.  Thus, of the five studies, two showed no benefit for biofeedback. 178, 180  Two showed a benefit for biofeedback: Asfour, Khalil, Waly, et al. 177 and the study reported by Flor, Haag, Turk, et al.,179 and by Flor, Haag, and Turk.181  One study showed a slight benefit for biofeedback compared with a placebo condition, but reported an even better benefit for relaxation training.182  Statistical combination of results from these studies was not done because it would require requesting the original data from the authors. 
  Conclusions from the attempted meta-analysis were that biofeedback as a treatment for low back problems has been studied only for chronic problems, and that most of the studies are of mediocre quality and arrive at conflicting results. 
  Potential Harms and Costs.  The risks for biofeedback are considered low.  The costs of biofeedback treatment are determined by the number of treatment visits. 
  Summary of Findings.  There is conflicting evidence on the effectiveness of biofeedback for treating patients with chronic low back problems. However, this technique has not been studied in patients with low back problems. 
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