TMD pain: the effect on health related quality of life and the influence of pain duration

Objectives: As impact of literature concerning this subject is scarce, the objectives of this study were to assess whether the Health Related Quality of Life (HRQoL) is decreased in patients with painful temporomandibular disorders as compared to the HRQoL in the general population, and to evaluate to what extent pain duration affects HRQoL. Methods: Data concerning physical and mental health were retrieved from patients with painful temporomandibular disorders. Assessment tools used were: the Mandibular Function Impairment Questionnaire (MFIQ), the Short-Form-36 (SF-36), the Hospital Anxiety and Depression Schedule (HADS), and the General Health Questionnaire (GHQ). In order to examine the influence of the duration of pain on HRQoL, the total sample was divided into three different subgroups. Subgroup 1 consisted of patients with complaints existing less than one year. Patients with complaints from 1 to 3 years were allocated to the second group. The 3rd subgroup included patients with complaints longer than 3 years. Results: The total sample consisted of 95 patients (90 females and 5 males). On most physical and social functioning items, groups 2 and 3 scored significantly worse than the general population. On the other hand, none of the groups differed from the general population when comparing the mental items. Duration of pain was significantly correlated with SF-36 subscale physical functioning and the mandibular impairment. Conclusion: Patients with TMD pain less than one year score better than compared to the population norm. With a longer duration of pain, mental health scores and role limitations due to emotional problems do not appear to be seriously affected by reduced physical health, while social functioning appears to be considerably affected

Incomplete quality of life data in lung transplant research: comparing cross sectional, repeated measures ANOVA, and multi-level analysis

BACKGROUND: In longitudinal studies on Health Related Quality of Life (HRQL) it frequently occurs that patients have one or more missing forms, which may cause bias, and reduce the sample size. Aims of the present study were to address the problem of missing data in the field of lung transplantation (LgTX) and HRQL, to compare results obtained with different methods of analysis, and to show the value of each type of statistical method used to summarize data. METHODS: Results from cross-sectional analysis, repeated measures on complete cases (ANOVA), and a multi-level analysis were compared. The scores on the dimension 'energy' of the Nottingham Health Profile (NHP) after transplantation were used to illustrate the differences between methods. RESULTS: Compared to repeated measures ANOVA, the cross-sectional and multi-level analysis included more patients, and allowed for a longer period of follow-up. In contrast to the cross sectional analyses, in the complete case analysis, and the multi-level analysis, the correlation between different time points was taken into account. Patterns over time of the three methods were comparable. In general, results from repeated measures ANOVA showed the most favorable energy scores, and results from the multi-level analysis the least favorable. Due to the separate subgroups per time point in the cross-sectional analysis, and the relatively small number of patients in the repeated measures ANOVA, inclusion of predictors was only possible in the multi-level analysis. CONCLUSION: Results obtained with the various methods of analysis differed, indicating some reduction of bias took place. Multi-level analysis is a useful approach to study changes over time in a data set where missing data, to reduce bias, make efficient use of available data, and to include predictors, in studies concerning the effects of LgTX on HRQL

A nonparametric scale analysis of the development of conservation

The purpose of this study was to investigate the development of conservation by using the nonparametric Mokken scale analysis. Subjects were 801 children from kindergarten and primary school Grades 1 and 2 who completed 13 conservation tasks derived from Piaget’s publications. It was shown that some selections (i.e., seven, eight, and nine tasks, respectively, at three successive administrations with three-month’s interval) formed strong Mokken scales, which were invariant for different samples at the same point in time of test administration. Furthermore, it was found that during the course of development the number of tasks which fitted on the scale increased. However, some reversals of the relative positions of a small number of tasks were found for the scales at different points in time of test administration. It was concluded that application of nonparametric Mokken scale analysis resulted in a new, but very useful instrument for analyzing the order of acquisition of conservation

Long-term health-related quality of life after lung transplantation:Different predictors for different dimensions

