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Cited by 413Temporomandibular Joint DisordersMusculoskeletal pain and rehabilitationMyofascial pain diagnosis and treatment

Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

Open access
Armijo-Olivo, Susan, Pitance, Laurent, Singh, Vandana, Neto, Francisco, Thie, Norman, Michelotti, Ambra·2016·Physical Therapy
DOI 10.2522/ptj.20140548PMC PMC4706597
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Abstract

Background: Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. Purpose: The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. Data Sources: Electronic data searches of 6 databases were performed, in addition to a manual search. Study Selection: Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed. Data Extraction: Data were extracted in duplicate on specific study characteristics. Data Synthesis: The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. Limitations: Quality of the evidence and heterogeneity of the studies were limitations of the study. Conclusions: No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 48 randomized controlled trials found no high-quality evidence and generally low certainty about the effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders (TMD). Manual therapy alone or combined with exercise showed promising effects, while exercise was not clearly superior to other conservative treatments.

Key findings

  • The overall evidence was considered low; none of the 48 included studies was rated low risk of bias, with 58.4% classified as unclear risk and 41.6% as high risk.
  • Postural training for myogenous TMD significantly increased maximum pain-free mouth opening (MD = 5.54 mm, 95% CI = 2.93, 8.15) and reduced disturbance with daily life (SMD = 1.13, 95% CI = 0.48, 1.78).
  • Manual therapy plus exercises for arthrogenous TMD significantly reduced pain (SMD = 0.40, 95% CI = 0.13, 0.68) and increased active mouth opening (MD = 3.58 mm, 95% CI = 1.46, 5.70); for mixed TMD, manual therapy plus exercises improved mouth opening (MD = 6.10 mm, 95% CI = 1.11, 11.09).
  • General jaw exercises in mixed TMD were not superior to other treatments for pain (SMD = −0.06, 95% CI = −0.50, 0.38) or mouth opening (MD = −0.25 mm, 95% CI = −2.08, 1.57).

Methods

  • Systematic review and meta-analysis reported according to PRISMA and registered in PROSPERO (CRD42013005628); 6 electronic databases were searched through April 7, 2015, plus a manual search.
  • Inclusion criteria were randomized controlled trials of adults (>18 years) with TMD comparing any manual therapy or exercise therapy with placebo, controlled comparison intervention, or standard care; primary outcomes were pain, range of motion, and oral function, with pressure pain threshold as a secondary outcome.
  • The search yielded 3,549 articles; 48 studies were included in the final analysis. Data were extracted in duplicate, risk of bias was assessed by 2 independent reviewers using a compiled tool, GRADE was used to assess evidence quality, and meta-analyses used MD or SMD with 95% CI and random-effects models when clinical heterogeneity was present.

Limitations

  • Stated by the paper: quality of evidence and heterogeneity were limitations; a small proportion of studies in other languages could not be translated; heterogeneity existed in TMD diagnosis, study intervention, and control/comparison intervention; many studies included exercise or manual therapy as part of a general treatment program, making isolated effects difficult to evaluate; only 21 of 48 studies used a valid, reliable, and reproducible diagnostic tool for TMD.
  • Evident from the text: no study was classified as low risk of bias, which precluded sensitivity analyses by quality; only 20 studies reported appropriate randomization, 4 reported allocation concealment, 12 used blinded outcome assessment, and 16 used intention-to-treat analysis; adverse events were reported in only 10 of 48 trials.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2522/ptj.20140548

Cites

121 of 121 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 190 cited sources checked · 16 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The minimal clinically important difference for pain has been reported to range from 1.5 to 3.2 points.

    “The minimal clinically important difference for pain has been reported to range from 1.5 to 3.2 points.30 -34”
    Quote in the paperNot a substantial claim1 of 5 sources checked
    • cites [30] Kovacs, 2007, Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain, Spine (Phila Pa 1976) source
    • cites [31] Farrar, 2001, Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, Pain source
    • cites [32] van der Roer, 2006, Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain, Spine (Phila Pa 1976) source
    • cites [33] Maughan, 2010, Outcome measures in chronic low back pain, Eur Spine J source

      The Discussion reports a minimal clinically important change of 4 points on the pain numerical rating scale, while the Abstract also gives a method-dependent estimate of 2.4 points. The paper therefore supports the existence of a point-based pain threshold, but not the claimed range of 1.5–3.2 points; its 4-point estimate falls outside it. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [34] Dworkin, 2008, Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations, J Pain source
  • Premisecitation

    Measurements of PPT have been shown to have good or excellent interrater and intrarater reliability.

