PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2010

Clinical Scenario

I recently had an initial evaluation of a patient with temporomandibular joint (TMJ) pain. The patient’s onset of TMJ came on after a car accident a few years ago, where she also experienced cervical and upper thoracic pain as well as vestibular impairments. I was interested in finding the most effective treatment approach. I would like to determine whether manual physical therapy and exercise would give better results than the use of modalities (ultrasound or electrical stimulation) and exercise.

Clinical Question

Population: Adults with TMJ pain or Temporomandibular joint disorder (TMD)

Intervention: Manual therapy and exercise

Comparison: Modalities (ultrasound or electrical stimulation) and exercise

Outcome: Pain (VAS), functional improvement in ROM

Clinical Bottom Line

Both of these articles supported the use of manual therapy in treating adults with TMD. However, the articles by Cuccia et al. and La Touche et al. are not very good matches to my clinical question, even though Cuccia et al. was of excellent quality (ranking 8/11 on the PEDro scale). Cuccia was a randomized controlled trial with 50 adults with TMD comparing osteopathic manipulation to conventional conservative treatment. La Touche et al. was a descriptive study following a cohort over a 12 week period looking at the response of manual therapy to the cervical spine. The results of these articles show statistical significant differences between baseline and end of treatment for active mouth opening. For improvements in pain, Cuccia et al. did not meet the MCID where as La Touche et al. did surpass the known MCID at both 48 hours and 12 weeks. The Cuccia et al. article had adequate internal validity, whereas La Touche et al. primary threat is a lack of control group and small sample size, decreasing the likelihood of any potential results and generalizing the results to the general clinical population. Although both articles showed statistical significance of functional mouth opening with the use of manual therapy, neither article directly addressed my clinical question, therefore further research is needed in order to accept any potential results. At this time these articles would not affect my treatment interventions for adults with TMJ.

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