title: Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  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 The evidence regarding their effectiveness provided by early systematic reviews is outdated.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Electronic data searches of 6 databases were performed, in addition to a manual search.
  
  
  METHODS
  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.
  
  
  METHODS
  Data were extracted in duplicate on specific study characteristics.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Quality of the evidence and heterogeneity of the studies were limitations of the study.
  
  
  CONCLUSIONS
  No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.
authors: S. Armijo-Olivo, PT, BScPT, MScPT, PhD, Department of Physical Therapy, Faculty of Rehabilitation Medicine, 3-48 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada T6G 2G4. sla4@ualberta.ca susanarmijo@gmail.com.
authors: Susan
authors: S
authors: Armijo-Olivo
authors: L. Pitance, PT, MT, PhD, Université Catholique de Louvain-Institute of Neuroscience, Brussels, Belgium, and Stomatology and Maxillofacial Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors: Laurent
authors: L
authors: Pitance
authors: V. Singh, DDS, MS, MSc, Department of Dentistry, Faculty of Medicine, TMD/Orofacial Pain Clinic, Kaye Edmonton Clinic, Edmonton, Alberta, Canada.
authors: Vandana
authors: V
authors: Singh
authors: F. Neto, PT, FisioNeto-Terapia Manual Ortopédica and Pilates Clínico, Póvoa de Varzim, Portugal.
authors: Francisco
authors: F
authors: Neto
authors: N. Thie, BSc, MSc, MMSc, DDS, School of Dentistry, Faculty of Medicine and Dentistry, TMD/Orofacial Pain Graduate Program, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada.
authors: Norman
authors: N
authors: Thie
authors: A. Michelotti, BSc, DDS, Orthodontic Post-Graduate Program and TMD/Orofacial Pain Master Program, School of Medicine Federico II-Dental School, Naples, Italy.
authors: Ambra
authors: A
authors: Michelotti
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013705:Temporomandibular Joint Disorders / Q000628:therapy*