    “Measurements of PPT have been shown to have good or excellent interrater and intrarater reliability.36 -38”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [36] Nussbaum, 1998, Reliability of clinical pressure-pain algometric measurements obtained on consecutive days, Phys Ther source
    • cites [37] Ylinen, 2005, Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial, Eur J Pain source
    • cites [38] Cathcart, 2006, Reliability of pain threshold measurement in young adults, J Headache Pain source
  • Findingown data

    When pooling results of studies investigating the effectiveness of exercise alone or in combination with other conservative therapies on pain intensity, there was no statistically significant difference in pain between exercise and control groups.

    “When pooling the results of the studies investigating the effectiveness of exercise alone or in combination with other conservative therapies on pain intensity, 58,61,68,86 we found that there was no statistically significant difference in pain between exercise and control groups.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [58] Maloney, 2002, Effect of a passive jaw motion device on pain and range of motion in TMD patients not responding to flat plane intraoral appliances, Cranio source
    • cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [68] de Felicio, 2008, Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy, Cranio source
    • cites [86] Yuasa, 2001, Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: a combination of NSAIDs and mouth-opening exercise versus no treatment, Oral Surg Oral Med Oral Pathol Oral Radiol Endod source
  • Findingcitation

    Four studies looked at MT techniques for people with myogenous TMD.

    “Four studies 64,65,77,81 looked at MT techniques, such as facial manipulation versus botulinum toxin 81 or intraoral myofascial therapy versus waiting list, and self-care education and exercises for people with myogenous TMD.64,65,77”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [64] Kalamir, 2013, Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial, Chiropr Man Therap source
    • cites [65] Kalamir, 2010, Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study, J Man Manip Ther source
    • cites [77] Kalamir, 2012, Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial, J Manipulative Physiol Ther source
    • cites [81] Guarda-Nardini, 2012, Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique, Cranio source
  • Findingcitation

    One study did not find that exercises were superior to a control group involving general physical therapy treatment.

    “However, one study 61 did not find that exercises were superior to a control group involving general physical therapy treatment.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res source

      The available passages, labeled Abstract with no page number, contain bibliographic information and keywords but no description of the treatment groups or results. Searches for exercise superiority and the control-group comparison returned no outcome passage, so our copy cannot verify the claimed finding. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 38
  • May combine two claims. 34
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Specific decision rules were developed to make decisions on risk of bias.

    “however, we developed specific decision rules to make decisions as described elsewhere.43”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [43] Armijo-Olivo, 2014, Poor reliability between Cochrane reviewers and blinded external reviewers when applying the Cochrane risk of bias tool in physical therapy trials, PloS One source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-one of the studies used the RDC/TMD established by Dworkin and LeResche to classify patients as having TMD.

    “Twenty-one of the studies 57-76 used the RDC/TMD established by Dworkin and LeResche 27 to classify the patients as having TMD.”
    Quote in the paperNot a substantial claim3 of 10 sources checked
    • cites [57] Mulet, 2007, A randomized clinical trial assessing the efficacy of adding 6 × 6 exercises to self-care for the treatment of masticatory myofascial pain, J Orofac Pain

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [58] Maloney, 2002, Effect of a passive jaw motion device on pain and range of motion in TMD patients not responding to flat plane intraoral appliances, Cranio source
    • cites [59] Komiyama, 1999, Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening, J Oral Rehabil source
    • cites [60] Wright, 2000, Usefulness of posture training for patients with temporomandibular disorders, J Am Dent Assoc source
    • cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res source

      The available passages identify Craane et al. as a trial on TMJ closed lock, but do not describe how its patients were classified. Searches for RDC/TMD, Dworkin and LeResche, and diagnostic criteria found no passage establishing that this trial used RDC/TMD; the paper also cannot establish the citing document’s count of 21 studies. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
    • cites [63] Gavish, 2006, Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study, Cranio source
    • cites [64] Kalamir, 2013, Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial, Chiropr Man Therap source
    • cites [65] Kalamir, 2010, Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study, J Man Manip Ther source
    • cites [66] Michelotti, 2004, The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial [erratum in: J Orofac Pain. 2006;20:106], J Orofac Pain

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The quality of the body of the evidence was assessed using the GRADE approach.

    “The quality of the body of the evidence was assessed using the GRADE approach.49”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [49] Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, BMJ source

  • May combine two claims.

