Skilled physical therapists are vital to the proper use of biofeedback therapies.[13] Experienced technicians are also necessary for several other modalities, including EEG, skin conductance, and ultrasound. Biofeedback technicians and clinical certificants are providers that have been certified by the Association for Applied Psychophysiology and Biofeedback (AAPB) to use biofeedback therapy. Finally, the patient's supervising physician is instrumental in determining the overall progress of the patient and coordinating the other therapies that the patient is receiving to maximize their progress.

Successful biofeedback training requires a great deal of motivation and participation. The individual must be able to communicate and to comprehend and follow through with instructions. The proper modality must be chosen for the correct indication. For example, electromyography biofeedback is more commonly used for musculoskeletal conditions, while real-time ultrasound biofeedback can be used for pelvic floor dysfunction.[6] For headaches, blood volume pulse feedback has been shown to have the most evidence for reducing headache severity and frequency.[14] For each modality, sensors will be attached to the patient in different areas depending on the indication. 

This process is essentially a form of operant conditioning with positive feedback for performing the desired action or behavior and negative feedback for not doing so. The first step is to choose the best modality and establish the baseline parameter. The next step is to learn to control the parameter and to practice until the action has become embedded into memory. An example of this is the use of biofeedback for hypertension. In thermal biofeedback, a temperature probe is attached to a patient's finger or toe and is instructed to increase or decrease the temperature in response to the feedback. Warming a digit involves decreasing sympathetic vasoconstrictive tone to that digit and thus increasing blood flow.[15] The overall goal is that this training can help systemically to decrease neural-mediated vasoconstriction and thus decrease the total peripheral resistance leading to a decrease in blood pressure.[15] Another common use of biofeedback is for urinary incontinence and enuresis in children. Electrodes get placed near the anus and on the leg, and a urotherapist teaches the child pelvic floor exercises.[16] A video game incorporates these exercises where the child plays as a caterpillar and is instructed to contract their pelvic floor muscles to avoid obstacles. The child is also then taught to continue these exercises at home, with the hope of improving pelvic floor strength and decreasing urinary incontinence.[16]

Biofeedback is a very safe and well-tolerated procedure that has minimal complications. If biofeedback is used at all times during therapy, there may be a drop in the performance following its discontinuation. It is, therefore, beneficial to practice the same techniques without the biofeedback equipment as part of the overall treatment for sustained improvement.[17] If the patient does not practice the techniques often, then the treatment can have less than intended results over time and may require retraining. 

Biofeedback techniques can potentially provide symptom relief and improve quality of life while also being safe and free of significant side effects. The methods allow patients to have some control over their disease, which is valuable in maintaining patient self-efficacy and overall well-being.[18] With enough training sessions, patients can make changes that will last without the use of these instruments. Biofeedback can potentially also reduce the amount of medication a patient is taking, which can help patients avoid the problem of polypharmacy and limit side effects from other drugs. 

Biofeedback techniques are suggested for symptom management for chronic pain, fatigue, and insomnia, but they are best as one part of a more extensive rehabilitation plan. Benefits vary between individuals, and results occur more often seen if used with some combination of cognitive-behavioral therapy, physical therapy, and other relaxation techniques.[19][20]  There have been several smaller studies and systemic reviews on biofeedback measures, but results are conflicting and likely subject to publication bias. Some of the studies had poor randomization or compared to a control of no treatment rather than standard physical therapy.[6][21] More long-term studies are necessary to see if the positive outcomes are maintainable over time. An interprofessional team, including primary care providers, pain specialists, neurologists, physical therapists, and specialty-trained psychiatric health nurses who can assist the clinician and track results, can maximize the benefits of these procedures. Nurses and therapists educate patients, monitor response to biofeedback, and inform the team about patient progress. There must also be open avenues of communication between the multiple potential clinicians on a case. A functioning interprofessional team will lead to better outcomes with biofeedback. [Level 5]

Symptoms of anxiety or abnormalities in gait are often first notified by nurses. It can be very beneficial for them to know when biofeedback is beneficial and when it may be offered as a supplemental treatment. There are many indications where biofeedback can help in the care of a patient, so nurses should be aware of presenting symptoms and consider its use. In some states, certain providers such as psychologists may not be able to physically touch their patients to apply sensors and may require a health care provider such as a nurse to act as a chaperone or apply the sensors. Nurses can also provide education to patients about their current medical condition. For instance, a patient with urinary incontinence may receive information from nurses about reducing accidents by having scheduled voiding times. 

During ongoing biofeedback therapy, primary monitoring is for fatigue, which can be exacerbated by ongoing treatment. Depending on the modality, nurses check for discomfort that some patients may experience, such as in some forms of fecal incontinence where probes and balloons are inserted into the rectum to stimulate defecation. Nurses also observe for complications such as reactions to sensor tape.[22]