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Surface electromyography evaluation of selected manual and physical therapy interventions in women with temporomandibular joint pain and limited mobility. Randomized controlled trial (RCT).

Injury
August 1, 2023
Magdalena Gębska et al. (4 authors)
Randomized Controlled TrialJournal ArticleHuman StudyClinical
Study Details

Study Goal

The researchers aimed to evaluate the short-term efficacy of manual therapy (including massage) and its effect on the bioelectrical function of the masseter muscle in women with pain and limited TMJ mobility.

Results Summary

Massage combined with therapeutic exercises (T5) led to complete resolution of pain after 10 days of therapy and showed the largest clinically significant difference in jaw mobility and muscle function. The study found manual therapy interventions (including massage) to be superior to physical and self-therapy in relaxation and analgesic efficacy.

Population

186 women with Ib disorder (myofascial pain with restricted mobility) diagnosed in DC/TMD.

Effective Dosage

Not specified (therapy administered for 10 days).

Duration

10 days

Interactions

None mentioned

Extracted Claims (14)
InterventionDirectionEndpointPopulationDosageImpactClaim #
magnetostimulation (T1)
neutral
-
186 women (T) with the Ib disorder diagnosed in DC/TMD
-
-
#1
magnetoledotherapy (T2)
neutral
-
186 women (T) with the Ib disorder diagnosed in DC/TMD
-
-
#2
magnetolaserotherapy (T3)
neutral
-
186 women (T) with the Ib disorder diagnosed in DC/TMD
-
-
#3
manual therapy- positional release and therapeutic exercises (T4)
decrease
pain
186 women (T) with the Ib disorder diagnosed in DC/TMD
complete resolution
led to complete resolution of pain
#4
manual therapy- positional release and therapeutic exercises (T4)
increase
MMO and LM parameter
186 women (T) with the Ib disorder diagnosed in DC/TMD
largest minimal clinically significant difference
largest minimal clinically significant difference
#5
manual therapy - massage and therapeutic exercises (T5)
decrease
pain
186 women (T) with the Ib disorder diagnosed in DC/TMD
complete resolution
led to complete resolution of pain
#6
manual therapy - massage and therapeutic exercises (T5)
increase
MMO and LM parameter
186 women (T) with the Ib disorder diagnosed in DC/TMD
largest minimal clinically significant difference
largest minimal clinically significant difference
#7
manual therapy - PIR and therapeutic exercises (T6)
neutral
-
186 women (T) with the Ib disorder diagnosed in DC/TMD
-
-
#8
self therapy - therapeutic exercises (T7)
neutral
-
186 women (T) with the Ib disorder diagnosed in DC/TMD
-
-
#9
manual therapy- positional release and therapeutic exercises (T4)
increase
parameters studied
186 women (T) with the Ib disorder diagnosed in DC/TMD
strongest
had the strongest effect
#10
manual therapy - massage and therapeutic exercises (T5)
increase
parameters studied
186 women (T) with the Ib disorder diagnosed in DC/TMD
strongest
had the strongest effect
#11
manual therapy - PIR and therapeutic exercises (T6)
increase
parameters studied
186 women (T) with the Ib disorder diagnosed in DC/TMD
strongest
had the strongest effect
#12
manual interventions
increase
therapeutic effect
186 women (T) with the Ib disorder diagnosed in DC/TMD
better
better therapeutic effect
#13
manual therapy treatments
increase
relaxation and analgesic efficacy
TMD pain patients
superior
superior to physical treatments
#14
Abstract

UNLABELLED: Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions. The aim of this study was to evaluate the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility. The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD. The control group consisted of 104 women without diagnosed TMDs. Diagnostic procedures were performed in both groups. The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self therapy - therapeutic exercises (T7). In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied. Therefore, it may be concluded that SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapeutic interventions. BACKGROUND: Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions in a qualitative and quantitative manner. However, there were numerous controversies reported regarding the use of surface electromyography (SEMG) in Orofacial Pain patients. Therefore, we wanted to assess the effectiveness of physiotherapy interventions in TMD patients using SEMG. PURPOSE: Evaluation of the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility. MATERIAL AND METHODS: The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD (Ib - myofascial pain with restricted mobility). The control group consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle SEMG bioelectric activity). Diagnostic procedures were performed in both groups (SEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity - NRS scale). The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self-therapy - therapeutic exercises (T7). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral SEMG signals of the masseter muscles were acquired. PC1 factor analysis was performed. A score of 99% in the PC1 parameter, demonstrates the clinical relevance of electromyography (MVC). RESULTS: Synergism of physical factors will lead to a higher MID on the NRS scale. Evaluating the MID of the therapeutic interventions used showed a better therapeutic effect of manual interventions over physical and self-therapy. In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied. CONCLUSIONS: 1. Exercise SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapy interventions. 2. Manual therapy treatments are superior to physical treatments in their relaxation and analgesic efficacy and should therefore be prescribed as a first line non-invasive intervention for TMD pain patients.

Medical Subject Headings (MeSH)
FemaleHumansElectromyographyPhysical Therapy ModalitiesExercise TherapyTemporomandibular JointPain
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality80/10
Citation Metrics
Total Citations5
Citations/Year2.5
Relative Citation Ratio2.83
NIH Percentile83.7%
Research Impact Scores
APT Score0.75
Weight Score2.68
Normalized Score0.70
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