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

In the paper

“The minimal clinically important difference for pain has been reported to range from 1.5 to 3.2 points.30 -34”

What the sources say

• ?Not checked — no full text of the sourcecites [30] Kovacs, 2007, Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain, Spine (Phila Pa 1976) source
• ?Not checked — no full text of the sourcecites [31] Farrar, 2001, Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, Pain source
• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  cites [33] Maughan, 2010, Outcome measures in chronic low back pain, Eur Spine J sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [34] Dworkin, 2008, Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations, J Pain source

In the paper

“Measurements of PPT have been shown to have good or excellent interrater and intrarater reliability.36 -38”

What the sources say

• ?Not checked — no full text of the sourcecites [36] Nussbaum, 1998, Reliability of clinical pressure-pain algometric measurements obtained on consecutive days, Phys Ther source
• ?Not checked — no full text of the sourcecites [37] Ylinen, 2005, Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial, Eur J Pain source
• Supported

  The Introduction reports that previous studies demonstrated high intra- and inter-rater reliability for PPT assessment in clinical and healthy subjects. The paper's own measurements used one rater, but its report of prior inter-rater findings supports the citing sentence. (LLM, conf=0.90)

  cites [38] Cathcart, 2006, Reliability of pain threshold measurement in young adults, J Headache Pain source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Could not verify

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

  cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [68] de Felicio, 2008, Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy, Cranio source
• ?Not checked — no full text of the sourcecites [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

In the paper

“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”

What the sources say

• Supported

  The Abstract Methods passage identifies this paper as a trial of intra-oral myofascial therapy in people with chronic myogenous TMD, compared with education and supervised self-care exercises. It therefore supports its inclusion as one of the four cited studies; the paper is not being cited to establish the count on its own. (LLM, conf=0.92)

  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
• Supported

  The Abstract identifies this as a pilot study of intra-oral myofascial therapy in people with chronic myogenous TMD. It compares therapy alone, therapy plus education and self-care, and a non-treated wait-list group, matching the study for which this source is cited. The claim's count of four refers to the citing paper's group of studies, not to a finding attributed to this individual source. (LLM, conf=0.93)

  cites [65] Kalamir, 2010, Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study, J Man Manip Ther source
• ?Not checked — no full text of the sourcecites [77] Kalamir, 2012, Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial, J Manipulative Physiol Ther source
• ?Not checked — no full text of the sourcecites [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

In the paper

“However, one study 61 did not find that exercises were superior to a control group involving general physical therapy treatment.”

What the sources say

• ?Could not verify

  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)

  cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res sourceExperimental — accuracy not yet measured

In the paper

“Regarding active mouth opening, a nonsignificant effect was found between general jaw exercises and education, splint therapy, or a control group when pooling 3 studies.58,61,86”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Could not verify

  The available passages identify Craane et al. as a randomized trial of physical therapy for TMJ closed lock, but provide no trial methods or results. Searches for active mouth opening, jaw exercises, comparators, and a nonsignificant effect found no passage establishing that this trial contributed to the stated three-study pooled result. (LLM, conf=0.72)

  cites [61] Craane, 2012, Randomized controlled trial on physical therapy for TMJ closed lock, J Dent Res sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“When pooling the results from 3 of these studies based on similar outcomes and diagnoses and comparing similar interventions regarding MT, 64,65,81 we found that MT significantly reduced pain at 4 to 6 weeks of treatment compared with botulinum toxin or waiting list, approaching a clinically relevant value.”

What the sources say

• Supported

  The citation identifies this paper as one of the studies the citing authors pooled; the pooled result is expressly presented as what ‘we found,’ not as this paper’s own finding. The Methods (Outcome measures) and Results (Primary outcomes) describe an intra-oral myofascial therapy trial measuring pain at six weeks. Its comparator was education and self-care, rather than botulinum toxin or a waiting list. (LLM, conf=0.88)

  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
• Supported

  The Interventions and Abstract identify this as a myofascial-therapy trial with a wait-list control, making it an appropriate citation for one of the studies the citing authors pooled. The Results table reports significantly lower pain on clenching at six weeks in the treatment groups than in the control group. The pooling and its comparison with botulinum toxin are explicitly the citing authors’ own finding, not a result attributed to this individual trial. (LLM, conf=0.88)

  cites [65] Kalamir, 2010, Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study, J Man Manip Ther source
• ?Not checked — no full text of the sourcecites [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

In the paper

“However, compared with other forms of active treatments, such as splints, a global postural re-education program, or acupuncture, [72][73][74]95,95,98,99 no significant differences between these treatments were found.”

