Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial.

The purpose of this study was to compare the short-term effectiveness of home physical therapy (HPT) alone with that of manual therapy (MT) in conjunction with home physical therapy (MT-HPT) performed for four weeks in patients with temporomandibular disorders (TMD). Forty subjects (nine males and 31 females; age, 18-72 years) with TMD were randomly divided into two groups: HPT (n = 20; five males and 15 females; mean age, 34.8 ± 12.4 years) and MT-HPT (n = 20; four males and 16 females; mean age, 37.0 ± 14.6 years). Pain intensity was evaluated at rest and with stress using a visual analogue scale (VAS). Pain-free maximum mouth opening (MMO) was also evaluated. Mean change score (MCS) in VAS and the smallest detectable difference (SDD) in pain-free MMO were measured over time. The results were analysed by MANOVA to evaluate the effects of treatment over time. At baseline, the groups did not differ from each other with respect to VAS scores and pain-free MMO (p > 0.05). Within each group, VAS with stress decreased (p < 0.001) and pain-free MMO increased (p < 0.001) over time. Between groups, both timetreatment effect and treatment effect were significant for VAS with stress (p < 0.001); however, only timetreatment effect was significant for pain-free MMO (p = 0.009). In the MT-HPT group, MCS for VAS with stress was 91.3% and SDD for pain-free MMO was 10 mm. Our results suggest that a four-week period of MT-HPT has a clinically significant effect on both pain and pain-free maximum mouth opening in patients with TMD.