Biofeedback improves activities of the lower limb after stroke: A systematic review

Rosalyn Stanton, Louise Ada*, Catherine M. Dean, Elisabeth Preston

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

59 Citations (Scopus)
36 Downloads (Pure)


Question: Is biofeedback during the practice of lower limb activities after stroke effective in improving performance of those activities, and are any benefits maintained after intervention ceases? Design: Systematic review with meta-analysis of randomised trials. Participants: People who have had a stroke. Intervention: Biofeedback during practice of sitting, standing up, standing, or walking. Outcome measures: Continuous measures of activity congruent with the activity trained. Results: 22 trials met the inclusion criteria and 19 contained data suitable for analysis. Effect sizes were calculated as standardised mean differences because different outcome measures were used. Since inclusion of all trials produced substantial statistical heterogeneity, only trials with a PEDro score >4 (11 trials) were included in the final analysis (mean PEDro score 5.7). In the short-term, biofeedback improved lower limb activities compared with usual therapy/placebo (SMD = 0.49, 95% CI 0.22 to 0.75). Lower limb activities were still improved compared with usual therapy/placebo 1 to 5 months after the cessation of intervention (SMD = 0.41, 95% CI 0.06 to 0.75). Conclusion: Augmenting feedback through the use of biofeedback is superior to usual therapy/placebo at improving lower limb activities in people following stroke. Furthermore, these benefits are largely maintained in the longer term. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised more widely in clinical practice.

Original languageEnglish
Pages (from-to)145-155
Number of pages11
JournalJournal of Physiotherapy
Issue number3
Publication statusPublished - Sept 2011
Externally publishedYes

Bibliographical note

Copyright the Publisher [2011]. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • Exercise therapy
  • Meta-analysis
  • Physical therapy techniques
  • Randomized controlled trials
  • Rehabilitation
  • Review systematic
  • Stroke


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