The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

<p>Abstract</p> <p>Background</p> <p>Temporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews.</p> <p>Methods</p> <p>A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: <it>in vitro </it>or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews.</p> <p>Results</p> <p>The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies.</p> <p>Conclusion</p> <p>The results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.</p

Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups

Effectiveness of manual therapies: the UK evidence report

<p>Abstract</p> <p>Background</p> <p>The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.</p> <p>Methods</p> <p>The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.</p> <p>Results</p> <p>By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.</p> <p>Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.</p> <p>Conclusions</p> <p>Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.</p> <p>Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.</p

Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibular disorder

Temporomandibular disorder (TMD) is a common condition that can be difficult to manage in physical therapy. A number of interventions, such as manual therapy, therapeutic exercise, and patient education have typically been used in some combination. However, the evidence regarding thrust manipulation of not only the local but also adjacent segments is sparse. Specifically, the use of cervicothoracic (CT) junction thrust manipulation has not previously been described in the management of individuals with TMD. In this case report, CT junction thrust manipulation, in addition to locally directed manual therapy, exercise, and postural education, was associated with immediate improvements in neck and jaw symptoms and function in a complex patient with TMD. The patient was seen for seven visits over the course of 2 months and demonstrated clinically significant changes in the neck disability index (NDI), the numeric rating of pain scale (NPRS), and the global rating of change (GROC) scale. The purpose of this report is to describe the successful physical therapy management of a patient with TMD utilizing manual therapy, including CT junction thrust manipulation, education, and exercise

Efeito da reeducação postural global no alinhamento corporal e nas condições clínicas de indivíduos com disfunção temporomandibular associada a desvios posturais Effect of global postural reeducation on body alignment and on clinical status of individuals with temporomandibular disorder associated to postural deviations

Este estudo visou verificar o efeito da técnica de reeducação postural global (RPG) nas condições físicas, psicológicas e psicossociais, assim como no alinhamento corporal, de indivíduos com disfunção temporomandibular (DTM) associada a desvio postural. Participaram 20 indivíduos com DTM e com desvio postural confirmado por exame físico, avaliados, antes e depois do tratamento de RPG, pelos critérios diagnósticos de desordens temporomandibulares (RDC/TMD, na sigla em inglês) e quanto às medidas angulares, por fotogrametria digital. O tratamento consistiu em 10 sessões semanais de RPG. Os resultados após o tratamento mostram, na classificação da disfunção, maior predomínio de desordens apenas musculares (em detrimento das articulares e por deslocamento de disco) e redução da intensidade da dor orofacial; o percentual de indivíduos sem depressão aumentou de 10% para 35%; o percentual de indivíduos com classificação normal de sintomas físicos (excluindo itens de dor) passou de 30% para 55%. Foi encontrada melhora estatisticamente significante na maioria das medidas angulares, exceto nos ângulos frontais dos membros inferiores e ângulo perna/retropé direito. O alinhamento horizontal da cabeça e as medidas de lordose cervical e lombar, com valores normais antes da RPG, não se modificaram. Conclui-se que, com o tratamento de RPG, os indivíduos apresentaram importantes melhoras dos sintomas físicos e psicológicos da DTM, assim como melhora do alinhamento e simetria corporais.<br>The purpose of this study was to assess the effects of the technique of global postural re-education (GPR) on body alignment and clinical status of individuals with temporomandibular disorder (TMD) associated to postural deviations. Twenty individuals with both TMD and postural deviations confirmed by physical examination were assessed, before and after treatment, by the research diagnostic criteria for temporomandibular disorders (RDC/TMD) and as to body angle measures, by digital photogrammetry. Treatment consisted of 10 weekly, 45-minute GPR sessions. Results after treatment show higher predominance of myogenic dysfunction (rather than joint or disc ones) and significant orofacial pain intensity relief; the percentage of individuals without depression raised from10% to 35%; the percentage of individuals with physical symptoms classified as normal (excluding pain items) raised from 30 to 55%. A statistically significant improvement was found in most body structures angle measures, except at lower limb frontal angles and at the right leg/foot angle. Head alignment and measures of cervical and lumbar lordosis, having normal values before treatment, did not change. Hence the GPR treatment may be said to have brought significant relief of TMD physical and psychological symptoms, as well as improvement in body alignment and symmetry