Os tratamentos com placa oclusal, terapia manual e aconselhamento s?o efetivos na redu??o da dor e ansiedade de pacientes portadores de disfun??o temporomandibular? Ensaio cl?nico randomizado

• Main Author: R?go, C?ssia Renata de Figueir?do
• Other Authors: 00984619402
• Language: Portuguese
• Published: PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA 2017
• Subjects: CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA; S?ndrome da disfun??o da articula??o temporomandibular; Ansiedade; Dor
• Online Access: https://repositorio.ufrn.br/jspui/handle/123456789/24298

Submitted by Automa??o e Estat?stica ([e-mail]) on 2017-11-03T21:39:40Z No. of bitstreams: 1 CassiaRenataDeFigueiredoRego_DISSERT.pdf: 2890152 bytes, checksum: 164151d0976f2e12e2b8dfaf582f7cc9 (MD5) === Approved for entry into archive by Arlan Eloi Leite Silva ([e-mail]) on 2017-11-17T23:46:17Z (GMT) No. of bitstreams: 1 CassiaRenataDeFigueiredoRego_DISSERT.pdf: 2890152 bytes, checksum: 164151d0976f2e12e2b8dfaf582f7cc9 (MD5) === Made available in DSpace on 2017-11-17T23:46:17Z (GMT). No. of bitstreams: 1 CassiaRenataDeFigueiredoRego_DISSERT.pdf: 2890152 bytes, checksum: 164151d0976f2e12e2b8dfaf582f7cc9 (MD5) Previous issue date: 2017-09-29 === Introdu??o: A ansiedade ? considerada um fator psicossocial relevante na etiologia multifatorial da disfun??o temporomandibular (DTM). Objetivo: Determinar o efeito do tratamento com placa oclusal (PO), terapia manual (TM), aconselhamento (AC) e da associa??o placa oclusal + aconselhamento (PAC), na mensura??o da dor e ansiedade em portadores de DTM. M?todologia: Foi realizado um ensaio cl?nico randomizado com 89 pacientes diagnosticados com DTM por meio do RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) e divididos em quatro grupos de tratamento: PAC (n=25), PO (n=24), TM (n=21) e AC (n=19). Os participantes foram avaliados antes e ap?s 1 m?s das terapias quanto ?s vari?veis dor, ansiedade e diagn?stico de DTM. A mensura??o da dor foi feita de acordo com uma escala visual anal?gica (EVA). Para avalia??o da ansiedade foram utilizados tr?s question?rios: a Escala Hospitalar de Ansiedade e Depress?o (HADS), o Invent?rio de Ansiedade de Beck (BAI) e o ?ndice de Ansiedade Tra?o-Estado (IDATE - T e E). Foi utilizado o teste Split Plot ANOVA para observar a diferen?a entre os grupos ao longo do tempo e dentro do pr?prio grupo, com n?vel de confian?a de 95%. Resultados: Entre os participantes houve predomin?ncia do sexo feminino (82,1%, n=72) e a m?dia de idade foi de 28 anos (?DP=9,34). Os quatro grupos obtiveram redu??o significativa (p < 0,001) na vari?vel dor ap?s 1 m?s de tratamento. A avalia??o da ansiedade, feita com tr?s question?rios diferentes, mostrou que houve redu??o dos sintomas de ansiedade ap?s 1 m?s para todos os grupos. Entretanto, esta redu??o s? obteve signific?ncia estat?stica quando avaliada ao longo do tempo, HADS (p < 0,001), BAI (p < 0,001), IDATE-T (p = 0,006), n?o sendo, portanto, significante a diminui??o dos sintomas entre os diferentes grupos de tratamento. Apenas para a avalia??o da ansiedade-estado feita pelo IDATE-E n?o foi encontrada redu??o significativa entre os grupos (p = 0,068) nem ao longo do tempo (p = 0,760). Conclus?o: Os resultados deste estudo mostram que as terapias utilizadas foram eficazes na redu??o da dor e dos sintomas de ansiedade em pacientes diagnosticados com DTM. Entretanto, nenhum grupo foi superior ao outro na redu??o das vari?veis estudadas. === Introduction: Anxiety is considered a relevant psychosocial factor in the multifactorial etiology of temporomandibular dysfunction (TMD). Aim: To determine the effect of treatment with occlusal splint (OS), manual therapy (MT), counseling (C) and the association of occlusal splint + counseling (OSC) in the measurement of pain and anxiety in patients with TMD. Methods: A randomized clinical trial was conducted with 89 patients diagnosed with TMD through RDC / TMD (Research Diagnostic Criteria for Temporomandibular Disorders) and divided into four groups of treatment: OSC (n = 25), OS (n = 24), MT (n = 21) and C (n = 19). Participants were assessed before and after 1 month of therapy for pain, anxiety and TMD diagnosis. Pain measurement was done according to a visual analogue scale (VAS). To assess anxiety, three questionnaires were used: the Hospital Anxiety and Depression Scale (HADS), the Beck Anxiety Inventory (BAI) and the Trait-State Anxiety Index (IDATE-T and E). The data were analyzed using SPSS (Statistical Package for Social Science) 22.0 with the Split Plot ANOVA test and with a confidence level of 95%. Results: Among the participants, there was a predominance of females (82.1%, n = 72) and the mean age was 28 years (? SD = 9.34). The four groups obtained a significant reduction (p <0.001) in the pain variable after 1 month of treatment. The evaluation of anxiety, made with three different questionnaires, showed that there was reduction of anxiety symptoms after 1 month for all groups. However, this reduction was only statistically significant when evaluated over time, HADS (p <0.001), BAI (p <0.001), IDATE-T (p = 0.006), and therefore, there was no significant decrease in symptoms among different treatment groups. Only for the evaluation of state-anxiety by the IDATE-E, no significant reduction was found between the groups (p = 0.068) nor over time (p = 0.760). Conclusion: The results of this study showed that the therapies used were effective in reducing pain and anxiety symptoms in patients diagnosed with TMD. However, no group was superior to the other in reducing the studied variables.