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Cited by 13EEG and Brain-Computer InterfacesStroke Rehabilitation and RecoveryTranscranial Magnetic Stimulation Studies

Clinical applications of neurofeedback based on sensorimotor rhythm: a systematic review and meta-analysis

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Ribeiro, Tatiana Ferri, Carriello, Marcelo Alves, de Paula, Eugenio Pereira, Garcia, Amanda Carvalho, Rocha, Guilherme Luiz da, Teive, Helio Afonso Ghizoni·2023·Frontiers in Neuroscience
DOI 10.3389/fnins.2023.1195066PMC PMC10694284
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Abstract

Background: Among the brain-machine interfaces, neurofeedback is a non-invasive technique that uses sensorimotor rhythm (SMR) as a clinical intervention protocol. This study aimed to investigate the clinical applications of SMR neurofeedback to understand its clinical effectiveness in different pathologies or symptoms. Methods: A systematic review study with meta-analysis of the clinical applications of EEG-based SMR neurofeedback performed using pre-selected publication databases. A qualitative analysis of these studies was performed using the Consensus tool on the Reporting and Experimental Design of Neurofeedback studies (CRED-nf). The Meta-analysis of clinical efficacy was carried out using Review Manager software, version 5.4.1 (RevMan 5; Cochrane Collaboration, Oxford, UK). Results: The qualitative analysis includes 44 studies, of which only 27 studies had some kind of control condition, five studies were double-blinded, and only three reported a blind follow-up throughout the intervention. The meta-analysis included a total sample of 203 individuals between stroke and fibromyalgia. Studies on multiple sclerosis, insomnia, quadriplegia, paraplegia, and mild cognitive impairment were excluded due to the absence of a control group or results based only on post-intervention scales. Statistical analysis indicated that stroke patients did not benefit from neurofeedback interventions when compared to other therapies (Std. mean. dif. 0.31, 95% CI 0.03–0.60, p = 0.03), and there was no significant heterogeneity among stroke studies, classified as moderate I 2 = 46% p -value = 0.06. Patients diagnosed with fibromyalgia showed, by means of quantitative analysis, a better benefit for the group that used neurofeedback (Std. mean. dif. −0.73, 95% CI −1.22 to −0.24, p = 0.001). Thus, on performing the pooled analysis between conditions, no significant differences were observed between the neurofeedback intervention and standard therapy (0.05, CI 95%, −0.20 to −0.30, p = 0.69), with the presence of substantial heterogeneity I 2 = 92.2%, p -value < 0.001. Conclusion: We conclude that although neurofeedback based on electrophysiological patterns of SMR contemplates the interest of numerous researchers and the existence of research that presents promising results, it is currently not possible to point out the clinical benefits of the technique as a form of clinical intervention. Therefore, it is necessary to develop more robust studies with a greater sample of a more rigorous methodology to understand the benefits that the technique can provide to the population.

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  • Although there is a growing number of studies regarding the effect of neurofeedback on FM in the literature, the level of evidence is still uncertain.

    “Although there is a growing number of studies regarding the effect of neurofeedback on FM in the literature, the level of evidence is still uncertain.28”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [28]

    The Introduction (page unavailable) says neurofeedback studies are growing in number but their evidence remains questionable; it does not say that the number of fibromyalgia-specific studies is growing. The Discussion and Final considerations (pages unavailable) describe fibromyalgia findings as promising but limited by small samples and in need of confirmation, supporting uncertainty about the evidence for FM. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Ribeiro, T. F., Carriello, M. A., de Paula, E. P., Garcia, A. C., Rocha, G. L. D., & Teive, H. A. G.
Affiliations
Universidade Federal do Paraná (BR)
Corresponding author
Ribeiro, Tatiana Ferri
ORCID
Venue
Frontiers in Neuroscience
Publisher
Frontiers Media SA
Published
2023-11-20
Volume
17
Pages
1195066-1195066
ISSN
1662-453X (ISSN-L)
DOI
10.3389/fnins.2023.1195066
PMC
PMC10694284
OpenAlex
W4388830097
Cited by
13
References
2
Citations by year
2026: 5 · 2025: 5 · 2024: 3
FWCI
0.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Neuroscience (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ((Code 001))
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
neurofeedback, stroke rehabilitation, fibromyalgia, clinical effectiveness, non-invasive brain stimulation, mild cognitive impairment, tetraplegia, paraplegia, insomnia, multiple sclerosis, standard therapy comparison, treatment effect heterogeneity

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