Self-management and Home Exercises for the Treatment of Masticatory Muscle Pain. A Clinical Trial
- Conditions
- Myalgia of Mastication Muscle
- Interventions
- Behavioral: Self-managementOther: Home exercises
- Registration Number
- NCT06054490
- Lead Sponsor
- Universidad Nacional Andres Bello
- Brief Summary
The objective of this study was to compare the clinical effectiveness of self-management (SM) together with mandibular home exercises (EX) in the treatment of myalgia of the masticatory muscles. A controlled clinical trial was carried out with a total of 48 subjects diagnosed with myalgia according to the diagnostic criteria for temporomandibular disorders (DC/TMD), who were randomized into two groups: treated with SM (SM group) and treated with SM and mandibular home exercises (SM-EX group). The follow-ups were carried out at 2, 6 and 10 weeks, where the following were evaluated: pain in the masticatory muscles, range of mandibular movement and mandibular functional limitation.
- Detailed Description
Materials and method. This randomized controlled clinical trial was conducted between January 2016 and June 2016 at the Andres Bello University Dental Clinic (Viña del Mar, Chile). Study subjects were recruited from the universe of patients seeking treatment for jaw pain at the School of Dentistry. All subjects were informed about the study by their operator and gave their written consent before beginning the study. The protocol, design, and implementation were approved by the Scientific Ethics Committee of the Faculty of Dentistry of the Andres Bello University, Viña del Mar, Chile (Folio No. 056, year 2016). Which was in accordance with the latest version of the Declaration of Helsinki of the World Medical Association (Declaration of the World Medical Association of Helsinki, 2013).
Sample's size calculation. An error percentage of 7% was calculated according to a confidence level of 91%, considering a prevalence of chewing muscle pain of 9% and an expected loss of 1.08% based on the losses obtained in the study carried out by Kalamir. et al. in 2012 (Kalamir et al., 2012). The minimum number of participants required for each group was 25 patients (50 patients in total).
Randomization and interventions. After meeting the inclusion and exclusion criteria, subjects were randomly assigned to two groups using a computer generated sequence "random list" developed by random.org.
Evaluation methods. The initial evaluation, to determine the degree of involvement of axis I, was carried out following the symptom questionnaire and clinical examination guidelines according to the DC/TMD protocol. Additionally, the questionnaire for the chronic pain grade scale (GCPS v2.0) and the functional limitation scale (JFLS-20) of axis II of the DC/TMD protocol were applied. In turn, an intraoral clinical examination was performed to rule out pain of dental origin.
Statistic analysis. Demographic characteristics of the sample were reported descriptively. Data were analyzed using Wilcoxon signed-rank test for comparisons between periods (initial evaluation, and weeks 2, 6, and 10) and Wilcoxon rank-sum test for comparison between groups of the variables MMP, MRM, JFLS-20. Qualitative evaluation of adherence to self-management was analyzed using Fisher exact test. Qualitative evaluation of adherence to home exercises was descriptively reported. The level of significance was established at p=0.05. All statistical analysis was performed using R-Crain 3.01 software.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 50
- "Age between 18 and 40 years", "Presence of myalgia of the masticatory muscles according to DC / TMD diagnostic criteria."
- "Painful joint TMD"; "history of treatment for TMD"; "recent history of facial or cervical trauma"; "ongoing orthodontic treatment"; "Tooth mobility secondary to periodontal disease"; "Subjects with loss of more than two teeth other than third molars and / or premolars due to orthodontic indication"; "subjects with systemic musculoskeletal diseases or who are under analgesic treatment"; "Subjects with a diagnosed intellectual disability who cannot express their will to participate in scientific research as established by law 20.584 of Chile."
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Self-management group (SM group) Self-management Subjects in this group received a scheme of self-management protocol consisting of verbal and written information on the etiology and prognosis of TMD. Self-management group (SM group) Home exercises Subjects in this group received a scheme of self-management protocol consisting of verbal and written information on the etiology and prognosis of TMD. Self-management plus home exercises group (SM+EX group) Home exercises Subjects in this group received self-management protocol in combination with a home self-exercise routine. Basic exercise therapy includes mobilization, stretching, and muscle strengthening exercises.
- Primary Outcome Measures
Name Time Method Masticatory muscle pain (MMP) It was applied in the initial evaluation, week 2, 6 and 10 Pain intensity was measured using a verbal numeric scale (VNS); subjects were asked to verbally rate the perceived intensity using a numerical rating scale where "0" corresponded to "no pain" and "10" corresponded to "extremely strong pain"
- Secondary Outcome Measures
Name Time Method Mandibular range of motion (MRM) It was applied in the initial evaluation, week 2, 6 and 10 Maximum mouth opening in an autonomous and comfortable way, that is, without feeling pain and not assisted by the operator, measured in millimeters from incisal edge to incisal edge of anterior teeth, compensating for overbite
Qualitative evaluation of adherence to home exercises It was applied only to the SM+EX group in weeks 2, 6, and 10 Qualitative evaluation of subjects' adherence to a routine self-exercise therapy at home, as recorded in a "patient diary" that was categorized as "good" (⅔ of the time), "moderate" (between ⅔ and ⅓ of the time) and "deficient" (less than ⅓ of the time).
Jaw functional limitation (JFLS-20) It was applied in the initial evaluation and week 10 Scale in charge of globally assessing masticatory limitation, vertical mobility limitation, verbal and non-verbal communication limitation, included within a 20-item instrument thanks to the survey of mandibular functional limitation of the DC / TMD. This scale has a score of 0 to 10, with 10 being a severe limitation
Qualitative evaluation of adherence to self-management It was applied in the initial evaluation, week 2, 6 and 10 Qualitative evaluation of subjects' adherence to a self-care protocol scheme that was categorized as "good" (⅔ of the time), "moderate" (between ⅔ and ⅓ of the time), and "deficient" (less than ⅓ of the time). Recorded in a "behavior and self-care log per session"