Department of Dentistry, Federal University of Rio Grande Do Norte UFRN, Natal, Brazil.
J Oral Rehabil. 2024 Dec;51(12):2548-2558. doi: 10.1111/joor.13853. Epub 2024 Sep 5.
Temporomandibular disorders (TMD) are a highly misreported health problem. Its diagnosis is complex and requires the use of valid and reliable instruments.
To develop and validate the Epidemiological Diagnostic Instrument for TMD (EDI/TMD).
Content validity (CV), response process (RP), construct validity (EFA), reliability (inter and intraobserver consistency), and convergence validity of the EDI/TMD were assessed and compared to the Diagnostic Criteria for TMD (DC/TMD).
An instrument composed of a 9-question questionnaire and a 12-step clinical protocol was developed. CV analysis reduced the instrument to a 5-question and 7-step clinical protocol (CVI = 0.93). Some instructions were included after the RP. The EFA found three factors: myogenous TMD, arthrogenous TMD, and differential diagnosis. The reliability scores ranged from substantial to excellent. When compared to the DC/TMD, the EDI/TMD total score indicated that this instrument is valid and provides satisfactory diagnostic criteria (Kappa = 0.906; p < 0.001), and can distinguish non-TMD and TMD individuals, with a cut-off point of 4.9 (Sensitivity = 1.0; Specificity = 1.0; AUC = 1.0). For individuals who had both myogenous and arthrogenous TMD, the cut-off point was 14 or higher (Sensitivity = 0.8; Specificity = 1.0; AUC = 0.987). For individuals who had either myogenous TMD (Sensitivity = 1.0; Specificity = 0.88; PPV = 0.89; NPV = 1.0) or arthrogenous TMD (Sensitivity = 0.95; Specificity = 0.87; PPV = 0.83; NPV = 0.96), the cut-off point was between 5 and 13.9, with the highest EFA score being the determinant factor for final diagnosis.
Based on its psychometric properties, the EDI/TMD is a valid and reliable assessment tool that is capable of diagnosing TMD and classifying its subtypes.
颞下颌关节紊乱（TMD）是一种高度误诊的健康问题。其诊断复杂，需要使用有效和可靠的工具。
开发和验证颞下颌关节紊乱的流行病学诊断工具（EDI/TMD）。
评估 EDI/TMD 的内容效度（CV）、反应过程（RP）、结构效度（EFA）、内部和观察者间一致性的可靠性以及与颞下颌关节紊乱的诊断标准（DC/TMD）的收敛效度。
开发了一种由 9 个问题的问卷和 12 步临床方案组成的工具。CV 分析将仪器简化为 5 个问题和 7 步临床方案（CVI=0.93）。一些说明在 RP 后包含。EFA 发现了三个因素：肌源性 TMD、关节源性 TMD 和鉴别诊断。可靠性评分从实质性到极好。与 DC/TMD 相比，EDI/TMD 总分表明该工具有效，并提供令人满意的诊断标准（Kappa=0.906；p<0.001），可以区分非 TMD 和 TMD 个体，截断值为 4.9（敏感性=1.0；特异性=1.0；AUC=1.0）。对于同时患有肌源性和关节源性 TMD 的个体，截断值为 14 或更高（敏感性=0.8；特异性=1.0；AUC=0.987）。对于仅患有肌源性 TMD 的个体（敏感性=1.0；特异性=0.88；PPV=0.89；NPV=1.0）或关节源性 TMD（敏感性=0.95；特异性=0.87；PPV=0.83；NPV=0.96），截断值在 5 到 13.9 之间，EFA 得分最高的是最终诊断的决定因素。
根据其心理测量特性，EDI/TMD 是一种有效且可靠的评估工具，能够诊断 TMD 并对其亚型进行分类。
