Electrostimulation of the posterior tibial nerve in individuals with overactive bladder: a literature review.

[Purpose] This study aims to gather scientific evidence to identify whether clinical trials on Electrostimulation of the Posterior Tibial Nerve (ESPTN) in individuals with overactive bladder present an adequate methodological standard according to the PEDro (Physiotherapy Evidence Database) criteria. [Methods] Integral literature review, including randomized controlled clinical trials found in PEDro. [Results] We found 16 articles, of which only one did not meet the inclusion criteria. This article has shown that ESPTN is a conservative tool of physiotherapy that is less invasive than other therapies, is well tolerated by patients and has been shown to be effective in the treatment of overactive bladder. However, few standardized clinical studies have been conducted, and only 26.6% of the articles included in this review obtained a score of more than five items on the PEDro scale. [Conclusion] This article has shown that ESPTN is a conservative tool of physiotherapy that is less invasive than other therapies, is well tolerated by patients and has been shown to be effective in the treatment of overactive bladder. Thus, there is a need for more clinical articles that follow the quality criteria for randomized clinical trials, allowing more reliable scientific results.

Systematic review of the measurement properties of instruments utilized to diagnose Temporomandibular Disorders according to the COSMIN checklist

Introduction: Most of the instruments used in Brazil to diagnose Temporomandibular Disorders (TMD) were developed in another Language. To effectively use instruments that were created in another language, it must be translated into the relevant target language before cross-cultural adaptation. Clinimetric tests should also be performed. Measurement properties consist of quality criteria related to evaluation instruments. These criteria are necessary to determine the quality of the instruments used in Brazil. Objectives: The aim of the present systematic review was to assess the quality of the measurement properties of instruments utilized to diagnose TMD. Methods: Systematic searches were performed of the PUBMED, SCIELO, LILACS and SCIENCE DIRECT databases. Studies addressing questionnaires translated and cross-culturally adapted for use in Brazil were retrieved and the quality of the measurement properties was analyzed using the COSMIN checklist. Results: In the 11 eligible articles, 10 instruments were identified. The studies were evaluated based on their analysis of structural validity, internal consistency, reproducibility (concordance and reliability), responsiveness, ceiling effect and floor effect. None the assessment tools had all its measurement properties tested. Conclusion: The measurement properties of the instruments were not completely tested. Thus, care must be taken when interpreting the scores of these questionnaires (AU).

Characteristics of EMG frequency bands in temporomandibullar disorders patients.

The aim of the present study was to determine whether any specific frequency bands of surface electromyographic (sEMG) signals are more susceptible to alterations in patients with temporomandibular disorders (TMD), when compared with healthy subjects. Twenty-seven healthy adults (19 women and eight men; mean age: 23±6.68years) and 27 TMD patients (20 women and seven men; mean age: 24±5.89years) voluntarily participated in the experiment. sEMG data were recorded from the right and left masseter muscles (RM and LM) and the right and left anterior temporalis muscles (RT and LT) as the participants performed tests of chewing (CHW) and maximal clenching effort (MCE). Frequency domain analysis of the sEMG signal was used to analyze differences between TMD patients and healthy subjects in relation to the Power Spectral Density Function (PSDF). The analysis focused on the median frequency (MDF) of the sEMG signal and PSDF frequency bands after the EMG spectrum was divided into twenty-five frequency band of 20Hz each. The Mann-Whitney test was used to compare MDF between TMD patients and healthy subjects and the frequency bands were analyzed using three-way ANOVA with three factors: frequency band, muscle and group. The results of the analysis confirmed that the median frequency values in TMD patients were significantly higher (p<0.05) than those recorded for healthy subjects in the two experimental conditions (MCE and CHW), for all of the muscles assessed (RM, LM, RT and LT). In addition, frequency content between 20 and 100Hz of the normalized PSDF range was significantly lower (p<0.05) in TMD patients than in healthy. This study contributes to quantitatively identify TMD dysfunctions, by non-invasive sEMGs; this assessment is clinically important and still lacking nowadays.

