Manual therapy improved signs and symptoms of temporomandibular disorders. 2016

Gaston Coutsiers Morell
General practitioner, Brussels, Belgium.

METHODS Medline, Cochrane, Web of Science, SciELO and Embase databases from 1993-2014. METHODS Randomised Controlled Trials (RCTs) comparing a manual therapy physical therapy intervention to a reference group (placebo intervention, controlled comparison intervention, standard treatment or other treatment). METHODS Two independent reviewers abstracted data and assessed quality and clinical relevance of each paper. In case of disagreement, a third reviewer was consulted. The PEDro (Physiotherapy Evidence-Based Database) scale was used to assess the methodological quality of the studies. RESULTS Eight studies were included. The number of patients in the studies ranged from 30-93. Seven out of the eight studies presented high methodological quality. Treatment effect size was calculated for pain, maximum mouth opening (MMO) and pressure pain threshold (PPT). There was moderate and low evidence that myofascial release and massage techniques are more effective than placebo or no intervention for MMO and pain outcomes respectively. There was also moderate evidence that no significant difference exists between myofascial release and toxin botulinum for improvement on the same outcomes. There was low to high quality evidence that upper cervical spine thrust manipulation or mobilisation techniques are more effective than control, while thoracic manipulations are not. Overall there was moderate-to-high evidence that MT techniques protocols are effective. Methodological heterogeneity of the trial protocols frequently contributed to a decrease in the quality of evidence. CONCLUSIONS 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.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013705 Temporomandibular Joint Disorders A variety of conditions affecting the anatomic and functional characteristics of the temporomandibular joint. Factors contributing to the complexity of temporomandibular diseases are its relation to dentition and mastication and the symptomatic effects in other areas which account for referred pain to the joint and the difficulties in applying traditional diagnostic procedures to temporomandibular joint pathology where tissue is rarely obtained and x-rays are often inadequate or nonspecific. Common diseases are developmental abnormalities, trauma, subluxation, luxation, arthritis, and neoplasia. (From Thoma's Oral Pathology, 6th ed, pp577-600) TMJ Disorders,TMJ Diseases,Temporomandibular Disorders,Temporomandibular Joint Diseases,Disease, TMJ,Disease, Temporomandibular Joint,Diseases, TMJ,Diseases, Temporomandibular Joint,Disorder, TMJ,Disorder, Temporomandibular,Disorder, Temporomandibular Joint,Disorders, TMJ,Disorders, Temporomandibular,Disorders, Temporomandibular Joint,Joint Disease, Temporomandibular,Joint Diseases, Temporomandibular,Joint Disorder, Temporomandibular,Joint Disorders, Temporomandibular,TMJ Disease,TMJ Disorder,Temporomandibular Disorder,Temporomandibular Joint Disease,Temporomandibular Joint Disorder
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D059408 Pain Management A form of therapy that employs a coordinated and interdisciplinary approach for easing the suffering and improving the quality of life of those experiencing pain. Management, Pain,Managements, Pain,Pain Managements
D020127 Recovery of Function A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. Function Recoveries,Function Recovery
D026201 Musculoskeletal Manipulations Various manipulations of body tissues, muscles and bones by hands or equipment to improve health and circulation, relieve fatigue, promote healing. Manipulation Therapy,Manipulations, Musculoskeletal,Reflexology,Bodywork,Craniosacral Massage,Manipulative Therapies,Manual Therapies,Rolfing,Therapy, Manipulation,Bodyworks,Manipulation Therapies,Manipulative Therapy,Manual Therapy,Massage, Craniosacral,Therapies, Manipulation,Therapies, Manipulative,Therapies, Manual,Therapy, Manipulative,Therapy, Manual

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