    Findingown data

    In general, MT plus exercises reduced symptoms and increased ROM for patients with arthrogenous TMD, particularly for those with reduced ROM due to disk displacements without reduction (closed lock).

    “In general, we found that MT plus exercises reduced symptoms and increased ROM for patients with arthrogenous TMD, particularly for those with reduced ROM due to disk displacements without reduction (”
    Quote in the paperSubstantial claim1 of 8 sources checked
    • cites [69] Ismail, 2007, Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD, J Oral Rehabil source
    • cites [70] Nascimento, 2013, Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial, Med Oral Patol Oral Cir Bucal source

      The Discussion reports improved mouth opening and jaw protrusion in both groups, and reduced pain in the group receiving anesthetic blockage plus physical therapy. It reports increased mouth opening for one patient with disc displacement without reduction, but does not establish that manual therapy plus exercises alone is particularly effective for patients with closed lock; that patient also received anesthetic blockage. Page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [78] Schiffman, 2007, Randomized effectiveness study of four therapeutic strategies for TMJ closed lock [erratum in: J Dent Res. 2013;92:98], J Dent Res source
    • cites [87] Carmeli, 2001, Comparative study of repositioning splint therapy and passive manual range of motion techniques for anterior displaced temporomandibular discs with unstable excursive reduction, Physiotherapy source
    • cites [88] Haketa, 2010, Randomized clinical trial of treatment for TMJ disc displacement, J Dent Res source
    • cites [89] Minakuchi, 2004, Self-reported remission, difficulty, and satisfaction with nonsurgical therapy used to treat anterior disc displacement without reduction, Oral Surg Oral Med Oral Pathol Oral Rad Endod source
    • cites [90] Minakuchi, 2001, Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction, J Dent Res source
    • cites [91] Yoshida, 2005, Simple manipulation therapy for temporomandibular joint internal derangement with closed lock, Asian J Oral Maxillofac Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In that study, 0.44% (1/224) had hematoma.

    “0.44% (1/224) had hematoma”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [70] Nascimento, 2013, Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial, Med Oral Patol Oral Cir Bucal source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In that study, 2.23% (5/224) had positive aspirations.

    “2.23% (5/224) had positive aspirations.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [70] Nascimento, 2013, Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial, Med Oral Patol Oral Cir Bucal source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Nascimento et al reported some adverse events due to the anesthetic blockages procedure.

    “Nascimento et al 70 reported some adverse events due to the anesthetic blockages procedure.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [70] Nascimento, 2013, Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial, Med Oral Patol Oral Cir Bucal source

  • May combine two claims.

    Premisecitation

    Effect sizes from trials that excluded participants in their analysis or that used a modified ITT protocol tended to be more beneficial than those from trials without exclusions, demonstrating that the ITT principle is important to preserve the benefits of randomization and keep unbiased estimates when the objective of the trial is to investigate effectiveness.

    “Effect sizes from trials that excluded participants in their analysis or that used a modified ITT protocol tended to be more beneficial than those from trials without exclusions, demonstrating that the ITT principle is important to preserve the benefits of randomization and keep unbiased estimates when the objective of the trial is to investigate effectiveness.110”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [110] Nuesch, 2009, The effects of excluding patients from the analysis in randomised controlled trials: meta-epidemiological study, BMJ source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fourteen of the studies examined the effectiveness of exercise or MT interventions in muscular TMD (myogenous TMD).

    “Fourteen of the studies examined the effectiveness of the exercise or MT interventions in muscular TMD (myogenous TMD)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The agreement between reviewers to select the articles for this review was kappa=0.98 (95% CI=0.977, 0.99).

    “The agreement between reviewers to select the articles for this review was kappaϭ0.98 (95% CIϭ0.977, 0.99).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three studies were obtained through a manual search.

    “In addition, 3 studies 55-57 were obtained through a manual search.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [55] Burgess, 1988, Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system, J Prosthetic Dent source
    • cites [56] Magnusson, 1999, Therapeutic jaw exercises and interocclusal appliance therapy: a comparison between two common treatments of temporomandibular disorders, Swed Dent J

      Not checked in the free run.

    • cites [57] Mulet, 2007, A randomized clinical trial assessing the efficacy of adding 6 × 6 exercises to self-care for the treatment of masticatory myofascial pain, J Orofac Pain

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The search of the literature resulted in a total of 3,549 published articles.

    “The search of the literature resulted in a total of 3,549 published articles.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 3,549 published articles, 106 were considered potentially relevant.

