Usefulness of biofeedback as a potentially educational treatment of temporomandibular disorders: a systematic review and network meta-analysis
Ada María González-González, Manuel Tello Pellitero, Natalia López Tejerina, Xabier Soto-Goñi, Juan Nicolás Cuenca‐Zaldívar, Eleuterio A. Sánchez Romero
Abstract
OBJECTIVE: To evaluate the effectiveness of biofeedback (BF) as a potential educational treatment for temporomandibular disorders (TMD) through a systematic review and a network meta-analysis. METHODS: A systematic search was conducted across five electronic databases (PubMed, Web of Science, PEDro, Scopus, and Cochrane Library) to identify clinical trials using BF as a therapeutic intervention in patients diagnosed with TMD according to RDC/TMD or DC/TMD criteria. A frequentist fixed-effects network meta-analysis was performed with robust variance estimation to account for within-study correlations in the repeated measures. Sensitivity analyses were conducted using an autoregressive lag-1 (AR1) model at correlation levels ranging from 0 to 0.8. Model fit was assessed using likelihood ratio tests (LRT) and corrected Akaike Information Criterion (AICc). RESULTS: Nine studies (N = 758) were included. No statistically significant differences in pain intensity were observed between the interventions at post-treatment or follow-up. The fixed-effects model without autocorrelation showed the best fit (AICc = 54.293). According to the P-score ranking, occlusal splints and no intervention showed the highest probabilities of effectiveness, whereas biofeedback ranked lower. No publication bias was detected according to Egger's test and funnel plot symmetry. CONCLUSIONS: Although BF did not outperform other interventions in terms of pain intensity, it showed comparable efficacy and may offer additional benefits by promoting self-regulation and psychological resilience. These findings suggest that BF can be explored as a complementary tool within the biopsychosocial approach to TMD rehabilitation.