Predictors of pain reduction following manual therapy in patients with temporomandibular disorders: a protocol for a prospective observational study

Abstract

IntroductionTemporomandibular disorders (TMDs) are principally characterised by pain in the craniomandibular area and probable limitations of jaw opening. Manual therapy, like other recommended conservative treatments included in clinical guidelines, is commonly used to treat patients with TMD to reduce pain and improve function. However, outcomes may be variable. The aim of this study is to identify predictors associated with pain reduction in patients with TMD following manual therapy by analysing a combination of patient-reported outcome measures and clinical tests. Such knowledge will support a more personalised management approach by facilitating clinical decision-making.Methods/analysisAn observational prospective design will recruit a cohort of 100 adults with a diagnosis of TMD (according to Axis I of the Diagnostic Criteria for TMD) at a Dental Hospital in Italy. Patients will be treated with four weekly sessions of manual therapy applied to craniomandibular structures. An array of predictors has been chosen based on previous research on prognostic factors for TMD and altered pain modulation in musculoskeletal disorders. Candidate predictors including demographic variables, general health variables, psychosocial features, TMD characteristics and clinical tests of the temporomandibular joint and masticatory muscles will be collected at baseline. Definition of good outcome is a clinically significant reduction of pain intensity over the last week (≥30% reduction Visual Analogue Scale) immediately following the four week intervention. Exploratory factor analysis will be applied to analyse factor loading of candidate predictors for good outcome at four weeks. Subsequently, a logistic multivariable regression model will be performed to calculate low and high risk of good outcome.Ethics and disseminationEthical approval has been obtained from the ‘Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico’ and University of Birmingham Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration number NCT03990662; Pre-results.

The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders

“…Current clinical guidelines for the treatment of TMD clearly indicate the need for conservative therapy, such as physiotherapy and manual therapy [ 1 , 3 , 10 ]. These interventions directly affect the muscular system, in order to reduce its excessive tension, and thus minimize pain in the area of the temporomandibular joints, and in muscles involved in the chewing process [ 1 , 3 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

“…Therefore, currently recommended approaches in TMD therapy include primarily prosthetic and orthodontic treatment [ 1 , 8 , 10 ], pharmacotherapy [ 1 , 11 , 12 ], as well as rehabilitation and education as forms of supportive treatment [ 1 , 2 , 3 , 13 , 14 , 15 , 16 , 17 , 18 ]. One of the most commonly used forms of conservative treatment is physiotherapy, including manual therapy [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. The use of these interventions with simultaneous prosthetic treatment significantly accelerates the restoration of proper functioning of the masticatory organ [ 1 , 13 , 14 ].…”

The impact of Covid-19-related distress on general health, oral behaviour, psychosocial features, disability and pain intensity in a cohort of Italian patients with temporomandibular disorders

“…This study reports findings from a prospective cohort study investigating predictors associated with pain reduction in patients with TMD following manual therapy [ 25 ]. The study took place at the TMJ-Unit of the Italian Stomatological Institute (Dental Hospital) in Milan, Italy.…”

“…After inclusion, participants were assigned to a single physiotherapist with more than 5 years of experience in TMD assessment and treatment for baseline data collection. Subsequently, participants received their therapy for their TMD consisting of manual therapy for the first month followed by exercises and an oral appliance if needed (for full details see Asquini et al 2020) [ 25 ]. When the pandemic started, all participants had already completed baseline data collection and at least one month of therapy.…”

Manual Therapy: Art or Science?

“…Nevertheless, in clinical practice, very different clinical responses are commonly observed in different patients as a result of the application of the same technique. In the last 20 years, several studies have tried to identify the clinical elements present at the baseline that could indicate the best therapeutic solution for each specific patient [90]. In particular, the so-called clinical prediction rules (CPRs) [91] have been studied and developed for the issues referred to in this chapter, also with reference to manipulative treatment in patients with lumbar [92], cervical [93], and shoulder pain [94], among others.…”