    “Of the 3,549 published articles, 106 were considered to be potentially relevant.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Five articles in other languages were not possible to translate and were not included in the final analysis.

    “There were 5 articles in other languages 50 -54 that were not possible to translate by our study team and were not included in the final analysis.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [50] Fink, 2007, The use of physcial therapy for the treatment of craniomandibular disorders: a prospective, randomised clinical trial [article in German], Manuelle Medizin Issue source
    • cites [51] Lalabonova, 2008, Physical and medicinal treatment of TMJ arthrosis [article in Russian], Stomatologiia (Mosk)

      Not checked in the free run.

    • cites [52] Petz, 1974, Therapy of restricted jaw movements [article in German], Z Arztl Fortbild (Jena)
    • cites [53] van der Glas, 2000, Vergelijking tussen behandelingsvormen bij myogene temporomandibulaire dysfunctie [Comparison of treatment options for myogenous temporomandibular dysfunction], Ned Tijdschr Tandheelkd
    • cites [54] Xue, 2007, Clinical observation on warming needle moxibustion plus exercise for treatment of temporomandibular joint dysfunction syndrome [article in Chinese], Zhongguo Zhen Jiu

  • May combine two claims.

    Findingown data

    That recent systematic review missed important RCTs in the area, including only 5 studies.

    “based on a preliminary search performed by our team, it was realized that this review missed important RCTs in the area (included only 5 studies).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Brantingham, 2013, Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review, J Manipulative Physiol Ther source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study looked at both myogenous and arthrogenous TMD.

    “One study looked at both myogenous and arthrogenous TMD.58”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Maloney, 2002, Effect of a passive jaw motion device on pain and range of motion in TMD patients not responding to flat plane intraoral appliances, Cranio source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The authors did not report intrarater or inter-rater reliability of the assessors who performed outcome measurements.

    “Moreover, the authors did not report intrarater or inter-rater reliability of the assessors who performed outcome measurements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only 17 studies reported reliability of outcome measures.

    “Only a few studies reported these items (11, 17, and 3 studies, respectively).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    The remaining 27 studies used their own diagnostic criteria, based on signs and symptoms of the patients.

    “The remaining 27 studies used their own diagnostic criteria, based on signs and symptoms of the patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The SMD for pain intensity at 4 weeks to 3 months was 0.40 (95% CI 0.13, 0.68), with a moderate effect size according to Cohen's guidelines.

    “The SMD for pain intensity at 4 weeks to 3 months was 0.40 (95% CIϭ0.13, 0.68), with a moderate effect size according to Cohen's guidelines 48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Cohen, 1988, The concepts of power analysis

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    The SMD for pain intensity was 0.68 (95% CI -0.04, 1.40), with a moderate effect size according to Cohen's guidelines.

    “The SMD for pain intensity was 0.68 (95% CIϭϪ0.04,1.40), with a moderate effect size according to Cohen's guidelines.48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Cohen, 1988, The concepts of power analysis

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    When pooling was focused on those studies including only a control group, similar results were found, although the SMD increased (SMD=1.11; 95% CI -0.73, 2.94).

    “When pooling was focused on those studies including only a control group, 68,86 similar results were found, although the SMD increased (SMDϭ1.11;95% CIϭϪ0.73,2.94).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] de Felicio, 2008, Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy, Cranio source
    • cites [86] Yuasa, 2001, Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: a combination of NSAIDs and mouth-opening exercise versus no treatment, Oral Surg Oral Med Oral Pathol Oral Radiol Endod source

  • May combine two claims.

    Findingown data

    Although the results for the intraoral myofascial therapy and exercise groups were superior to the results for the waiting-list control group, there was no statistically significant difference between them.

    “Although the results for the intraoral myofascial therapy and exercise groups were superior to the results for the waiting-list control group, there was no statistically significant difference between them.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At 3 months after treatment, facial manipulation was slightly superior in reducing subjective pain perception, and botulinum toxin injections were slightly superior in increasing ROM.

    “However, at 3 months after treatment, facial manipulation was slightly superior in reducing subjective pain perception, and botulinum toxin injections were slightly superior in increasing ROM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although the quality of the evidence is mostly uncertain and low, the results of our systematic review showed positive results when using postural exercises and jaw exercises to treat both myogenous and arthrogenous TMD disorders.

