Quality of life and level of physical activity of individuals with temporomandibular disorders with and without otological symptoms: Secondary analysis of a cross-sectional study.

BACKGROUND AND PURPOSE: Otological symptoms (OS) are highly prevalent in individuals with temporomandibular disorders (TMD). Individuals with TMD and OS have more neck disability and decreased deep neck muscles endurance when compared to individuals without OS. However, no studies have evaluated whether OS is associated with lower Quality of Life (QoL) and worse levels of physical activity. This study aimed to evaluate the QoL and level of physical activity of individuals with TMD with and without OS. METHODS: In this cross-sectional study, 62 individuals with TMD were allocated into 2 groups: TMD with OS (n = 36) or TMD without OS (n = 26). Self-reported complaints of dizziness, vertigo, tinnitus, earache, ear fullness, or hypoacusis were considered as OS. QoL was assessed with the WHOQOL-Bref and physical activity with the IPAQ-SF. Independent t-test and chi-squared test were used for analysis between-groups. Effect sizes were reported using Cohen's d. A Pearson correlation was used to compare the number of OS and QoL scores. A significance level of p < 0.05% and 95% confidence intervals were considered statistically significant. RESULTS: The total generic scores for QoL were not different between-groups (p = 0.076), but individuals with TMD with OS had lower satisfaction (p = 0.015; d: 0.63) and physical domain (p = 0.015; d: 0.64) scores with a moderate effect size. In TMD with OS, 69.4% of individuals were irregularly active and 50% for the TMD without OS, with no statistical significance (p > 0.05). The number of OSs was inversely and weakly associated with the QoL total score. CONCLUSION: Individuals with TMD and OS are associated with worsened QoL (physical domain and satisfaction) when compared to individuals with TMD without OS. The higher the number of OS, the worse the QoL score. Individuals with TMD with and without OS had similar levels of physical activity, but a high prevalence of irregularly active and sedentary individuals within TMD diagnosed population was found.

Impact of working and learning from home during the COVID-19 pandemic on the head, the neck and orofacial health: A cross-sectional pilot study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, about 81% of the world's population moved their workplace to a home office. OBJECTIVES: The main objective of this cross-sectional pilot study was to determine the impact of working and/or learning from home during the COVID-19 pandemic on the head, the neck and orofacial health in university students, faculty and staff. MATERIAL AND METHODS: Participants from 4 universities were recruited for an online survey. The survey included 33 questions related to demographics, health issues before and during the lockdown, work/study from home, and the awareness of the health effects of the lockdown. Descriptive statistics and single logistic regression analysis were employed. RESULTS: A total of 96 subjects aged 26 ±10.5 years participated in the study. Of these, 60% did not consider their home workstation to be adequate. The development of new symptoms or the worsening of the pre-existing symptoms was observed in 67%, 24%, 59%, and 37% of the participants with regard to neck pain, temporomandibular joint (TMJ)-related issues, headaches, and parafunctional oral habits, respectively. In addition, 87% of the respondents reported that their oral habits were aggravated by neck pain and a bad posture. As compared to the faculty and the staff, the students were more likely to experience headaches or the exacerbation of the pre-existing headaches during the pandemic. In the survey, 91% of the participants reported an increased awareness of the impact of the lockdown on their head and neck, and orofacial health. CONCLUSIONS: The present study helps understand the self-perceived effects of working and/or learning from home during the COVID-19 pandemic, and may facilitate implementing the appropriate models of treatment of the craniocervical-mandibular region during a pandemic.

Reliability and Responsiveness of a Novel Device to Evaluate Tongue Force.

