Predicting the outcome of a physical medicine treatment for temporomandibular disorder patients.
OBJECTIVE
To investigate whether any of the pretreatment physical signs, symptoms, and responses on psychological questionnaires would predict treatment outcomes after a standardized temporomandibular disorder (TMD) treatment program.


METHODS
The care provided to 157 TMD patients was a short course of physical therapy, an occlusal appliance, and over-the-counter nonsteroidal anti-inflammatory drugs (OTC NSAIDs). A multidimensional outcome assessment was performed using six variables. Follow-up data were available on 81.5% of enrolled subjects and elapsed time from initial visit to the two follow-up points was 13 +/- 4.7 and 33.6 +/- 9.8 months, respectively. Multiple regression analyses were conducted to assess the relationship between 18 predictor variables and the six outcome variables.


RESULTS
The results showed that the combination of a higher initial visual analog scale (VAS) pain score plus a lower jaw function interference score was significantly associated with a reduction of VAS pain after treatment (P < .05; adjusted R2 = 0.54). Moreover, the combination of a higher initial activity limitation score plus a lower jaw function interference score was associated with a greater reduction of the activity limitation score after treatment (P < .05; adjusted R2 = 0.36). None of the other outcomes were found to relate to any of the pretreatment variables. It must be noted that no single variable was a strong predictor and the odds ratios between the above three variables and the predicted outcomes were not robust.


CONCLUSIONS
The corollary of these results suggests that if a high degree of jaw function interference is present (eg, clicking, locking), then the prognosis of improvement with brief self-directed physical therapy, an occlusal appliance, and OTC NSAID is lower, at least within the time frame of this study.
Clark
Glenn T
GT
School of Dentistry, University of Southern California, Los Angeles, CA, USA.
Baba
Kazuyoshi
K
McCreary
Charles P
CP
D000203:Activities of Daily Living; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis; D003863:Depression / Q000175:diagnosis; D005157:Facial Pain / Q000175:diagnosis; D005260:Female; D006801:Humans; D008950:MMPI; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D017090:Occlusal Splints; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011379:Prognosis; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal