Patterns of cervical and masticatory impairment in subgroups of people with temporomandibular disorders–an explorative approach based on factor analysis

Objectives: To identify clinical patterns of impairment affecting the cervical spine and masticatory systems in different subcategories of temporomandibular disorder (TMD) by an explorative data-driven approach. Methods: For this observational study, 144 subjects were subdivided according to Research Diagnostic Criteria for TMDs into: Healthy controls, temporomandibular joint (TMJ) signs without symptoms, TMJ affected, temporomandibular muscles affected, or TMJ and muscles affected. Factor analysis and linear regression were applied to cervical spine and masticatory data to identify and characterize clinical patterns in subgroups. Results: Factor analysis identified five clinical dimensions, which explained 59% of all variance: Mechanosensitivity, cervical movement, cervical and masticatory dysfunction, jaw movement, and upper cervical movement. Regression analysis identified different clinical dimensions in each TMD subgroup. Conclusion: Distinct clinical patterns of cervical spine and masticatory function were found among subgroups of TMD, which has clinical implications for therapeutic management

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study

Background: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. Objectives: To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. Design/methods: Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. Results: Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. Conclusions: Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache

International consensus on the most useful assessments used by physical therapists to evaluate patients with temporomandibular disorders: A Delphi study

Objective To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT). Methods A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e‐survey, according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES) was posted using SurveyMonkey for each round. Percentages of responses were analyzed for each question from each round of the Delphi survey administrations. Results Twenty‐three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools, and 3) physical examination tests. The following was the consensus‐based decision regarding the identification of the clinically most useful assessments. 1) 4 of 9 questionnaires were identified: Jaw Functional Limitation (JFL‐8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD), and the Neck Disability Index (NDI). 2) 3 of 8 identified pain screening tests: Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NRS), and pain during mandibular movements. 3) 8 of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine, and the Neck Flexor Muscle Endurance Test. Conclusion After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity), and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research