BACKGROUND: Measurements of tongue force are important in clinical practice during both the diagnostic process and rehabilitation progress. It has been shown that patients with chronic temporomandibular disorders have less tongue strength than asymptomatic subjects. Currently, there are few devices to measure tongue force on the market, with different limitations. That is why a new device has been developed to overcome them. The objectives of the study were to determine the intra- and inter-rater reliability and the responsiveness of a new low-cost device to evaluate tongue force in an asymptomatic population. MATERIALS AND METHODS: Two examiners assessed the maximal tongue force in 26 asymptomatic subjects using a developed prototype of an Arduino device. Each examiner performed a total of eight measurements of tongue force in each subject. Each tongue direction was measured twice (elevation, depression, right lateralization, and left lateralization) in order to test the intrarater reliability. RESULTS: The intrarater reliability using the new device was excellent for the measurements of the tongue force for up (ICC > 0.94), down (ICC > 0.93) and right (ICC > 0.92) movements, and good for the left movement (ICC > 0.82). The SEM and MDC values were below 0.98 and 2.30, respectively, for the intrarater reliability analysis. Regarding the inter-rater reliability, the ICC was excellent for measuring the tongue up movements (ICC = 0.94), and good for all the others (down ICC = 0.83; right ICC = 0.87; and left ICC = 0.81). The SEM and MDC values were below 1.29 and 3.01, respectively, for the inter-rater reliability. CONCLUSIONS: This study showed a good-to-excellent intra- and inter-reliability and good responsiveness in the new device to measure different directions of tongue force in an asymptomatic population. This could be a new, more accessible tool to consider and add to the assessment and treatment of different clinical conditions in which a deficit in tongue force could be found.

Pain, deep neck flexors performance, disability, and head posture in individuals with temporomandibular disorder with and without otological complaints.

BACKGROUND: Otological complaints (OC) are highly prevalent in subjects with temporomandibular disorders (TMD) and so is the risk of neck dysfunctions. OBJECTIVE: To evaluate pain, deep neck flexor (DNF) performance, disability, and head and neck posture of individuals with TMD with and without OC. METHODS: In this cross-sectional study, 57 individuals were divided into a group with TMD and OC (n= 31) and a group with TMD without OC (n= 26). Self-reported pain intensity, masticatory and neck muscles pressure pain thresholds, DNF performance, neck disability, and head and neck posture were evaluated. Data were compared between groups using the independent t test and Mann-Whitney test with Bonferroni correction for multiple comparisons. Effect sizes were evaluated using Cohen's index. RESULTS: The TMD with OC group presented less muscle activation [26 (24-28) vs. 24 (24-26) mmHg; p< 0.05], less endurance [105 (46-140) vs. 44 (28-78) points; p< 0.05], and greater neck disability (8.15 ± 5.89 vs. 13.32 ± 6.36 points; p< 0.05). No significant difference was observed in self-reported pain, head and neck posture, or pressure pain thresholds. CONCLUSION: Individuals with TMD with OC presented decreased DNF performance and increased neck disability compared to individuals with TMD without OC.

Usability and effects on gait of an optimized schoolchildren backpack.

BACKGROUND: Backpacks used by children is a global concern, because may cause musculoskeletal discomforts and pain. OBJECTIVE: The purpose of this study was to test the usability and effects on gait kinematics wearing the Trunkpack versus a traditional backpack and no backpack. METHODS: Twenty-four children (9 to 11 years old) from a public school participated in this study. The usability was evaluated after a five-week testing period using a questionnaire. Gait kinematics was evaluated (Vicon) when the children were wearing a standard backpack, an optimized backpack (Trunkpack), and no backpack. Both backpacks were loaded with 10% of body weight. RESULTS: Was observed more trunk, hip and knee flexion when the children carried a standard backpack in comparison using the Trunkpack and not carrying a backpack (p < 0.01). The Trunkpack and no backpack were similar. The Trunkpack was well accepted by the schoolchildren (81% positive responses), 79% liked the head opening, 88% liked the waist straps, and 83% liked the facility to put and take objects in and out of the Trunkpack. CONCLUSION: Trunkpack requires less postural adjustments during gait than a standard backpack. Gait kinematics with the Trunkpack was comparable to the gait without carrying a backpack.

Are neck pain, disability, and deep neck flexor performance the same for the different types of temporomandibular disorders?

OBJECTIVE: To evaluate neck pain, disability, and deep neck flexor (DNF) performance of individuals with temporomandibular disorders (TMD). METHODS: Eighty individuals were divided into the following: arthrogenic TMD (n = 40), myogenic TMD (n = 12), and mixed TMD (n = 28). Neck pain intensity, neck disability, and DNF performance were evaluated. RESULTS: Individuals with arthrogenic TMD reported lower intensity of neck pain when compared to mixed TMD (p = 0.01). Individuals with arthrogenic TMD had less neck disability than individuals with myogenic TMD (p = 0.037) and mixed TMD (p < 0.001). A moderate positive correlation was found between neck pain and neck disability (p < 0.001). No differences were found for DNF performance. CONCLUSION: Neck pain and disability differs according to subtype of TMD, but performance of the deep neck flexors does not. Neck pain intensity and neck disability were correlated in patients with TMD.

Prevalence of temporomandibular disorders in musicians: A systematic review and meta-analysis.

OBJECTIVE: To determine the prevalence of temporomandibular disorders (TMD) in musicians. MATERIALS AND METHODS: Electronic database searches and a manual search were performed. Qualitative and quantitative analysis including risk of bias was performed for studies that met the inclusion criteria. A meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored according to the moderating variable through subgroup analysis and metaregression. The certainty of the evidence was assessed using the GRADE tool. RESULTS: A total of 13 articles were included for the meta-analysis. Pooled prevalence estimate was 52.8% (CI 95%; 33.4%-71.7%) for wind instruments, 53.9% (CI 95%; 42.4%-65.2%) for string instruments and 53.9% (CI 95%; 23.5%-82.7%) for string and wind instruments. The average time of use of the musical instrument explained 82.38%, the heterogeneity between the sizes of the effects observed in the analysis (R2  = 82.38%; P < .0001). For prevalence of TMD, the GRADE criteria were considered very low. CONCLUSION: The overall combined prevalence of TMD in musicians was approximately 53.9%, and musicians who use their instruments daily and for a long period of time may have a higher prevalence of TMD. CLINICAL SIGNIFICANCE: Due to the high prevalence of TMD in musicians, health professionals must be careful not to underestimate signs and symptoms and correctly diagnose these cases.

International consensus on the most useful assessments used by physical therapists to evaluate patients with temporomandibular disorders: A Delphi study.

OBJECTIVE: To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT). METHODS: A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e-survey, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was posted using SurveyMonkey for each round. Percentages of responses were analysed for each question from each round of the Delphi survey administrations. RESULTS: Twenty-three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools and 3) physical examination tests. The following was the consensus-based decision regarding the identification of the clinically most useful assessments. (1) Four of 9 questionnaires were identified: Jaw Functional Limitation (JFL-8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD) and the neck disability index (NDI). (2) Three of 8 identified pain screening tests: visual analog scale (VAS), numeric pain rating scale (NRS) and pain during mandibular movements. (3) Eight of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine and the Neck Flexor Muscle Endurance Test. CONCLUSION: After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity) and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research.

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey.

