Arribas-Pascual Manuel, Hernández-Hernández Sofia, Jiménez-Arranz Christian, Grande-Alonso Mónica, Angulo-Díaz-Parreño Santiago, La Touche Roy, Paris-Alemany Alba
Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, 28023 Madrid, Spain.
Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, 28023 Madrid, Spain.
J Clin Med. 2023 Jan 18;12(3):788. doi: 10.3390/jcm12030788.
The aim of this meta-meta-analysis was to assess the current evidence regarding the effect of physical therapy (PT) interventions on pain and functional variables in temporomandibular disorders (TMD). We conducted an umbrella systematic review (SR) and four meta-meta-analyses (MMA) and created an evidence map to determine the effectiveness of PT on pain intensity and maximum mouth opening in patients with TMD. The quality of the included SR was assessed with the AMSTAR 2, and the risk of bias with ROBIS. Of the 31 SR included in the umbrella SR, only 10 were included in the MMA. The MMA showed moderate effects for manual therapy and therapeutic exercise, and large effects for low-level laser therapy on improving pain intensity and maximum mouth opening in patients with TMD, with a limited to moderate quality of evidence. The overlapping analyses showed only a slight overlap for all the MMA according to the corrected covered area (range from 0.07 to 0.2), 23.1% to 41.6%. This umbrella SR showed that manual therapy and exercise interventions, as well as low-level laser therapy interventions, are effective in the reduction in pain intensity and improvement of maximum mouth opening in TMD. This article presents a synthesis of the available evidence related to the various physical therapy interventions used in patients presenting with temporomandibular disorders. These results could help clinicians to select the optimal intervention for their patients and to reject those that are less useful.
这项元元分析的目的是评估目前关于物理治疗（PT）干预对颞下颌关节紊乱症（TMD）疼痛和功能变量影响的证据。我们进行了一项汇总系统评价（SR）和四项元元分析（MMA），并创建了一个证据图谱，以确定PT对TMD患者疼痛强度和最大开口度的有效性。采用AMSTAR 2评估纳入的SR的质量，采用ROBIS评估偏倚风险。在汇总SR纳入的31项SR中，只有10项纳入了MMA。MMA显示，手法治疗和治疗性运动有中度效果，低强度激光治疗对改善TMD患者的疼痛强度和最大开口度有较大效果，证据质量有限至中等。重叠分析显示，根据校正后的覆盖面积（范围为0.07至0.2），所有MMA的重叠度仅为轻微重叠，为23.1%至41.6%。这项汇总SR表明，手法治疗和运动干预以及低强度激光治疗干预在降低TMD患者的疼痛强度和改善最大开口度方面是有效的。本文对与颞下颌关节紊乱症患者使用的各种物理治疗干预相关的现有证据进行了综合。这些结果可以帮助临床医生为患者选择最佳干预措施，并摒弃那些不太有用的措施。