Correlation between temporomandibular disorder and quality of sleep in women / Correlação entre Disfunção temporomandibular e qualidade do sono em mulheres

Abstract Introduction: Temporomandibular Disorder (TMD) is caused by multiple factors and exhibits various symptoms. Its most common symptom is pain, a factor that can influence the quality of an individual's sleep. Objective: The aim of the present study was to assess the correlation between TMD and sleep. Methods: A cross-sectional study was conducted with 60 women, aged between 18 and 40 years, who had been diagnosed with TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Fonseca's anamnestic index (FAI) was used to classify the severity of the dysfunction. To complete the assessment, each volunteer was assessed using the visual analogue scale (VAS) for pain. They also responded to two questions related to their quality of sleep and the average hours of sleep per night. Results: The more severe the TMD, the fewer hours of sleep per night (r = -0.5663). In total, 63.33% of the volunteers reported not sleeping well. Concerning pain, the greater the VAS score, the less hours of sleep (r = -0.516) and the more severe the TMD. Conclusion: It was found that the severityof TMD was correlated with pain symptoms and the number of hours of sleep per night.

Resumo Introdução: A etiologia da Disfunção Temporomandibular (TMD) é multifatorial e apresenta sintomatologia variada, sendo a dor o sintoma mais comum, o que pode influenciar na qualidade do sono. Objetivo: Este estudo teve como objetivo avaliar a correlação entre a TMD e a qualidade e quantidade de sono. Métodos: Estudo transversal no qual foram selecionadas 60 mulheres entre 18 e 40 anos, portadoras de TMD, diagnosticadas por meio do Critérios de Diagnóstico para Pesquisa das Desordens Temporomandibulares (RDC/TMD), e que responderam ao Índice Anamnético de Fonsecapara classificação quanto ao grau de severidade da disfunção. Para completar a avaliação, cada voluntária respondeu a Escala visual analógica da dor, e duas questões com relação a qualidade do sono, e a quantidade média de horas de sono por noite. Resultados: Verificou-se que quanto mais severa a TMD, menor o número de horas dormidas por noite (r = -0,5663) e 63,33% das voluntárias relataram não dormir bem. Com relação a dor, quanto maior a dor, menor as horas dormidas (r = -0,516) e quanto mais severa a TMD, maior a dor. Conclusão: Observou-se que quanto mais severa a TMD, maior a dor e menor o número de horas que as voluntárias referiam dormir por noite.

Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature.

The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: "temporomandibular joint laser therapy" and "TMJ laser treatment". [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.

Effects of phototherapy on muscle activity and pain in individuals with temporomandibular disorder: a study protocol for a randomized controlled trial.

BACKGROUND: According to the International Association for the Study of Pain (IASP), the term temporomandibular disorder (TMD) regards a subgroup of orofacial pain, the symptoms of which include pain or discomfort in the temporomandibular joint, ears, masticatory muscles and neck on one or both sides, as well as joint sounds, limited mandibular movements or mandibular deviation and difficulties chewing. Phototherapy, such as low-level laser therapy (LLLT) and light-emitting diode (LED) therapy, is one of the resources used to treatment muscle pain. Thus, there is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (LLLT and LED) in the same apparatus. The aim of the proposed study is to evaluate the effects of four different doses of phototherapy on pain, activity of the masticatory muscles (masseter and bilateral anterior temporal) and joint mobility in individuals with temporomandibular disorder. A further aim is to determine the cumulative effect 24 and 48 hours after a single session. METHODS/DESIGN: A placebo-controlled, double-blind, randomized, clinical trial will be carried out involving 72 women between 18 and 40 years of age with a diagnosis of myogenous TMD. The participants will then be randomly allocated to four groups totaling 18 individuals per group. Three groups will be submitted to a single session of phototherapy with different light sources, and one group will receive placebo therapy: Group A (2.62 Joules); Group B (5.24 Joules); Group C (7.86 Joules); and Group D (0 Joules). The following assessment tools will be administered on four separate occasions (baseline and immediately after, 24 h after and 48 h after phototherapy). Pain intensity will be assessed using the visual analog scale for pain, while pain thresholds will be determined using algometer, and electromyographic (EMG) analysis on the masseter and anterior temporal muscles. DISCUSSION: The study will contribute to the practice of the evidence-based use of phototherapy in individuals with a myogenous TMD. Data will be published after the study is completed. TRIAL REGISTRATION: This study is registered with the Brazilian Registry of Clinical Trials, NCT02018770, date of registration: 7 December 2013.

Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial.

BACKGROUND: Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee. METHODS/DESIGN: A double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks. DISCUSSION: The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed. TRIAL REGISTRATION: The protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014.

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.