颞下颌关节紊乱症非侵入性干预措施的有效性：安大略交通伤害管理协议（OPTIMa）协作组的系统评价
The Effectiveness of Noninvasive Interventions for Temporomandibular Disorders: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
作者信息
Randhawa Kristi, Bohay Richard, Côté Pierre, van der Velde Gabrielle, Sutton Deborah, Wong Jessica J, Yu Hainan, Southerst Danielle, Varatharajan Sharanya, Mior Silvano, Stupar Maja, Shearer Heather M, Jacobs Craig, Taylor-Vaisey Anne
机构信息
*UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT)-Canadian Memorial Chiropractic College (CMCC) †Divisions of Graduate Education and Research ‡Undergraduate Education §§Clinical Education, Canadian Memorial Chiropractic College (CMCC) #Toronto Health Economics and Technology Assessment (THETA) Collaborative **Leslie Dan Faculty of Pharmacy, University of Toronto ††Institute for Work and Health ‡‡UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto ∥Canada Research Chair in Disability Prevention and Rehabilitation ¶Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa §Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
出版信息
Clin J Pain. 2016 Mar;32(3):260-78. doi: 10.1097/AJP.0000000000000247.
OBJECTIVE
To determine the effectiveness and cost-effectiveness of noninvasive interventions for temporomandibular disorders (TMD).
METHODS
We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central register from 1990 to 2014 for effectiveness studies and the Cochrane Health Technology Assessment Database, EconLit, NHS Economic Evaluation Database, and Tufts Medical Center Cost-Effectiveness Analysis Register from 1990 to 2014 for cost-effectiveness studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Evidence from eligible studies was synthesized using best-evidence synthesis methodology.
RESULTS
Our search for effectiveness studies yielded 16,995 citations; 31 were relevant and 7 randomized controlled trials (published in 8 articles) had a low risk of bias. We found no relevant cost-effectiveness studies. The evidence suggests that for persistent TMD: (1) cognitive-behavioral therapy and self-care management lead to similar improvements in pain and disability but cognitive-behavioral therapy is more effective for activity interference and depressive symptoms; (2) cognitive-behavioral therapy combined with usual treatment provides short-term benefits in pain and ability to control pain compared with usual treatment alone; (3) intraoral myofascial therapy may reduce pain and improve jaw opening; and (4) structured self-care management may be more effective than usual treatment. The evidence suggests that occlusal devices may not be effective in reducing pain and improving motion for TMD of variable duration. Evidence on the effectiveness of biofeedback is inconclusive.
DISCUSSION
The available evidence suggests that cognitive-behavioral therapy, intraoral myofascial therapy, and self-care management are therapeutic options for persistent TMD.
目的
确定颞下颌关节紊乱病（TMD）非侵入性干预措施的有效性和成本效益。
方法
我们系统检索了1990年至2014年的MEDLINE、EMBASE、CINAHL、PsycINFO和Cochrane中央注册库以查找有效性研究，并检索了1990年至2014年的Cochrane卫生技术评估数据库、EconLit、英国国家卫生服务体系经济评估数据库和塔夫茨医学中心成本效益分析注册库以查找成本效益研究。由随机配对的独立评审员使用苏格兰校际指南网络标准对符合条件的研究进行严格评估。使用最佳证据综合方法对符合条件的研究证据进行综合。
结果
我们对有效性研究的检索共得到16,995条引文；31条相关，7项随机对照试验（发表于8篇文章）存在低偏倚风险。我们未找到相关的成本效益研究。证据表明，对于持续性TMD：（1）认知行为疗法和自我护理管理在疼痛和功能障碍改善方面效果相似，但认知行为疗法在活动干扰和抑郁症状方面更有效；（2）与单纯常规治疗相比，认知行为疗法联合常规治疗在疼痛和疼痛控制能力方面具有短期益处；（3）口内肌筋膜疗法可能减轻疼痛并改善张口度；（4）结构化自我护理管理可能比常规治疗更有效。证据表明，咬合装置对于不同病程的TMD在减轻疼痛和改善活动方面可能无效。关于生物反馈有效性的证据尚无定论。
讨论
现有证据表明，认知行为疗法、口内肌筋膜疗法和自我护理管理是持续性TMD的治疗选择。
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