Research Papers

A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

Lauche, Romy, Cramer, Holger, Häuser, Winfried, Dobos, Gustav, Langhorst, Jost (2015) · Evidence-Based Complementary and Alternative Medicine

Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

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Biofeedback in rehabilitation

Giggins, Oonagh M., Persson, Ulrik McCarthy, Caulfield, Brian (2013) · Journal of Neuroengineering and Rehabilitation

This paper reviews the literature relating to the biofeedback used in physical rehabilitation. The biofeedback methods used in rehabilitation are based on biomechanical measurements and measurements of the physiological systems of the body. The physiological systems of the body which can be measured to provide biofeedback are the neuromuscular system, the respiratory system and the cardiovascular system. Neuromuscular biofeedback methods include electromyography (EMG) biofeedback and real-time ultrasound imaging (RTUS) biofeedback. EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of many musculoskeletal conditions and in post cardiovascular accident (CVA) rehabilitation. RTUS biofeedback has been demonstrated effective in the treatment of low back pain (LBP) and pelvic floor muscle dysfunction. Cardiovascular biofeedback methods have been shown to be effective in the treatment of a number of health conditions such as hypertension, heart failure, asthma, fibromyalgia and even psychological disorders however a systematic review in this field has yet to be conducted. Similarly, the number of large scale studies examining the use of respiratory biofeedback in rehabilitation is limited. Measurements of movement, postural control and force output can be made using a number of different devices and used to deliver biomechanical biofeedback. Inertial based sensing biofeedback is the most widely researched biomechanical biofeedback method, with a number of studies showing it to be effective in improving measures of balance in a number of populations. Other types of biomechanical biofeedback include force plate systems, electrogoniometry, pressure biofeedback and camera based systems however the evidence for these is limited. Biofeedback is generally delivered using visual displays, acoustic or haptic signals, however more recently virtual reality (VR) or exergaming technology have been used as biofeedback signals. VR and exergaming technology have been primarily investigated in post-CVA rehabilitation, however, more recent work has shown this type of biofeedback to be effective in improving exercise technique in musculoskeletal populations. While a number of studies in this area have been conducted, further large scale studies and reviews investigating different biofeedback applications in different clinical populations are required.

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Differential shaping of EEG theta rhythms

Sittenfeld, Dr Pola, Budzynski, Thomas, Stoyva, Johann (1976) · Biofeedback and Self-regulation

Heart rate, EEG, frontal EMG, and forearm EMG were recorded in 20 subjects for 3 baseline, 8 feedback, and 2 postbaseline sessions in order to compare two biofeedback methods of teaching subjects to increase theta EEG activity. Subjects were divided into high- and low-EMG groups. Five high-EMG subjects, and 5 low-EMG subjects then received 8 sessions of strictly theta feedback. The remaining 10 subjects, 5 from the high-EMG group, and 5 from the low-EMG group, received a “graduated” training which involved shaping the target response. This procedure consisted of 4 initial sessions of EMG feedback, followed by a second phase consisting of 4 sessions of theta feedback. Results showed a clear relationship between subjects' baseline frontal EMG levels and the effect of the training methods. Although subjects with high-EMG baseline increased their theta output only with the two-phase training, subjects with low-EMG baseline levels performed better when given theta feedback only. This result shows not only that amounts of theta can be reliably increased, but that training techniques should be adapted to the physiological characteristics of the individual—in this case, baseline levels of frontal EMG levels.

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