Purpose: It is unclear how physical therapists in Florida currently treat people with knee osteoarthritis and whether current best evidence is used in clinical decision making. Methods: We conducted a survey of physical therapists in Florida. We assessed the perceived effectiveness and actual use of physical therapy (PT) interventions and quantified the association between the actual use of interventions and different characteristics of physical therapists. Results: A total of 413 physical therapists completed the survey. Most respondents perceived therapeutic exercise (94%) and education (93%) as being effective or very effective. Interventions least perceived as effective or very effective were electrotherapy (28%), wedged insole (20%), and ultrasound (19%). Physical therapists who followed the principles of evidence-based practice were more likely to use therapeutic exercise (OR 3.89; 95% CI: 1.21, 12.54) and education (OR 3.63; 95% CI: 1.40, 9.43) and less likely to use ultrasound (OR 0.32; 95% CI: 0.16, 0.63) and electrotherapy (OR 0.32; 95% CI: 0.17, 0.58). Results also indicated that older physical therapists were more likely to use ultrasound (OR 3.57; 95% CI: 1.60, 7.96), electrotherapy (OR 2.53; 95% CI: 1.17, 5.47), kinesiology tape (OR 3.82; 95% CI: 1.59, 9.18), and ice (OR 1.95; 95% CI: 1.02, 3.73). Conclusions: In line with clinical guidelines, most physical therapists use therapeutic exercise and education to treat people with knee osteoarthritis. However, interventions that lack scientific support, such as electrotherapy and ultrasound, are still used. A modifiable therapist characteristic, adherence to evidence-based practice, is positively associated with the use of interventions supported by scientific evidence.

Objectif : on ne sait pas comment les physiothérapeutes de la Floride traitent les personnes atteintes d'arthrose du genou et s'ils tiennent compte des meilleures données probantes dans leur prise de décisions cliniques. Méthode : nous avons mené un sondage auprès des physiothérapeutes de la Floride. Nous avons évalué l'efficacité perçue et le recours réel aux interventions de physiothérapie (PT) et avons quantifié le lien entre le recours réel aux interventions et différentes caractéristiques des physiothérapeutes. Résultats : au total, 413 physiothérapeutes ont répondu au sondage. La plupart des répondants croient que les exercices thérapeutiques (94 %) et l'éducation (93 %) sont efficaces ou très efficaces. Les interventions les moins perçues comme étant efficaces ou très efficaces sont l'électrothérapie (28 %), les orthèses plantaires (20 %) et les ultrasons (19 %). Les physiothérapeutes qui suivent les principes de la pratique fondée sur des données probantes sont plus susceptibles d'avoir recours aux exercices thérapeutiques (rapport des cotes [RC]=3,89; IC à 95 % 1,21; 12,54) et à l'éducation (RC 3,63; IC à 95 % 1,40; 9,43) et sont moins susceptibles d'utiliser l'ultrason (RC 0,32; IC à 95 % 0,16; 0,63) et l'électrothérapie (RC 0,32; IC à 95 % 0,17; 0,58). Les résultats indiquent aussi que les physiothérapeutes plus âgés sont plus susceptibles d'utiliser l'ultrason (RC 3,57; IC à 95 % 1,60; 7,96), l'électrothérapie (RC 2,53; IC à 95 % 1,17; 5,47), le ruban kinésiologique (RC 3,82; IC à 95 % 1,59; 9,18) et la glace (RC 1,95; IC à 95 % 1,02; 3,73). Conclusions : conformément aux normes de pratique clinique, la plupart des physiothérapeutes ont recours aux exercices thérapeutiques et à l'éducation pour traiter les personnes atteintes d'arthrose du genou. Cependant, des interventions peu appuyées par la science, comme l'électrothérapie et l'ultrason, sont toujours utilisées. Une caractéristique modifiable du thérapeute, l'adhésion à la pratique fondée sur des données probantes, est associée de manière positive au recours aux interventions appuyées par les données scientifiques.

Effect of time of contraction and rest on the masseter and anterior temporal muscles activity in subjects with temporomandibular disorder. / Efeito do tempo de contração e repouso na atividade dos músculos masseter e temporal anterior em indivíduos com DTM.

