Usefulness of biofeedback as a potentially educational treatment of temporomandibular disorders: a systematic review and network meta-analysis.

Abstract

<h4>Objective</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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.<h4>Conclusions</h4>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.