We assessed patient perspectives about in-person physical therapist (PT)-delivered biofeedback-assisted relaxation (BAR) for migraine.

Biofeedback is a Grade A evidence-based behavioral therapy for migraine. Although typically conducted by psychologists, PTs can receive training to administer biofeedback.

We qualitatively analyzed 1:1 semi-structured exit interviews (n=20) conducted in a Phase 2a, randomized, parallel study of PT-delivered BAR for migraine.

The following themes were identified: 1) Participants recognized benefits of PT-delivered BAR and generally found the in-person aspect to be enjoyable and necessary; 2) Participants experienced changes in their perspective on biofeedback and behavioral therapies for migraine after attending PT-delivered BAR sessions, in essence cognitive reframing, and would recommend PT-delivered BAR to others; 3) Participants tended to prefer specific BAR techniques more than others or found certain techniques more useful, informing proposed protocol alterations to consider; 4) Most participants continued to practice biofeedback techniques after protocol completion (i.e., 6 sessions), but recognized barriers to practicing between sessions/after protocol completion; 5) Participants had mixed opinions on potential similarities and differences between BAR delivered by PTs versus psychologists with some questioning about accessibility of BAR in the real world. Protocol recommendations included: additional/booster sessions, technique/exercise order, technique/exercise repetition, improved instructions for at-home practice, online or in-person group sessions/check-ins/reminders, and provision of wearable/device.

While PT-delivered BAR was generally well received, future work may focus on refining the current protocol based on patient feedback to better fit the needs of patients with migraine.