Limited evidence to support the use of physical therapy for temporomandibular disorder.

/Home/Chiropractic Treatment for Other Symptoms/Chiropractic Treatment for Temporomandibular Joint

Limited evidence to support the use of physical therapy for temporomandibular disorder.
2007
Mannheimer JS.
PubMed

Data sourcesMedline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane Central Register of Controlled Trials were searched, using the search terms "facial pain", "physical therapy", "rehabilitation", "temporomandibular disorder" (TMD), "temporomandibular joint" (TMJ), "temporomandibular joint syndrome" and "therapy". The search was restricted to English-language publications from 1966 to January 2005.Study selectionFor inclusion, studies had to meet the following criteria: subjects were from one of three groups identified in the first axis of the Research Diagnostic Criteria for TMD; the intervention was within the realm of physical therapist practice; an experimental design was used; and outcome measures assessed one or more of the primary presenting symptoms.Data extraction and synthesisStudies were evaluated using Sackett's rules of evidence and 10 scientific rigour criteria. One reviewer performed the literature search, study selection and data abstraction. Four randomly selected articles were also rated independently by two reviewers to assess the reliability of the first author. Effect size was also calculated for studies for which raw data were available.ResultsThe search identified 108 articles, of which 30 studies met the inclusion criteria. Inter-reviewer agreement was 100% for levels of evidence and 73.5% for methodological rigour. Of the 30 studies reviewed, 22 were randomised controlled trials (RCT) but of low study quality. The following recommendations arising from the 30 studies were:active exercises and manual mobilisations may be effective;postural training may be used in combination with other interventions, as independent effects of postural training are unknown;mid-laser therapy may be more effective than other electrotherapy modalities;programmes involving relaxation techniques and biofeedback, electromyography training and proprioceptive re-education may be more effective than placebo treatment or occlusal splints;combinations of active exercises, manual therapy, postural correction and relaxation techniques may be effective.ConclusionsThese recommendations should be considered with caution because none were supported by numerous, decisive studies. Consensus on the definition of TMD, and subsequent inclusion and exclusion criteria, would allow further comparison across groups studied. In addition, agreement on use of valid and reliable outcome measures would yield more rigorous research.Evidence-Based Dentistry (2007) 8, 110-111. doi:10.1038/sj.ebd.6400528.