The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta-analysis.
Dickerson SM, Weaver JM, Boyson AN, Thacker JA, Junak AA, Ritzline PD, Donaldson MB.
Clin Rehabil. 2017 Aug;31(8):1039-1048. doi: 10.1177/0269215516672275.
OBJECTIVE: To investigate the effectiveness of exercise therapy on pain, function, and mobility outcomes in patients with temporomandibular joint dysfunction. STUDY DESIGN: Systematic review with meta-analysis. METHODS: A systematic review and meta-analysis undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that met the inclusion criteria: (1) randomized controlled trials; (2) a population with the diagnosis of temporomandibular joint dysfunction; and (3) interventions that included exercise therapy were considered for review. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. RESULTS: Six articles with a total of 419 participants were included in the review and only four studies were included in the meta-analysis. Mobility and mixed exercise therapy approaches appear to be the most common exercise approaches utilized for management of temporomandibular joint dysfunction. Exercise therapy and the associated dosage provide moderate short-term and varying long-term benefits in reduction of pain and improvement of range of motion of the in patients with temporomandibular joint dysfunction. CONCLUSION: Included studies suggest a mobility or a mixed approach to exercise therapies have impact on reducing pain, significant impact for increasing range of motion, but lack a significant impact for functional improvement. LEVEL OF EVIDENCE: Therapy, level 1a-.
Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: Systematic review and meta-analysis.
Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A.
Phys Ther. 2016 Jan;96(1):9-25. doi: 10.2522/ptj.20140548.
BACKGROUND: Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. PURPOSE: The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. DATA SOURCES: Electronic data searches of 6 databases were performed, in addition to a manual search. STUDY SELECTION: Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed. DATA EXTRACTION: Data were extracted in duplicate on specific study characteristics. DATA SYNTHESIS: The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. LIMITATIONS: Quality of the evidence and heterogeneity of the studies were limitations of the study. CONCLUSIONS: No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.
Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis.
Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, Lagoa Goncalves KF, Bonini-Rocha AC, Dugailly PM, de Oliveira RJ.
Man Ther. 2016 Feb;21:10-7. doi: 10.1016/j.math.2015.06.009.
BACKGROUND: Temporomandibular joint disorder (TMD) requires a complex diagnostic and therapeutic approach, which usually involves a multidisciplinary management. Among these treatments, musculoskeletal manual techniques are used to improve health and healing. OBJECTIVES: To assess the effectiveness of musculoskeletal manual approach in temporomandibular joint disorder patients. DESIGN: A systematic review with meta-analysis. METHODS: During August 2014 a systematic review of relevant databases (PubMed, The Cochrane Library, PEDro and ISI web of knowledge) was performed to identify controlled clinical trials without date restriction and restricted to the English language. Clinical outcomes were pain and range of motion focalized in temporomandibular joint. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at every post treatment. The PEDro scale was used to demonstrate the quality of the included studies. RESULTS/FINDINGS: From the 308 articles identified by the search strategy, 8 articles met the inclusion criteria. The meta-analysis showed a significant difference (p < 0.0001) and large effect on active mouth opening (SMD, 0.83; 95% CI, 0.42 to 1.25) and on pain during active mouth opening (MD, 1.69; 95% CI, 1.09 to 2.30) in favor of musculoskeletal manual techniques when compared to other conservative treatments for TMD. CONCLUSIONS: Musculoskeletal manual approaches are effective for treating TMD. In the short term, there is a larger effect regarding the latter when compared to other conservative treatments for TMD.
The effectiveness of physiotherapy in the management of temporomandibular disorders: A systematic review and meta-analysis.
Paco M, Peleteiro B, Duarte J, Pinho T.
J Oral Facial Pain Headache. Summer 2016;30(3):210-20. doi: 10.11607/ofph.1661.
AIMS: To analyze the methodologic quality, summarize the findings, and perform a meta-analysis of the results from randomized controlled trials that assessed the effects of physiotherapy management of temporomandibular disorders. METHODS: A literature review was performed using the electronic databases PubMed, Science Direct, and EBSCO. Each article was independently assessed by two investigators using the Physiotherapy Evidence Database (PEDro), Jadad scales, and the Cochrane Risk of Bias tool. A meta-analysis was conducted by using the DerSimonian-Laird random-effects method to obtain summary estimates of the standardized mean differences (SMD) and the corresponding 95% confidence intervals (95% CI). Between-study heterogeneity was computed and publication bias was assessed. RESULTS: Seven articles met the inclusion criteria and were used in the analysis, corresponding to nine estimates of SMD. The meta-analysis showed that for pain reduction, the summary SMD favored physiotherapy (SMD = -0.63; 95% CI: -0.95 to -0.31; number of studies = 8; I² = 0.0%), while for active range of movement (ROM) the differences between the intervention and control groups were not statistically significant (SMD = 0.33; 95% CI: -0.07 to 0.72; number of studies = 9; I² = 61.9%). CONCLUSION: Physiotherapy seems to lead to decreased pain and may improve active ROM. However, the results are not definitive and further studies and meta-analyses are needed before these results can be considered fully generalizable.e.
Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials.
Calixtre LB, Moreira RF, Franchini GH, Alburgquerque-Sendin F, Oliveira AB.
J Oral Rehabil. 2015 Nov;42(11):847-61. doi: 10.1111/joor.12321.
There is a lack of knowledge about the effectiveness of manual therapy (MT) on subjects with temporomandibular disorders (TMD). The aim of this systematic review is to synthetise evidence regarding the isolated effect of MT in improving maximum mouth opening (MMO) and pain in subjects with signs and symptoms of TMD. MEDLINE(®) , Cochrane, Web of Science, SciELO and EMBASE(™) electronic databases were consulted, searching for randomised controlled trials applying MT for TMD compared to other intervention, no intervention or placebo. Two authors independently extracted data, PEDro scale was used to assess risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied to synthetise overall quality of the body of evidence. Treatment effect size was calculated for pain, MMO and pressure pain threshold (PPT). Eight trials were included, seven of high methodological quality. Myofascial release and massage techniques applied on the masticatory muscles are more effective than control (low to moderate evidence) but as effective as toxin botulinum injections (moderate evidence). Upper cervical spine thrust manipulation or mobilisation techniques are more effective than control (low to high evidence), while thoracic manipulations are not. There is moderate-to-high evidence that MT techniques protocols are effective. The methodological heterogeneity across trials protocols frequently contributed to decrease quality of evidence. In conclusion, there is widely varying evidence that MT improves pain, MMO and PPT in subjects with TMD signs and symptoms, depending on the technique. Further studies should consider using standardised evaluations and better study designs to strengthen clinical relevance.
A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder.
Medlicott MS, Harris SR.
Phys Ther. 2006 Jul;86(7):955-73.
BACKGROUND AND PURPOSE: This systematic review analyzed studies examining the effectiveness of various physical therapy interventions for temporomandibular disorder. METHODS: Studies met 4 criteria: (1) subjects were from 1 of 3 groups identified in the first axis of the Research Diagnostic Criteria for Temporomandibular Disorders, (2) the intervention was within the realm of physical therapist practice, (3) an experimental design was used, and (4) outcome measures assessed one or more primary presenting symptoms. Thirty studies were evaluated using Sackett's rules of evidence and 10 scientific rigor criteria. Four randomly selected articles were classified independently by 2 raters (interrater agreement of 100% for levels of evidence and 73.5% for methodological rigor). RESULTS: The following recommendations arose from the 30 studies: (1) active exercises and manual mobilizations may be effective; (2) postural training may be used in combination with other interventions, as independent effects of postural training are unknown; (3) mid-laser therapy may be more effective than other electrotherapy modalities; (4) programs involving relaxation techniques and biofeedback, electromyography training, and proprioceptive re-education may be more effective than placebo treatment or occlusal splints; and (5) combinations of active exercises, manual therapy, postural correction, and relaxation techniques may be effective. DISCUSSION AND CONCLUSION: These recommendations should be viewed cautiously. Consensus on defining temporomandibular joint disorder, inclusion and exclusion criteria, and use of reliable and valid outcome measures would yield more rigorous research.
A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders.
McNeely ML, Armijo Olivo S, Magee DJ. Phys Ther. 2006 May;86(5):710-25.
BACKGROUND AND PURPOSE: The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders. METHODS: A literature search of published and unpublished articles resulted in the retrieval of 36 potential articles. RESULTS: Twelve studies met all selection criteria for inclusion in the review: 4 studies addressed the use of therapeutic exercise interventions, 2 studies examined the use of acupuncture, and 6 studies examined electrophysical modalities. Two studies provided evidence in support of postural exercises to reduce pain and to improve function and oral opening. One study provided evidence for the use of manual therapy in combination with active exercises to reduce pain and to improve oral opening. One study provided evidence in support of acupuncture to reduce pain when compared with no treatment; however, in another study no significant differences in pain outcomes were found between acupuncture and sham acupuncture. Significant improvements in oral opening were found with muscular awareness relaxation therapy, biofeedback training, and low-level laser therapy treatment. DISCUSSION AND CONCLUSION: Most of the studies included in this review were of very poor methodological quality; therefore, the findings should be interpreted with caution.