    “Although the quality of the evidence is mostly uncertain and low, the results of our systematic review showed positive results when using postural exercises and jaw exercises to treat both myogenous and arthrogenous TMD disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Most of these exercise programs were part of a general conservative treatment regimen including other therapies and did not provide clear information regarding dosage, frequency, or adherence, so the isolated effect of exercise to treat TMD and the optimal regimen are uncertain at this time.

    “However, most of these exercise programs were part of a general conservative treatment regimen including other therapies and did not provide clear information regarding dosage, frequency, or adherence, so the isolated effect of exercise to treat TMD and the optimal regimen are uncertain at this time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In general, exercises for mixed TMD compared with control groups had better results for decreasing pain and improving function and pain sensitivity of the masticatory muscles.

    “In general, exercises for mixed TMD compared with control groups had better results for decreasing pain and improving function and pain sensitivity of the masticatory muscles.55, 71,96,97”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [55] Burgess, 1988, Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system, J Prosthetic Dent source
    • cites [71] de Felicio, 2010, Effects of orofacial myofunctional therapy on temporomandibular disorders, Cranio source
    • cites [96] Tegelberg, 1988, Short-term effect of physical training on temporomandibular joint disorder in individuals with rheumatoid arthritis and ankylosing spondylitis, Acta Odontol Scand source
    • cites [97] Tegelberg, 1996, A 3-year follow-up of temporomandibular disorders in rheumatoid arthritis and ankylosing spondylitis, Acta Odontol Scand source

  • May combine two claims.

    Findingown data

    The SMD for pain intensity was -0.06 (95% CI -0.50, 0.38), with a very small effect size according to Cohen's guidelines.

    “The SMD for pain intensity was Ϫ0.06 (95% CIϭϪ0.50, 0.38), with a very small effect size according to Cohen's guidelines.48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Cohen, 1988, The concepts of power analysis

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    No statistical differences were found between MT targeted to the jaw and jaw exercises plus splint therapy, between cervical chiropractic adjustment and cervical trigger point therapy, upper thoracic manipulation and placebo, or masticatory muscle massage and splint for improving symptoms of patients with mixed TMD.

    “However, no statistical differences were found between MT targeted to the jaw and jaw exercises plus splint therapy, 100 between cervical chiropractic adjustment and cervical trigger point therapy, 102 upper thoracic manipulation and placebo, 76 or masticatory muscle mas- sage and splint 104 for improving symptoms of patients with mixed TMD.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [100] Cuccia, 2010, Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial, J Bodyw Mov Ther source
    • cites [102] O'Reilly, 1996, TMJ pain and chiropractic adjustment: a pilot study, Chiropractic J Aust

      Not checked in the free run.

    • cites [76] Packer, 2014, Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial, Am J Phys Med Rehabil source
    • cites [104] Gomes, 2014, Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial, J Manipulative Physiol Ther source

  • May combine two claims.

    Findingown data

    Manual therapy targeted to the cervical spine decreased pain and increased mouth ROM in patients with myogenous TMD.

    “Manual therapy targeted to the cervical spine decreased pain and increased mouth ROM in patients with myogenous TMD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The studies by Mansilla-Ferragud et al and Otano and Legal showed positive results at improving mouth ROM and increasing PPT in the orofacial region when comparing mobilization of the atlantoaxial joint versus placebo.

    “The studies by Mansilla-Ferragud et al 101 and Otano and Legal 103 showed positive results at improving mouth ROM and increasing PPT in the orofacial region when comparing mobilization of the atlantoaxial joint versus placebo.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [101] Mansilla-Ferragud, 2008, Efecto de la manipulacion de la charnela occipito-atlo-axoidea en la apertura de la boca [Effect of upper cervical spine manipulation on mouth opening], Osteopatia Cientifica source
    • cites [103] Otano, 2010, Modificaciones radiologicas del espacio entre el occipucio y el cuerpo del atlas tras una manipulacion global (OAA) de Fryette [Radiological changes in the atlanto-occipital space after Fryette global manipulation (OAA)], Osteopatia Cientifica source

  • May combine two claims.

    Findingnone given

    No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and manual MT for TMD.

    “No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and manual MT for TMD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    We did not perform sensitivity analyses based on quality because the risk of bias of the analyzed studies was either unclear or high, with no study being classified as low risk.

    “We did not perform sensitivity analyses based on quality because the risk of bias of the analyzed studies was either unclear or high, with no study being classified as low risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    That recent systematic review included several types of designs and did not focus on RCTs.