Background: Lung transplantation has proven to be an effective treatment option for patients with end-stage lung disease with profound effects on both survival and health-related quality of life (HRQL). Generally, studies have reported improved HRQL after lung transplantation. When assessing HRQL, physical, psychologic or social dimensions are usually included. However, it is unclear what predicts outcome, to what extent, and whether there are differences in predictors between dimensions of HRQL. Knowledge about these predictors may be useful when making choices regarding therapy. The research question in the present study was: What are the predicting variables of physical and psychologic dimensions of HRQL, and do they differ? Methods: Results from studies of the physical dimension (the Nottingham Health Profile's energy and mobility scales) and the psychologic dimension (Zung depression and STAI anxiety scores) from 140 transplanted patients with a maximum follow-up of almost 10 years were assessed using mixed-model analysis. For both dimensions, the following variables were tested for their predictive value: age; gender; diagnosis; year of transplantation; time on the waiting list; type of transplantation; bronchiolitis obliterans syndrome; and pre-transplant HRQL scores. Results: With regard to the physical dimension after lung transplantation, presence of bronchiolitis obliterans syndrome (BOS), age and pre-transplant scores on the measure under study were significant predictors for both energy and mobility. For mobility, gender appeared to be an additional predictor. With regard to the psychologic dimension after lung transplantation, BOS was a predictor for both anxiety and depression. Pre-transplant depression was an additional predictor for post-transplant depression, and age was an additional predictor for anxiety. Conclusions: Several variables were identified that predicted HRQL after lung transplantation. These variables differed between the physical and psychologic dimensions. The presence of BOS was a predictor for both dimensions. The present findings may be helpful when choosing or developing interventions aimed at improving HRQL after lung transplantation

TMD pain: the effect on health related quality of life and the influence of pain duration

Abstract Objectives As impact of literature concerning this subject is scarce, the objectives of this study were to assess whether the Health Related Quality of Life (HRQoL) is decreased in patients with painful temporomandibular disorders as compared to the HRQoL in the general population, and to evaluate to what extent pain duration affects HRQoL. Methods Data concerning physical and mental health were retrieved from patients with painful temporomandibular disorders. Assessment tools used were: the Mandibular Function Impairment Questionnaire (MFIQ), the Short-Form-36 (SF-36), the Hospital Anxiety and Depression Schedule (HADS), and the General Health Questionnaire (GHQ). In order to examine the influence of the duration of pain on HRQoL, the total sample was divided into three different subgroups. Subgroup 1 consisted of patients with complaints existing less than one year. Patients with complaints from 1 to 3 years were allocated to the second group. The 3rd subgroup included patients with complaints longer than 3 years. Results The total sample consisted of 95 patients (90 females and 5 males). On most physical and social functioning items, groups 2 and 3 scored significantly worse than the general population. On the other hand, none of the groups differed from the general population when comparing the mental items. Duration of pain was significantly correlated with SF-36 subscale physical functioning and the mandibular impairment. Conclusion Patients with TMD pain less than one year score better than compared to the population norm. With a longer duration of pain, mental health scores and role limitations due to emotional problems do not appear to be seriously affected by reduced physical health, while social functioning appears to be considerably affected.</p

The effect of intra-articular injection of ultracain in the temporomandibular joint in patients with preauricular pain - A randomized prospective double-blind placebo-controlled crossover study

Objectives: To evaluate the distinguishing ability of intraarticular anesthesia from placebo in orofacial pain patients with pain located in the temporomandibular joint (TMJ) region, aiming at a validation of intra-articular anesthesia injection as a diagnostic test of pain in the TMJ region. Materials and Methods: A randomized prospective double-blind, placebo-controlled crossover study was conducted among 19 patients (18 females, I male) with pain in the TMJ region. The short-term effects of intra-articular ultracain and saline injections on pain and maximum mouth opening were measured and analyzed. Results: Compared with placebo injections, a statistically significant difference in pain scores was found after intraarticular injection of a local anesthetic on Visual Analog Scale values. The maximum mouth opening scores did, however, not differ between the 2 groups. Discussion: TMJ injection with local anesthesia leads to the decrease of pain in patients with preauricular pain. To establish the source of pain, injection of a local anesthetic in the TMJ may be used as a diagnostic tool. However, the results of diagnostic injections should still be interpreted cautiously