目的:对于患有肌源性颞下颌关节紊乱病(MTMD)的成人最有效的保守治疗方法几乎没有证据。我们旨在评估宫颈康复干预对MTMD成人疼痛强度和敏感性的有效性,与安慰剂等比较干预相比,假治疗,教育或不干预。
方法:对于本系统综述和荟萃分析,我们搜索了PubMed,EMBASE,Medline,PEDro数据库,通过PROSPERO的正向和反向引用和灰色文献研究,从开始到2021年12月1日之间没有语言或日期限制的临床试验和数据注册。我们选择了基于MTMD成年人群的随机对照试验(RCT),这些人群接受了颈椎康复干预,该干预被定义为针对颈椎解剖结构的任何保守干预。疼痛的主要结局指标是通过咬肌和颞肌的压力疼痛阈值(PPT)自我报告的疼痛强度和疼痛敏感性。包括最大张口的次要结果指标(在MMO上)。使用Cochrane偏倚风险工具对纳入研究的偏倚进行评估。来自随机对照试验的证据被合成以确定治疗效果大小,作为疼痛强度变化的标准化平均差(SMD)之间的差异,PPT和MMO将接受宫颈康复干预治疗的成人与MTMD与对照组进行比较。这项研究在Prospero注册,编号CRD42021289299。
结果:我们的总体搜索产生了2647项研究,其中7项RCT符合资格标准,但偏倚风险较低。疼痛强度(五项研究,n=223,SMD-0.98,95%CI-1.67至-0.28,I2=79%),咬肌的PPT(六项研究,n=395,SMD0.64,95%CI0.43至0.86,I2=90%)和颞肌(五项研究,n=295,SMD0.76,95%CI0.07至1.45,I2=84%)显示出较大的治疗效果估计,与不治疗相比,有利于宫颈康复干预,假宫颈治疗,患者教育或非颈部神经肌肉技术。与控制干预相比,一种颈椎康复干预,单独使用颈椎手法治疗或与颈部锻炼计划相结合具有统计学意义,对疼痛强度的大治疗效果估计(四项研究,n=203,SMD-1.52,95%CI-2.50至-0.55)。
结论:这篇综述发现,在短期内,对于患有MTMD的成人患者,宫颈康复干预措施尤其是单纯上宫颈MT或与颈部锻炼计划联合使用可有效改善多种疼痛结局.然而,需要进一步的研究来衡量这种干预的长期效果.
OBJECTIVE: Little evidence exists for the most effective conservative treatment approach for adults with myogenic temporomandibular disorders (MTMD). We aim to assess the effectiveness of cervical rehabilitation interventions on pain intensity and sensitivity in adults with MTMD compared to comparison intervention such as placebo, sham treatment, education or no intervention.
METHODS: For this systematic
review and meta-analysis, we searched PubMed, EMBASE, Medline, PEDro databases, forward and backward citations and grey literature studies through PROSPERO, clinical trials and data registries without language or date restrictions between inception and 1 December 2021. We selected randomised controlled trials (RCTs) based on adult populations with MTMD who had a cervical rehabilitation intervention which was defined as any conservative intervention targeting the anatomical structures of the cervical spine. The primary outcome measures for pain were self-reported pain intensity and pain sensitivity through the pressure pain threshold (PPT) of the masseter and temporalis muscles. Secondary outcome measures of maximal mouth opening (on MMO) were included. Included studies were assessed for bias with the Cochrane risk of bias tool for randomised trials. Evidence from RCTs was synthesised to determine treatment effect size as differences between standardised mean difference (SMD) for changes in pain intensity, PPT and MMO comparing adults with MTMD who were treated with cervical rehabilitation interventions compared to a control group. This study is registered on Prospero, number CRD 42021289299.
RESULTS: Our general search yielded 2647 studies where seven RCTs met eligibility criteria with low to some concerns in their risk of bias. Pain intensity (five studies, n = 223, SMD -0.98, 95% CI -1.67 to -0.28, I2 = 79%), PPT of the masseter muscle (six studies, n = 395, SMD 0.64, 95% CI 0.43 to 0.86, I2 = 90%) and the temporalis muscles (five studies, n = 295, SMD 0.76, 95% CI 0.07 to 1.45, I2 = 84%) showed large treatment effect estimates favouring cervical rehabilitation interventions compared to no treatment, sham cervical treatment, patient education or non-cervical neuromuscular techniques. Compared to control interventions, one type of cervical rehabilitation intervention, cervical manual therapy alone or in combination with a neck exercise program was associated with statistically significant, large treatment effect estimates on pain intensity (four studies, n = 203, SMD -1.52, 95% CI -2.50 to -0.55).
CONCLUSIONS: This
review found that in the short-term, cervical rehabilitation interventions especially upper cervical MT alone or in combination with a neck exercise program are effective in improving multiple pain outcomes in adults with MTMD. However, further research is needed to measure the long-term effects of this type of intervention.