J Orthop Sports Phys Ther. 2020 Aug;50(8):455-465. doi: 10.2519/jospt.2020.9175. Epub 2020 Jan 6.
To determine the immediate and short-term effects of adding cervical spine high-velocity, low-amplitude thrust (HVLAT) to behavioral education, soft tissue mobilization, and a home exercise program on pain and dysfunction for people with a primary complaint of temporomandibular disorder (TMD) with myalgia.
Randomized clinical trial.
Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for 4 visits over 4 weeks. Participants in both groups received other treatments, including standardized behavioral education, soft tissue mobilization, and a home exercise program. Primary outcomes included maximal mouth opening, the numeric pain-rating scale, the Jaw Functional Limitation Scale (JFLS), the Tampa Scale of Kinesiophobia for TMD (TSK-TMD), and a global rating of change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, and follow-ups of 1 week and 4 weeks. A 2-by-4 mixed-model analysis of variance was used, with intervention group as the between-subjects factor and time as the within-subject factor. Separate analyses of variance were performed for dependent variables, and the hypothesis of interest was the group-by-time interaction.
There was no significant interaction for maximal mouth opening, the numeric pain-rating scale, or secondary measures. There were significant 2-way interactions for the JFLS ( = 0.60) and TSK-TMD ( = 0.80). The HVLAT group had lower fear at 4 weeks and improved jaw function earlier (1 week). The GROC favored the HVLAT group, with significant differences in successful outcomes noted immediately after baseline treatment (thrust, 6/25; sham, 0/25) and at 4 weeks (thrust, 17/25; sham, 10/25).
Both groups improved over time; however, differences between groups were small. There were significant differences between groups for the JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear for treating TMD. .
确定对原发性颞下颌关节紊乱病（TMD）伴肌痛患者在接受行为教育、软组织松解和家庭运动方案的基础上，增加颈椎高速度、低幅度推扳（HVLAT）治疗，对疼痛和功能障碍的即刻和短期影响。
随机临床试验。
50 名 TMD 患者被随机分配接受颈椎 HVLAT 或假手法治疗，共 4 次，4 周内完成。两组患者均接受其他治疗，包括标准化行为教育、软组织松解和家庭运动方案。主要结局包括最大张口度、数字疼痛评分、下颌功能受限量表（JFLS）、颞下颌关节肌筋膜疼痛功能紊乱量表（TSK-TMD）和整体变化评级（GROC）。在基线、初始治疗后即刻、1 周和 4 周随访时进行自我报告和客观测量。采用 2×4 混合模型方差分析，干预组为组间因素，时间为组内因素。对因变量进行方差分析，感兴趣的假设是组间×时间的交互作用。
最大张口度、数字疼痛评分或次要测量指标均无显著的组间×时间交互作用。JFLS（ = 0.60）和 TSK-TMD（ = 0.80）存在显著的 2 因素交互作用。HVLAT 组在 4 周时恐惧程度较低，下颌功能更早改善（1 周）。GROC 有利于 HVLAT 组，在基线治疗后即刻（推扳组 6/25，假手法组 0/25）和 4 周时（推扳组 17/25，假手法组 10/25）有显著的治疗成功差异。
两组患者的病情均随时间改善，但组间差异较小。JFLS、TSK-TMD 和 GROC 组间存在显著差异。颈椎 HVLAT 对标准治疗的附加临床效果治疗 TMD 仍不清楚。