Purpose The main objective of this study was to investigate the effect of time of contraction and rest on the masseter and temporal muscles activity. Methods 49 female subjects between 18 and 30 years of age were divided into TMD (n: 26) and control groups (n: 23). Surface electromyograph was used to evaluate the anterior temporal and masseter muscles during contraction and rest protocols. The root means square, median frequency and slope coefficient of the linear regression line parameters were analyzed. Results A significant effect of time in the contraction and rest muscle protocols was found. TMD patients showed a significant decrease in median frequency in the right masseter muscle and the slope coefficient in the right temporal muscle during the contraction protocol to control subjects. Conclusion Despite the TMD patients presented with higher fatigue susceptibility compared to the control group, both groups must meet the maximum time of 5 s of maximum voluntary contraction and at least 30 s rest between successive contractions of masticatory muscles during clinical or research assessment protocols.

Efeito do tempo de contração e repouso na atividade dos músculos masseter e temporal anterior em indivíduos com DTM / Effect of time of contraction and rest on the masseter and anterior temporal muscles activity in subjects with temporomandibular disorder

RESUMO Objetivo O principal objetivo deste estudo foi investigar o efeito do tempo de contração e repouso na atividade dos músculos masseter e temporal. Métodos 49 sujeitos do sexo feminino com idade entre 18 e 30 anos foram divididos em grupos DTM (n: 26) e controle (n: 23). A eletromiografia de superfície foi utilizada para avaliar os músculos temporal anterior e masseter durante protocolos de contração e repouso muscular. Foram analisados os parâmetros eletromiográfico raiz quadrada da média, frequência mediana e o coeficiente da inclinação da reta de regressão linear. Resultados Foi encontrado efeito significativo do tempo no protocolo de contração e de repouso muscular. No protocolo de contração, sujeitos com DTM apresentaram significativa diminuição da frequência mediana no masseter direito e do coeficiente de inclinação do músculo temporal direito comparados ao grupo controle. Conclusão Apesar de os sujeitos com DTM apresentarem maior suscetibilidade à fadiga, comparados aos controles, ambos os grupos devem respeitar o tempo máximo de 5 s de contração voluntária máxima e no mínimo 30 s de repouso entre sucessivas contrações da musculatura mastigatória durante protocolos de avaliação clínica ou de pesquisa.

ABSTRACT Purpose The main objective of this study was to investigate the effect of time of contraction and rest on the masseter and temporal muscles activity. Methods 49 female subjects between 18 and 30 years of age were divided into TMD (n: 26) and control groups (n: 23). Surface electromyograph was used to evaluate the anterior temporal and masseter muscles during contraction and rest protocols. The root means square, median frequency and slope coefficient of the linear regression line parameters were analyzed. Results A significant effect of time in the contraction and rest muscle protocols was found. TMD patients showed a significant decrease in median frequency in the right masseter muscle and the slope coefficient in the right temporal muscle during the contraction protocol to control subjects. Conclusion Despite the TMD patients presented with higher fatigue susceptibility compared to the control group, both groups must meet the maximum time of 5 s of maximum voluntary contraction and at least 30 s rest between successive contractions of masticatory muscles during clinical or research assessment protocols.

Effect of mandibular mobilization on electromyographic signals in muscles of mastication and static balance in individuals with temporomandibular disorder: study protocol for a randomized controlled trial.

BACKGROUND: The stomatognathic system and dysfunction in this system may be related to postural control. The proposal of the present study is to assess the effect of mandibular mobilization in individuals with temporomandibular disorder using surface electromyography of the muscles of mastication and stabilometric variables. METHODS/DESIGN: A randomized, controlled, blind, clinical trial will be carried out, with the participants divided into three groups: 1) facial massage therapy (control group), 2) nonspecific mandibular mobilization and 3) specific mandibular mobilization. All groups will be assessed before and after treatment using the Research Diagnostic Criteria for Temporomandibular Disorders, surface electromyography of the masseter and temporal muscles and stabilometry. This study is registered with the Brazilian Registry of Clinical Trials (RBR9x8ssz). DISCUSSION: A large number of studies have employed surface electromyography to investigate the function/dysfunction of the muscles of mastication and associations with signs and symptoms of temporomandibular disorders. However, it has not yet been determined whether stabilometric variables offer adequate reliability in patients with this disorder. The results of the proposed study will help determine whether specific and/or nonspecific mandibular mobilization exerts an effect on the muscles of mastication and postural control. Moreover, if an effect is detected, the methodology defined in the proposed study will allow identifying whether the effect is local (found only in the muscles of mastication), global (found only in postural control) or generalized.