    “That review included several types of designs and did not focus on RCTs, which are the best evidence when looking at interventions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Brantingham, 2013, Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review, J Manipulative Physiol Ther source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Assessments of quality (risk of bias) were completed by 2 independent reviewers.

    “Assessments of quality (risk of bias) were completed by 2 independent reviewers (any 2 members of the research team).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The reporting of this systematic review is based on the PRISMA guidelines.

    “The reporting of this systematic review is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Ann Intern Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    According to Byrt's criteria, the agreement between reviewers was excellent.

    “According to Byrt's criteria, 41 the agreement between reviewers was excellent.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Byrt, 1996, How good is that agreement?, Epidemiology source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The risk of bias tool was used with the main outcome of each study to make the assessments.

    “In addition, the risk of bias tool was used with the main outcome of each study to make the assessments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data extraction was carried out independently by 2 reviewers.

    “For each part of the review, data extraction was carried out independently by 2 reviewers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Any disagreements on data extraction were resolved by consensus.

    “Any disagreements on data extraction were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The funding bodies had no input in the design, collection, analysis, or interpretation of data; writing of the manuscript; or the decision to submit the manuscript for publication.

    “The funding bodies had no input in the design, collection, analysis, or interpretation of data; writing of the manuscript; or the decision to submit the manuscript for publication.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two independent investigators screened titles and abstracts of publications found in the databases.

    “Two independent investigators screened the titles of publications found in the databases and, if available, the abstract of the publication.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Disagreements between reviewers on inclusion were resolved by consensus.

    “Disagreements between reviewers on inclusion were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The guidelines established by the Cochrane Collaboration were followed to perform assessments of risk of bias.

    “We followed the guidelines established by the Cochrane Collaboration to perform assessments of risk of bias”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Any discrepancies in quality ratings were resolved by discussion, and if consensus could not be reached, a third member acted as arbitrator.

    “Any discrepancies in quality ratings were resolved by discussion.If consensus could not be reached, a third member of the review team with expertise in quality assessments (S.A-O.)acted as an arbitrator and made a final decision.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Two reviews were conducted 9 years previously and included few randomized controlled trials.

    “However, 2 reviews 19,23 were conducted 9 years previously and included few randomized controlled trials (RCTs).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] Medlicott, 2006, A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder, Phys Ther source
    • cites [23] McNeely, 2006, A systematic review of physical therapy intervention for temporomandibular disorders, Phys Ther source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This systematic review was registered in PROSPERO (CRD42013005628).

    “This systematic review was registered in PROSPERO (CRD42013005628).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationcitation

    The 5.54 mm MD in maximum pain-free mouth opening was clinically significant in favor of postural training.

    “which was clinically significant in favor of postural training.35”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Kropmans, 1999, Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint, J Dent Res source

  • May combine two claims.

    Interpretationreasoning

    The results of these studies support the use of MT to treat myogenous TMD, as people treated with all of these approaches had improved mouth opening and reduced jaw pain from baseline.

    “The results of these studies support the use of MT to treat myogenous TMD, as people treated with all of these approaches had improved mouth opening and reduced jaw pain from baseline.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The results indicate noninvasive procedures as a first line of treatment.

    “The results indicate noninvasive procedures as a first line of treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Conservative treatment plus exercises is appropriate to treat disk displacement without reduction or when patients have restricted mandibular movement.

    “implying that conservative treatment plus exercises is appropriate to treat disk displacement without reduction or when patients have restricted mandibular movement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The effect sizes for pain intensity and PPT were considered clinically relevant.

    “The effect sizes found in this study for pain intensity (28.75 points; 95% CIϭ21.65,35.85) and PPT (1.12 kg/cm 2 ; 95% CIϭ0.96, 1.29) were considered clinically relevant.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    General aerobic exercises have been shown to improve muscle strength, flexibility, and functional capacity and could induce analgesia.

    “General aerobic exercises have been shown to improve muscle strength, flexibility, and functional capacity and could induce analgesia.107”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [107] Sharma, 2010, Aerobic exercise alters analgesia and neurotrophin-3 synthesis in an animal model of chronic widespread pain, Phys Ther source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Conservative treatments are a first line of treatment for arthrogenous TMD.

    “with conservative treatments as a first line of treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Selection bias could have existed, as only 20 trials reported appropriate randomization and only 4 reported concealment of allocation.

    “Selection bias could have existed, as only 20 trials reported appropriate randomization and only 4 reported concealment of allocation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There was a small proportion of studies in other languages that our team could not translate.

