The Research Diagnostic Criteria for Temporomandibular Disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms.
OBJECTIVE
To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses.


METHODS
The multisite RDC/TMD Validation Project's dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by two TMD experts using criterion examination data, including temporomandibular joint imaging. Cutoff points for target validity were sensitivity > or = 0.70 and specificity > or = 0.95. Reliability of revised algorithms was assessed in 27 study participants.


RESULTS
Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as "any joint pain." Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other disc displacement diagnoses, osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was > or =0.63.


CONCLUSIONS
Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements as well as osteoarthritis and osteoarthrosis.
Schiffman
Eric L
EL
Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN 55455, USA. schif001@umn.edu
Ohrbach
Richard
R
Truelove
Edmond L
EL
Tai
Feng
F
Anderson
Gary C
GC
Pan
Wei
W
Gonzalez
Yoly M
YM
John
Mike T
MT
Sommers
Earl
E
List
Thomas
T
Velly
Ana M
AM
Kang
Wenjun
W
Look
John O
JO
D000465:Algorithms; D018771:Arthralgia / Q000175:diagnosis; D002983:Clinical Competence; D032921:Consensus; D005157:Facial Pain / Q000175:diagnosis; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D015588:Observer Variation; D010003:Osteoarthritis / Q000175:diagnosis; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013705:Temporomandibular Joint Disorders / Q000145:classification* / Q000175:diagnosis*; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis; D054928:Validation Studies as Topic