title: Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial.
abstract: BACKGROUND
  Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program.
  
  
  METHODS
  Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.
  
  
  RESULTS
  After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points.
  
  
  CONCLUSIONS
  This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12610000508077.
authors.affiliation: Department of Chiropractic, Faculty of Science, Macquarie University, North Ryde, NSW, Australia.
authors.forename: Allan
authors.initials: A
authors.lastname: Kalamir
authors.affiliation: Department of Statistics, Faculty of Science, Macquarie University, North Ryde, NSW, Australia.
authors.forename: Petra L
authors.initials: PL
authors.lastname: Graham
authors.affiliation: Department of Academic Affairs, Anglo-European College of Chiropractic, Bournemouth, Dorset, UK.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Vitiello
authors.affiliation: Department of Chiropractic, Faculty of Science, Macquarie University, North Ryde, NSW, Australia.
authors.forename: Rodney
authors.initials: R
authors.lastname: Bonello
authors.affiliation: School of Exercise Science, Faculty of Sports Science, Australian Catholic University, Sydney, NSW, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Pollard
keywords: Clinical trial; Craniomandibular disorders; Education; Exercise; Musculoskeletal manipulations; Myofascial pain syndrome; Self-care; Temporomandibular joint dysfunction syndrome; Trigger points