Head and cervical posture in patients with temporomandibular disorders.

AIM: To determine whether patients with myogenous or mixed (ie, myogeneous plus arthrogeneous) temporomandibular disorders (TMD) had different head and cervical posture measured through angles commonly used in clinical research settings when compared to healthy individuals. METHODS: One hundred fifty-four persons participated in this study. Of these, 50 subjects were healthy, 55 subjects had myogenous TMD, and 49 subjects had mixed TMD (ie, arthrogenous plus myogenous TMD). A lateral photograph was taken with the head in the self-balanced position. Four angles were measured in the photographs: (1) Eye-Tragus-Horizontal, (2) Tragus-C7-Horizontal, (3) Pogonion-Tragus-C7, and (4) Tragus-C7-Shoulder. Alcimagen software specially designed to measure angles was used in this study. All of the measurements were performed by a single trained rater, a dental specialist in orthodontics, blinded to each subject's group status. RESULTS: The only angle that reached statistical significance among groups was the Eye-Tragus-Horizontal (F = 3.03, P = .040). Pairwise comparisons determined that a mean difference of 3.3 degrees (95% confidence intervals [CI]: 0.15, 6.41) existed when comparing subjects with myogenous TMD and healthy subjects (P = .036). Postural angles were not significantly related to neck disability, jaw disability, or pain intensity. Intrarater and interrater reliability of the measurements were excellent, with intraclass correlation coefficient (ICC) values ranging between 0.996-0.998. CONCLUSION: The only statistically significant difference in craniocervical posture between patients with myogenous TMD and healthy subjects was for the Eye-Tragus-Horizontal angle, indicating a more extended position of the head. However, the difference was very small (3.3 degrees) and was judged not to be clinically significant.

Sensitivity of clinical assessments of sagittal head posture.

RATIONALE, AIMS AND OBJECTIVES: Historically, clinicians visually evaluate posture using anatomical landmarks. Advances in technology made digital photographs now feasible to use in clinical practice. Photogrammetry may increase the reliability of the assessment of postural changes. However, differences between visually estimated and photogrammetric recorded changes in posture need to be tested. The objective of this study was to evaluate the sensitivity of visual assessments of changes in head posture in the sagittal plane in relation to photogrammetric recorded data. METHODS: The head posture of 29 female subjects in a sagittal plane was assessed visually and photogrammetrically. The visual assessment of head posture was conducted using a postural grid with a plumb for checking the alignment. The patients were classified as having forward head posture (FHP), slight FHP or no FHP. Photogrammetry of head posture was performed using the Alcimage software (Alcimar B. Soares, Uberlândia, MG, Brasil). Three reference points were used to measure the head posture angle: mentus, external auditory meatus and manubrium. The visually classified groups were compared in relation to the photogrammetric angles using one-way ANOVA. RESULTS: A significant difference was found between the FHP and no FHP groups (P = 0.001), and between the FHP and slight FHP groups (P = 0.002). However, no significant difference was found between the slight FHP and no FHP groups. CONCLUSIONS: Visual assessments of sagittal head posture were sensitive to detect differences between no FHP and FHP groups, but were not sensitive to detect differences between no FHP and slight FHP groups. Head posture photogrammetry is recommended to quantitatively detect less evident differences in head posture.

Scales to assess the quality of randomized controlled trials: a systematic review.

BACKGROUND AND PURPOSE: The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales. METHODS: Extensive electronic database searches, along with a manual search, were performed. RESULTS: One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence; however, its validity for physical therapy trials has not been supported. DISCUSSION AND CONCLUSION: Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.