A meta-analysis of EMG biofeedback treatment of temporomandibular disorders

Aims: Outcome evaluations of treatments incorporating electromyographic (EMG) biofeedback for temporomandibular disorders (TMD) have been conducted for more than 2 decades. The purpose of this study was to review the available literature to determine the efficacy of biofeedback-based treatments and to estimate treatment effect sizes. Methods: A literature search located 13 studies of EMG biofeedback treatment for TMD, including 6 controlled, 4 comparative treatment, and 3 uncontrolled trials. Three types of outcome were examined: patient pain reports, clinical exam findings, and ratings of global improve ment. Results: Five of the 6 controlled trials found EMG biofeedback treatments to be superior to no treatment or psychologic placebo controls for at least 1 of the 3 types of outcome. Data from 12 studies contributed to a meta-analysis that compared pre- to posttreatment effect sizes for EMG biofeedback treatments to effect sizes for control conditions, Mean effect sizes for both reported pain and clinical exam outcomes were substantially larger for biofeedback treatments than for control conditions. In addition, 69% of patients who received EMG biofeedback treatments were rated as symptom-free or significantly improved compared with 35% of patients treated with a variety of placebo interventions. Follow-up outcomes for EMG biofeedback treatments showed no deterioration from posttreatment levels. Conclusion: Although limited in extent, the available data support the efficacy of EMG biofeedback treatments for TMD.