The role of biofeedback in patellofemoral pain conservative treatment: a systematic review

Abstract BACKGROUND Biofeedback techniques are gaining popularity in physiatry. The number of papers regarding this topic is rising. However, no previous systematic reviews exist on biofeedback techniques for patellofemoral pain syndrome (PFPS). This paper aims to investigate the effectiveness and the outcomes of the association between different types of biofeedback techniques and therapeutic exercises in the conservative treatment of PFP. METHODS The present study is a systematic review. We used the PRISMA statement guidelines and followed the Cochrane Handbook for Systematic Reviews of Interventions. Between April and June 2022, the following electronic databases were searched: PubMed, ScienceDirect, BIOMED Central, Cochrane Library, Google Scholar e PEDro. Only randomized controlled trials (RCTs) were selected. The bias risk evaluation of these studies was done using the Risk of Bias 2 (RoB 2) tool by Cochrane Collaboration. RESULTS Following the search, we underlined 414 records, and after using strict inclusion and exclusion criteria, we retrieved 12 RCTs to include in this systematic review, assessing 513 patients. We evaluated the treatment effectiveness by dividing the results based on the protocols used (multimodal, visual feedback and therapeutic exercise, auditory feedback and therapeutic exercise, and somesthetic feedback and therapeutic exercise). CONCLUSIONS The association between biofeedback and therapeutic exercise may be beneficial for pain, function (AKPS), extensor muscle strength, reduction of the dynamic knee valgus and vastus medialis (VM) and vastus lateralis (VL) (EMG) optimization. All these results were valued in the short term. Regarding the intervention type, it was possible to correlate the EMG-biofeedback with the benefits of the knee extensors strength and the EMG activity of VM and VL. Conversely, using mirror, verbal, and somesthetic (hands and band) feedback seems to be linked to the reduction of the knee dynamic valgus. To conclude, these findings are preliminary since this topic's number of studies is still low. More studies are needed to understand the effectiveness of these treatments.