Assessment and further development of RDC/TMD Axis II biobehavioural instruments: a research programme progress report

Abstract

A symposium was held in Toronto, 2008, in which research progress regarding the biobehavioral dimension of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was presented. An extended workshop was held April 2009 in which further recommendations were made from an expert panel, using the 2008 symposium material as a base. This paper is a summary of the 2008 symposium proceedings with elaborations based on further developments. Seven studies were conducted between 2001 and 2008, in which the following were investigated: (a) basic properties of Axis II instruments, (b) reliability and criterion validity of Axis II instruments, (c) expansion of predictors, (d) metric equivalence of the depression and non-specific physical symptoms subscales in the RDC/TMD, (e) laboratory investigation of oral behaviors, (f) field data collection of oral behaviors, and (g) functional limitation of the jaw. Methods and results for each of these studies are described. Based on the results of these studies that have been published, as well as the direction of interim results from the few studies that await completion and publication, the biobehavioral domain of the RDC/TMD, as published in 1992, is reliable and valid. These results also provide strong evidence supporting the future growth of the biobehavioral domain as the RDC/TMD matures into subsequent protocols for both clinical and research applications.

Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions

“…Participants in OPPERA study also completed the Jaw Functional Limitation Scale , 43,47 a 20-item instrument that measures limitation in the use of the jaw, and the Oral Behaviors Checklist , 49,50 which is a 21-item instrument that evaluates the frequency of a series of parafunctional oral behaviors.…”

Clinical Findings and Pain Symptoms as Potential Risk Factors for Chronic TMD: Descriptive Data and Empirically Identified Domains from the OPPERA Case-Control Study

“…The OBC 59,64 assesses the self-reported frequency over the preceding month of each of 21 activities involving the jaw such as clenching the teeth or bracing the jaw (5 ordinal response options, ranging from “none of the time,” coded 0, to “all of the time,” coded 4). Evaluations of this instrument suggest that it is valid, with terminology corresponding to the behaviors that are reliable and the recalled behaviors matching those measured using Ecological Momentary Assessment approaches.…”

“…Evaluations of this instrument suggest that it is valid, with terminology corresponding to the behaviors that are reliable and the recalled behaviors matching those measured using Ecological Momentary Assessment approaches. 59,64,69 An ordinal summary measure was computed based on adding the coded, ordinal responses to each of the 21 activities, and this was reduced to 4 categories using tertiles. More detailed data and alternate scoring will be available in a forthcoming manuscript.…”

Determinants of Pain Treatment Response and Nonresponse: Identification of TMD Patient Subgroups

“…11 The RDC/TMD consists of 31 items assessing orofacial pain complaints along two axes: a physical disorders axis (Axis-I) to detect muscle disorders, disk displacements, and other joint conditions, and a psychosocial axis (Axis-II) to assess perceived pain intensity, pain-related disability, functional limitations, depression and non-specific symptoms suggestive of somatization. The RDC/TMD has demonstrated reliability, 40 including physical examination by the oral surgeon. Patients were examined by one of two participating oral surgeons, each trained to criterion reliability (ICC=.90).…”