Author Names
Armijo-Olivo, Susan; Pitance, Laurent; Singh, Vandana; Neto, Francisco; Thie, Norman; Michelotti, Ambra
Reviewer Name
Gabrielle Stanley, Duke SPT 2
Reviewer Affiliation(s)
University of California-Davis B.S. Human Development 2019
Paper Abstract
Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. Electronic data searches of 6 databases were performed, in addition to a manual search. Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed.nData were extracted in duplicate on specific study characteristics. The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. Quality of the evidence and heterogeneity of the studies were limitations of the study. No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.
NIH Risk of Bias Tool
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Cannot Determine, Not Reported, Not Applicable
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- No
Key Finding #1
No high-quality evidence was found indicating the uncertainty of effectiveness for manual therapy in the treatment of TMD; however, low quality evidence does indicate that a combination of manual therapy of the orofacial region in conjunction with manual therapy of the cervical spine is more effective than home exercises in treatment of people with mixed TMD.
Key Finding #2
Cervical spine manual therapy appears to be more effective in the treatment of pain reduction in patients with myogenous TMD more so than the orofacial region manual therapy.
Please provide your summary of the paper
This research includes systemically selected research protocols comparing groups who received manual therapy or manual therapy in conjunction with exercise to control groups who received only exercise or no treatment at all. While the method for collecting data was systemic, and risk of bias was analyzed, the research itself that was being reviewed was low to moderate quality. This research indicates that cervical manual therapy in conjunction with orofacial manual therapy is the most effective manual therapy intervention for TMD, followed by solely cervical treatment, and lastly solely orofacial treatment. However, for these claims to be incorporated into best practice interventions, higher quality research must first be assessed.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
While this meta-analysis gathered data suggesting that combined orofacial and cervical manual therapy are successful in the treatment of pain reduction in mixed TMD, the quality of the evidence which suggests this is low. In order to incorporate manual therapy into recommended clinical practice guideline for treating TMD, first higher quality research must be conducted.
