| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 99 === The prevalence of temporomandibular disorders (TMD) is 20 to 60%. Most patients suffer from myofascial pain (MFP) subtype of TMD. Since the MFP can be resulted from pathologies of masticatory muscles as well as temporomandibular joints (TMJs), the term ‘TMD-related MFP’ will be used in the study to indicate MFP secondary to TMJ inflammation with subsided primary symptoms. To treat TMD-related MFP, dentists may use medication, local muscle injection or oral appliance. They also refer the patients to physical therapists frequently. Many physical therapy (PT) modalities and techniques are applied on these patients. The effectiveness of single PT approach is well studied. However, previous studies only confirmed the immediate effect of manual myofascial release. It is worthwhile to investigate the long-term effect of this technique on patients with TMD-related MFP. Since physical therapists usually treat patients with program which consists of passive and active approach, the effect of program consisting of manual myofascial release and exercise also needs investigation. Therefore, the purpose of this study is to compare the effect of PT intervention and oral appliance on subjects with TMD-related MFP.
This study was a prospective randomized controlled trial. Forty-nine women with TMD-related MFP were recruited from TMJ special clinic of National Taiwan University Hospital (NTUH) and 41 of them completed intervention course and follow-up. After pre-intervention evaluation, the subjects were randomly allocated into ‘PT program group’ (PT group) or ‘oral appliance group’ (Splint group). Subjects in PT group visited physical therapists twice per week to receive manual myofascial release and exercise therapy. Those in Splint group received a custom-made fabricated appliance and wore it during night every day. The treatment duration was 8 weeks for both groups. Post-intervention evaluation was performed after intervention for both groups. Subjects in PT group received additional follow-up evaluation at the fourth week of intervention and 4 weeks after intervention completion.
Primary outcomes were subjective and objective pain status. Visual Analog Scale (VAS) was used for subjective pain status measurement and pressure pain threshold (PPT) was used for objective one. Secondary outcomes were active and passive maximal mouth opening range (AMMO and PMMO), stiffness of masseter taut band, maximal bite force, repetitions of bite, as well as Quality of Life (QoL). Statistical analyses were performed by SPSS 13.0. Descriptive statistics was used for presenting the basic data. Two-way ANOVA was used to investigate the group by time effect. Nonparametric between group comparisons was investigated through Mann-Whitney U test. The paired t-test or Wilcoxon signed-rank test was used to investigate the pre- to post-intervention effect. All analyses were tested with a significance level of p<0.05 by using the intention to treat principle.
After intervention, there were time effects on energy/ fatigue, social functioning and pain domain of QoL in patients with TMD-related MFP (p<0.05). Physical therapy had significant better effect on general health domain of QoL (p<0.05). There was also significant pre- to post-intervention improvement on subjective pain status in PT group. However, there was no significant difference of other outcomes between or within groups.
In conclusion, the present study suggests that physical therapy program has the same and even superior effect comparing oral appliance on TMD-related MFP. However, these results should be interpreted with caution, considering the limitation such as small power and effect size.
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