Author Names
La Touche, R., Garcia, S., Garcia, B., Acosta, A., Juarez, D., Perez, J., Angualo-Diaz-Parreno, S., Cuenca-Martinez, F., Paris-Alemany, A., Suso-Marti, L.
Reviewer Name
Anastasia Engelsman
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective. To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT. Design. Systematic review and meta-analysis (MA). Methods. A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies’ objectives. The qualitative analysis was based on classifying the results into lev- els of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results. Regarding cervical MT, MA included three studies and showed statistically significant differences in pain in- tensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervi- cal MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain inten- sity reduction and pain-free maximal mouth opening, with a large clinical effect. Conclusions. Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain- free MMO over cervical intervention alone in TMD and headache, with low evidence.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- 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?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- 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?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
Tempo mandibular joint disorder can be treated with cervical or craniomandibular manual therapy interventions and may be even more effective than cervical interventions alone.
Key Finding #2
In comparison to no intervention or cervical intervention alone, manual therapy significantly decreased pain intensity and pressure pain thresholds.
Please provide your summary of the paper
It has been well known that manual therapy is an effective treatment for tempo mandibular joint disorder (TMD), however, it is unknown which area or type of intervention may produce the most effective outcomes. The purpose of this study was to analyze current research for the effectiveness of cervical manual therapy (MT) in patient with TMD and to compare the usefulness of cervico-craniomandibular MT treatment vs cervical treatment. Two researchers conducted a PRISMA-based search for relevant literature to complete the systematic review and meta-analysis. Articles were chosen based on their relevance to the studies objectives, inclusion criteria, and publication before 2019. 6 articles were found to fit all criteria, and it was discovered that cervical MT treatment is more effective at reducing pain than no MT intervention. Furthermore, cervico-craniomandibular MT interventions achieved greater short-term reductions in pain intensity than cervical intervention alone in individuals with TMD.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This review demonstrated that TMD may be treated successfully with cervical or craniomandibular MT interventions and may be even more effective than cervical interventions alone. In comparison to no intervention or cervical intervention, MT significantly decreased pain intensity and pressure pain thresholds. Due to the nature of the review, however, the forms of MT intervention were not uniform in terms of type of manipulation, amplitude, and frequency. More research is needed to determine the most advantageous type and frequency of manipulations for tempo mandibular disorders. In the present, clinicians should utilize MT in the treatment of TMD in addition to other cervical or cervico-craniomandibular interventions.
