A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder

Abstract

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. [Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86:955-973.]

Temporomandibular disorders assessment: medicolegal considerations in the evidence‐based era

“…Systematic reviews on TMD treatments covered the arguments of the effectiveness of several treatment modalities, viz., occlusal treatments ( n = 5) (45, 81, 83, 84, 123), orthognathic surgery ( n = 2) (124, 125), arthrocentesis ( n = 2) (125, 126), NTI‐tss devices ( n = 1) (127), simple versus multimodal therapies ( n = 1) (128), any intervention’s effect on quality of life ( n = 1) (129), exercise and relaxation therapy ( n = 1) (130), physical therapy ( n = 1) (131), pharmacological therapy ( n = 1) (132), total TMJ prosthesis ( n = 1) (27) (Table 2).…”

The Use of Vestibular Rehabilitation for Individuals with Migraines: A Systematic Review

“…Following this independent screening process, the authors discussed any discrepancies that may have occurred and ultimately reached a consensus on the evidence level of each research study. A tool developed by Medlicott and Harris [15] was used to examine the methodological rigor of each included research study (Table 2). This tool rates methodological rigor from 0 to 10.…”

“…Sugaya et al [21] non-randomized controlled study 3 [15]. Item 1=randomization; Item 2=inclusion and exclusion criteria were listed for the subjects; Item 3=similarity of groups at baseline; Item 4=the treatment protocol was sufficiently described to be replicable; Item 5=reliability of data obtained with the outcome measures was investigated; Item 6=validity data obtained with the outcome measures was addressed; Item 7=blinding of patient, treatment provider, and assessor; Item 8=dropouts were reported; Item 9=long-term results were assessed via follow-up; Item 10=adherence to home programs was investigated.…”

The effectiveness of cognitive‐behavioural therapy for temporomandibular disorders: a systematic review

“…Although TMD is not a life‐threatening disease, the quality of their lives can be reduced for the chronic pain nature. The prevalence of TMD is estimated to be 20% of Western population, and only 10–20% of those seek treatment (3–5). The reported prevalence of signs in China is 75·8%, whereas it reduces to 13·1% in regard to symptoms (6).…”

“…The RDC/TMD is a dual axis to assess and classify patients with TMD. The Axis I measures physical diseases, including persistent oro‐facial pain, limitations in mandibular range of motion, pain on masticatory muscle palpation and detectable sounds in the TMJ during jaw function (9, 10), while Axis II includes a 31‐questionnaire to evaluate the psychological and psychosocial status of TMD, such as pain status variables, disability levels, depression and non‐specific physical symptoms (5, 10).…”