Lee Nam-Woo, Lee Sook-Hyun, Kim Koh-Woon, Ha In-Hyuk, Cho Jae-Heung, Lee Yoon Jae
Altern Ther Health Med. 2023 Jan;29(1):258-268.
Temporomandibular disorder (TMD) affects patients' quality of life (QoL) because of the resulting structural and functional impairment and pain.
This study aimed to evaluate the evidence regarding the effectiveness, safety and improvement in QoL in patients who underwent Chuna manual therapy (CMT) for TMD.
We searched 11 databases and included randomized controlled trials (RCT) on CMT for TMD published before March 2020. A meta-analysis was conducted, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was used to evaluate the evidence level. We included 12 RCTs that compared CMT and conventional care.
CMT showed significantly better patient pain reduction, functional improvement and QoL. A superior result was seen in the use of CMT in conjunction with Traditional Chinese Medicine (TCM) or conventional care. CMT showed no minor or serious adverse events compared with medical treatments. The evidence level was low for all outcomes, except QoL.
We found that CMT for TMD resulted in functional improvement, pain reduction and improvement in QoL, with fewer adverse events. However, since the evidence level varied from very low to moderate due to imprecision and the risk of bias with the included studies, we are limited in determining the efficacy of Chuna therapy using these studies. High-quality, well-designed and large-scale RCTs are needed to conclusively determine the clinical efficacy of CMT in TMD.
颞下颌关节紊乱病（TMD）会导致结构和功能受损以及疼痛，从而影响患者的生活质量（QoL）。
本研究旨在评估接受针对TMD的整骨推拿疗法（CMT）的患者在有效性、安全性和生活质量改善方面的证据。
我们检索了11个数据库，并纳入了2020年3月之前发表的关于CMT治疗TMD的随机对照试验（RCT）。进行了荟萃分析，并使用推荐分级评估、制定和评价（GRADE）方法来评估证据水平。我们纳入了12项比较CMT和传统护理的RCT。
CMT在减轻患者疼痛、改善功能和提高生活质量方面表现出显著更好的效果。CMT与中医（TCM）或传统护理联合使用时效果更佳。与药物治疗相比，CMT未出现轻微或严重不良事件。除生活质量外，所有结局的证据水平均较低。
我们发现针对TMD的CMT可改善功能、减轻疼痛并提高生活质量，且不良事件较少。然而，由于纳入研究存在不精确性和偏倚风险导致证据水平从极低到中等不等，我们利用这些研究来确定整骨推拿疗法的疗效时受到限制。需要高质量、精心设计的大规模RCT来最终确定CMT在TMD中的临床疗效。