    “There was a small proportion of studies in other languages that our team could not translate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Many studies included the use of exercises or MT as part of a general treatment program, which made the evaluation of these treatments in isolation difficult.

    “Many studies included the use of exercises or MT as part of a general treatment program, which made the evaluation of these treatments in isolation dif-ficult.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    As with any systematic review, there is the potential for selection bias, yet our group used a comprehensive search strategy and included databases as well as manual search.

    “As with any systematic review, there is the potential for selection bias, yet our group used a comprehensive search strategy and included databases as well as manual search.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Based on the results of this systematic review, MT shows promising results for treatment of myogenous, arthrogenous, and mixed TMD, although the evidence is limited and low.

    “Based on the results of this systematic review, MT shows promising results for treatment of myogenous, arthrogenous, and mixed TMD, although the evidence is limited and low.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Despite this lack of standardized diagnosis, the study populations in all trials appeared to be representative of patients seen in clinical practice.

    “Despite this lack of standardized diagnosis, the study populations in all trials appeared to be representative of patients seen in clinical practice.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The study populations in the included trials are representative of patients seen in clinical practice.

  • May combine two claims.

    Interpretationnone given

    Exercises and manual therapy are safe and simple interventions for patients with temporomandibular disorders.

    “exercises and MT are safe and simple interventions”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The present study used a compilation of items from all of the scales used in the reviewed physical therapy literature in addition to the risk of bias tool.

    “The present study used a compilation of items from all of the scales used in the reviewed physical therapy literature in addition to the risk of bias tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other systematic reviews have shown similar results.

    “Other systematic reviews have shown similar results.24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Miller, 2010, Manual therapy and exercise for neck pain: a systematic review, Man Ther source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    The findings of this review are specific to TMD (nonsurgical) and to exercise and MT.

    “The findings of this review are specific to TMD (nonsurgical) and to exercise and MT.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Studies did not control for cointerventions and did not have adequate adherence to treatment.

    “In addition, they did not control for cointerventions and did not have adequate adherence to treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Active and passive exercise for the jaw, postural exercises, and neck exercises appear to have favorable effects for patients with temporomandibular disorders.

    “Active and passive exercise for the jaw, postural exercises, and neck exercises appear to have favorable effects for patients with TMD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    We believe that most of the representative studies were included in the final analysis of this systematic review.

    “However, we believe that most of the representative studies were included in the final analysis of this systematic review.”
    Quote in the paperNot a substantial claim
67 of 67

  • The authors state this as an assumption.

    There is interstudy variability in the included studies.

    “based on the assumption of the presence of interstudy variability to provide a more conservative estimate of the true effect.”

  • The authors state this as an assumption.

    There is clinical heterogeneity in the study population or intervention.

    “In the presence of clinical heterogeneity in the study population or intervention, the DerSimonian and Laird random-effects model of pooling was used based on the assumption of the presence of interstudy variability to provide a more conservative estimate of the true effect.”

  • The paper relies on this without support.

    The study populations in the included trials are representative of patients seen in clinical practice.

    “Despite this lack of standardized diagnosis, the study populations in all trials appeared to be representative of patients seen in clinical practice.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Diversity in professional practice contributes to heterogeneity in the literature, as treatment outcomes are shaped by differences in clinical approach, underlying etiology, and involvement of structures such as joints, muscles, and neuropathic components.

    “This diversity contributes to heterogeneity in the literature, as treatment outcomes are shaped by differences in clinical approach [15,16], underlying etiology, and involvement of structures such as joints (TMJ or spine), muscles, and neuropathic components – factors that complicate differential diagnosis [17,18].”

    From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [16]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Limitations with those reviews and their supporting evidence make it difficult to determine the efficacy of cervical spine joint mobilizations or manipulations.

    “However, limitations with those reviews and their supporting evidence makes it difficult to determine the efficacy of cervical spine joint mobilizations or manipulations.”

    From The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis (2023) · cites this paper as [5]

    The Methodological Elements and Overall Quality of the Evidence and Limitations sections rate the evidence as low and caution that study bias and combined treatments make effects difficult to assess. This supports uncertainty about the reviewed treatments, but the review is explicitly limited to temporomandibular disorders; it does not establish the efficacy of cervical spine mobilizations or manipulations generally. Page numbers were not available in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Other systematic reviews have investigated the efficacy of various cervical manual therapy techniques on temporomandibular joint dysfunction, including myofascial release, mobilization/manipulation, and combined interventions.

