A Preliminary Analysis of the Acceptability and Feasibility of Biofeedback-Assisted Relaxation Delivered by Physical Therapists for Patients with Migraine
Mia Minen1, Julia Dorf1, Alexis George2, Kristina Fanning3, Ryan Bostic3, Peter Schultz4
1Department of Neurology, NYU Langone Health, 2Doctoral Program in Psychology, The Graduate Center, City University of New York, 3MIST Research INC, 4Dynamic Sports Physical Therapy
Objective:
To conduct interim analyses to assess the feasibility, acceptability, and preliminary impact of a 6-session, in-person, PT-delivered BAR program for patients with migraine.
Background:
There are accessibility barriers to biofeedback-assisted relaxation (BAR), a Grade A evidence-based migraine preventive treatment, typically delivered by psychologists. Despite having BAR training for other conditions, physical therapists (PTs) do not traditionally deliver BAR for migraine.
Design/Methods:
We conducted a randomized, single-blinded parallel study comparing BAR to Enhanced Usual Care (EUC) in patients with migraine. Between in-person sessions, participants were asked to practice daily. EUC participants were given educational handouts. Both groups completed a daily electronic headache diary. Outcome measures included migraine-related quality of life (MSQv2) and migraine-related disability (MIDAS).
Results:
Fifty participants enrolled (BAR=25, EUC=25). The majority (81.0%, 17/21 BAR; 79.2%, 19/24 EUC) agreed/strongly agreed that the electronic headache diary was easy to understand. BAR feasibility data (n=19) showed 89.5% attended 4+ sessions. BAR practice data (n=18) showed 66.7% reported daily practice, and 55.6% reported 10+ minutes of practice/session. Although not statistically significant, the BAR group had greater improvements in each MSQv2 subdomain compared to EUC (Role Function-Restrictive BAR=14.2 vs EUC=6.0, Role Function Preventive BAR=8.3 vs EUC=4.8, Emotional Function BAR=16.8 vs EUC=14.2). The BAR group had a greater mean change in MIDAS compared to EUC (-27.4 + 31.5 vs -5.48 + 22.0; P=0.010).
Conclusions:
Of the patients with migraine who did PT-delivered BAR, the majority practiced daily (up to 10+ minutes/day), and there were clinically significant improvements in migraine-related disability compared to EUC.
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