Asquini Giacomo, Devecchi Valter, Borromeo Giulia, Viscuso Domenico, Morato Federico, Locatelli Matteo, Falla Deborah
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK; Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK.
Musculoskelet Sci Pract. 2022 Dec;62:102634. doi: 10.1016/j.msksp.2022.102634. Epub 2022 Jul 31.
Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function.
To identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making.
A cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped samples.
Patients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram.
The high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research.
NCT03990662.
临床指南推荐对颞下颌关节紊乱病（TMD）采用保守治疗，手法治疗（MT）常用于减轻疼痛和改善功能。
确定TMD患者接受手法治疗方案（MTP）后疼痛减轻和功能改善的预测因素，并开发一种可用于临床实践以促进决策的初步筛查工具。
对102名诊断为TMD的成年人进行队列研究，在应用于颅下颌结构的MTP中每周进行四次治疗。候选预测因素包括人口统计学变量、一般健康变量、心理社会特征、TMD特征和相关临床检查。MTP后疼痛强度至少降低30%被认为是良好结局。采用逻辑回归建立预测模型，并从解释方差、校准和区分度方面评估其性能。在500个自抽样样本中进一步评估预测模型的内部验证。
张口时疼痛强度大于2/10、对MTP结局有积极期望、疼痛定位于颅颈区域以及中枢敏化量表得分较低的患者在MTP后获得了良好结局。经内部验证，所确定的身体和心理变量的预测性能具有高解释方差（R2 = 58%）和区分度（AUC = 89%）。开发了一种初步筛查临床工具并以列线图形式呈现。
预测模型的高区分度显示出有前景的结果，尽管这些结果需要在未来研究中进行外部验证。
NCT03990662。