    “Other systematic reviews have investigated the efficacy of various cervical MT techniques on TMJ dysfunction,5,19,23,24 such as myofascial release to the masticatory and cervical muscles, mobilization/manipulation to the cervical and thoracic spine, and interventions combining the two.5,19”

    From The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis (2023) · cites this paper as [5]

    The sections “Manual Therapy Targeted to the Orofacial Region in Myogenous TMD” and “Manual Therapy and Mixed TMD” review intraoral myofascial therapy, cervical mobilization, and upper-thoracic manipulation. “Manual Therapy Plus Exercises for Mixed TMD” also examines combined orofacial and cervical treatment. The copy does not specifically identify myofascial release to cervical muscles or an intervention combining that release with spinal mobilization or manipulation; page numbers were not available in the indexed passages. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • These reviews suggest that manual therapy combined with other interventions improves outcomes for those with temporomandibular joint dysfunction.

    “These reviews suggest that MT combined with other interventions improves outcomes for those with TMJ dysfunction.5,19,23”

    From The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis (2023) · cites this paper as [5]

  • Details about specific manual therapy techniques used were not consistently provided, and manual therapy techniques were variable.

    “Details about specific MT techniques used were not consistently provided, and MT techniques were variable, including soft tissue release, joint mobilizations, and joint manipulations performed to the cervical spine and/or TMJ.5,19,23,24”

    From The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis (2023) · cites this paper as [5]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Risk-of-bias classification rule conflicts with reported classifications

    Minor

    The stated rule classifies a trial with an unclear overall risk-of-bias assessment as low risk. The results instead report that no study was low risk and that 58.4% were classified as unclear.

  • Intervention-description percentage does not match the study count

    Minor

    The review included 48 studies. Thirty of 48 is 62.5%, not 64.6%.

    Reported 64.6 · recomputed 62.5

  • Two upper confidence limits are reported for the same mouth-opening estimate

    Minor

    The results text gives an upper 95% confidence limit of 45.06 mm, while the GRADE table gives 45.08 mm for the same estimate.

3 of 3

Cites

Flagged first, then by citations

3 of the 124 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. McNeill, 1993, Epidemiology, 19
  2. Armijo, 2001, Clinic and teleradiographic alterations in patients with anterior disc displacement with reduction, Kinesiologia, 64, 82
  3. Higgins, 2006, Cochrane Handbook for Systematic Reviews of Interventions, Version 4.2.6
  4. Cohen, 1988, The concepts of power analysis, 1
  5. Diracoglu, 2009, Arthrocentesis vs conventional methods in the pain and functional status of the patients with temporomandibular disc displacement without reduction, Pain Practice, 9, 47
  6. Maluf, 2009, A comparison of two muscular stretching modalities on pain in women with myogenous temporomandibular disorders, Pain Pract, 9, 49
  7. O'Reilly, 1996, TMJ pain and chiropractic adjustment: a pilot study, Chiropractic J Aust, 26, 4

Cited by

Sorted by citations

Related

Authors
Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A.
Affiliations
  • University of Alberta (CA)
  • Cliniques Universitaires Saint-Luc (BE)
  • F. Neto, PT, FisioNeto–Terapia Manual Ortopédica and Pilates Clínico, Póvoa de Varzim, Portugal.
  • N. Thie, BSc, MSc, MMSc, DDS, School of Dentistry, Faculty of Medicine and Dentistry, TMD/Orofacial Pain Graduate Program, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada.
  • Federico II University Hospital (IT)
Corresponding author
Armijo-Olivo, Susan
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2016-01-01
Volume
96
Issue
1
Pages
9-25
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.2522/ptj.20140548
PMC
PMC4706597
OpenAlex
W2180651192
Cited by
413
References
124
Citations by year
2026: 30 · 2025: 40 · 2024: 58 · 2023: 63 · 2022: 54 · 2021: 50 · 2020: 46 · 2019: 27 · 2018: 24 · 2017: 15 · 2016: 3 · 2015: 1 · 2013: 1
FWCI
5.04
Type
journal article
Language
en
Open access
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
  • Digital Access to Libraries (submittedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
Keywords
temporomandibular disorders, manual therapy, exercise therapy, manipulation, pain, range of motion, oral function, conservative treatment, risk of bias
MeSH terms
Exercise Therapy, Humans, Pain Measurement, Temporomandibular Joint Disorders, Range of Motion, Articular, Musculoskeletal Manipulations

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-12.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-12.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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