Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability

“…Measurement of both mouth opening and right and left laterotrusion demonstrated high agreement and were within the predetermined non‐inferiority margin, 9 demonstrating that telehealth assessment was valid and could be used interchangeably with conventional in‐person measurements. Despite an excellent ICC demonstrating a strong relationship between the measures, the upper bound of the protrusion limit of agreement fell marginally outside of the pre‐determined limit which is likely due to the exceedingly small distances produced with protrusion 29 .…”

“…Although there was some variability in agreement, the majority demonstrated a level of agreement which is comparable to when the performance of these tests are compared between two in-person assessors. 9 This suggests that factors external to the delivery medium (in-person, telehealth), such as the performance and interpretation of the test, also influence outcomes. Despite this, a recent study 33 demonstrated almost perfect agreement between in-person and telehealth when diagnosing either myogenic or arthrogenic TMD presentations, suggesting that the addition of the patient interview +/− associated medical imaging facilitates diagnosis decisions.…”

“…The average (of the three repeated measures) for each physiological movement was calculated and absolute agreement between methods (in‐person, telehealth) was analysed using both intraclass correlation coefficients (ICC (2,k) ) 19 and Bland–Altman limits of agreement statistics using the in‐person as the reference standard 20 . The limits of agreement (or non‐inferiority margin) for each movement were established a priori based on previously reported smallest detectable change (SDC) of repeated in‐person assessments of mandibular movements 9 (Table 2). Test–retest reliability was assessed with ICC (2,k) as described above.…”

“…facial muscles), joint sounds with movement, accessory movements, manual screening of the cervical spine and neck flexor muscle endurance test. 8 The majority of these physical tests have been demonstrated to have good to excellent inter-tester reliability when performed in-person by post-graduate musculoskeletal physiotherapists, 9 while they appears to be poor to moderate reliability between assessors for screening tests of the cervical spine. 8,10,11 In response to the COVID-19 global pandemic, many individuals are now seeking healthcare virtually which has led to a significant uptake of telehealth activity.…”

Validity of the Isometric Contraction Test of the Masticatory Muscles for Diagnosis of Muscular Temporomandibular Disorders

“…Previous research has shown that various clinical tests (active, passive, joint sounds, isometrics, joint mobility, joint provocation, and so on) obtain excellent reliability data in patients with TMD, given that 4–5 tests were positive out of the 7 tests conducted. Further, the general isometric contraction tests determined a high inter-examiner reliability with a kappa index (95% CI 0.50–0.92) [ 16 ]. Osiewicz et al compared the values of the dynamic and static tests to the palpatory tests in patients with TMD, showing high reliability values (intra-examiner and inter-examiner evaluation ICC, ranging from 0.63 to 0.70 for mouth opening, 0.68–0.73 for mouth closing, and 0.52–0.72 for protrusion, respectively [ 11 ]).…”