Article

An effective application of biofeedback for interventions in older
adults with balance and mobility disorders may be compromised due to
co-morbidity. OBJECTIVE: To evaluate the feasibility and the effectiveness of
biofeedback-based training of balance and/or mobility in older adults. DATA
SOURCES: PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the
Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO
(1840-2009). The search strategy was composed of terms referring to biofeedback,
balance or mobility, and older adults. Additional studies were identified by
scanning reference lists. STUDY SELECTION: For evaluating effectiveness, 2
reviewers independently screened papers and included controlled studies in older
adults (i.e. mean age equal to or greater than 60 years) if they applied
biofeedback during repeated practice sessions, and if they used at least one
objective outcome measure of a balance or mobility task. DATA EXTRACTION: Rating
of study quality, with use of the Physiotherapy Evidence Database rating scale
(PEDro scale), was performed independently by the 2 reviewers. Indications for
(non)effectiveness were identified if 2 or more similar studies reported a
(non)significant effect for the same type of outcome. Effect sizes were
calculated. RESULTS AND CONCLUSIONS: Although most available studies did not
systematically evaluate feasibility aspects, reports of high participation rates,
low drop-out rates, absence of adverse events and positive training experiences
suggest that biofeedback methods can be applied in older adults. Effectiveness
was evaluated based on 21 studies, mostly of moderate quality. An indication for
effectiveness of visual feedback-based training of balance in (frail) older
adults was identified for postural sway, weight-shifting and reaction time in
standing, and for the Berg Balance Scale. Indications for added effectiveness of
applying biofeedback during training of balance, gait, or sit-to-stand transfers
in older patients post-stroke were identified for training-specific aspects. The
same applies for auditory feedback-based training of gait in older patients with
lower-limb surgery. IMPLICATIONS: Further appropriate studies are needed in
different populations of older adults to be able to make definitive statements
regarding the (long-term) added effectiveness, particularly on measures of
functioning.

Langue : ANGLAIS