Fricton James R, Ouyang Wei, Nixdorf Donald R, Schiffman Eric L, Velly Ana Miriam, Look John O
School of Dentistry, University of Minnesota, 515 Delaware St. SE, 6-320 Moos, Minneapolis, MN 55455, USA.
J Orofac Pain. 2010 Spring;24(2):139-51.
To evaluate the quality of methods used in randomized controlled trials (RCTs) of treatments for management of pain and dysfunction associated with temporomandibular muscle and joint disorders (TMJD) and to discuss the implications for future RCTs.
A systematic review was made of RCTs that were implemented from 1966 through March 2006, to evaluate six types of treatments for TMJD: orthopedic appliances, occlusal therapy, physical medicine modalities, pharmacologic therapy, cognitive-behavioral and psychological therapy, and temporomandibular joint surgery. A quality assessment of 210 published RCTs assessing the internal and external validity of these RCTs was conducted using the Consolidated Standards of Reporting Trials (CONSORT) criteria adapted to the methods of the studies.
Independent assessments by raters demonstrated consistency with a mean intraclass correlation coefficient of 0.63 (95% confidence interval). The mean percent of criteria met was 58%, with only 10% of the RCTs meeting the four most important criteria.
Much of the evidence base for TMJD treatments may be susceptible to systematic bias and most past studies should be interpreted with caution. However, a scatter plot of RCT quality versus year of publication shows improvement in RCT quality over time, suggesting that future studies may continue to improve methods that minimize bias.
评估用于治疗与颞下颌肌肉和关节紊乱（TMJD）相关的疼痛和功能障碍的随机对照试验（RCT）中所使用方法的质量，并讨论其对未来RCT的启示。
对1966年至2006年3月期间实施的RCT进行系统评价，以评估六种治疗TMJD的方法：矫形器具、咬合治疗、物理医学方法、药物治疗、认知行为和心理治疗以及颞下颌关节手术。使用根据研究方法改编的《报告试验的统一标准》（CONSORT）标准，对评估这些RCT的内部和外部有效性的210篇已发表RCT进行质量评估。
评估者的独立评估显示一致性，组内相关系数均值为0.63（95%置信区间）。符合标准的平均百分比为58%，只有10%的RCT符合四个最重要的标准。
TMJD治疗的许多证据基础可能易受系统偏差影响，大多数既往研究应谨慎解读。然而，RCT质量与发表年份的散点图显示，随着时间的推移RCT质量有所提高，这表明未来的研究可能会继续改进将偏差降至最低的方法。