What the sources say

• Supported

  The Methods describe conservative therapy alone versus conservative therapy with either of two occlusal appliances. The Results and Discussion report no significant differences in therapeutic effectiveness between the three groups, supporting the splint comparison for which this source is cited. (LLM, conf=0.90)

  cites [72] Ficnar, 2013, Evaluation of the effectiveness of a semi-finished occlusal appliance: a randomized, controlled clinical trial, Head Face Med source
• ?Not checked — no full text of the sourcecites [73] Niemela, 2012, Efficacy of stabilisation splint treatment on temporomandibular disorders, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [74] Truelove, 2006, The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial, J Am Dent Assoc source
• ?Not checked — no full text of the sourcecites [95] Klobas, 2006, Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders, Acta Odontol Scand source
• ?Not checked — no full text of the sourcecites [98] Tavera, 2012, Approaching temporomandibular disorders from a new direction: a randomized controlled clinical trial of the TMDes ear system, Cranio source
• ?Not checked — no full text of the sourcecites [99] Raustia, 1986, Acupuncture compared with stomatognathic treatment for TMJ dysfunction, part III: effect of treatment on mobility, J Prosthet Dent source

In the paper

“Pooling the results of the 2 studies 75,105,106 with similar interventions, outcomes, and diagnoses, we found that MT targeted to the orofacial region or in combination with cervical treatment was better than home exercises for the jaw and neck alone or treatment to cervical spine alone for improving mouth opening.”

What the sources say

• ?Not checked — no full text of the sourcecites [75] Tuncer, 2013, Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial, J Bodyw Mov Ther source
• Partly supported

  The Intervention section confirms that this trial compared orofacial treatment, usually combined with cervical treatment, against cervical treatment alone. But the Results section reports improvement in cervical movement, while restricted mouth opening is described as a baseline sign; our copy does not report improvement in mouth opening. The pooling result is the citing authors’ own finding, not a finding attributed to this trial alone. (LLM, conf=0.85)

  cites [105] von Piekartz, 2013, Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial, Man Ther sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [106] von Piekartz, 2011, Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study, Cranio source

In the paper

“Eight of the trials 57,65,67,74,75,77,87,88 reported no adverse events with the treatments.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• Supported

  The Conclusion states that no participant had an adverse reaction during this trial. That supports citing this paper as one of the trials reporting no adverse events; it does not itself establish the count of eight trials. (LLM, conf=0.93)

  cites [65] Kalamir, 2010, Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study, J Man Manip Ther source
• ?Not checked — no full text of the sourcecites [67] La Touche, 2013, Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain: a randomized-controlled trial, Clin J Pain source
• ?Not checked — no full text of the sourcecites [74] Truelove, 2006, The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial, J Am Dent Assoc source
• ?Not checked — no full text of the sourcecites [75] Tuncer, 2013, Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial, J Bodyw Mov Ther source
• ?Not checked — no full text of the sourcecites [77] Kalamir, 2012, Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial, J Manipulative Physiol Ther source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [88] Haketa, 2010, Randomized clinical trial of treatment for TMJ disc displacement, J Dent Res source

In the paper

“In that study, 29.4% of the patients (66/224) had temporary facial nerve paralysis”

What the sources say

• Supported

  The Discussion reports the same figure and complication: 29.4% (66/224) with temporary facial nerve paralysis. The claim closely follows the paper’s wording. (LLM, conf=0.95)

  cites [70] Nascimento, 2013, Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial, Med Oral Patol Oral Cir Bucal source

In the paper

“The overall quality of evidence for most comparisons was low to moderate according to the GRADE approach.49”

What the sources say

• Supported

  The section “How does the GRADE system classify quality of evidence?” identifies low and moderate as GRADE quality levels. The citation supports the approach used to rate the comparisons; the finding that most comparisons received those ratings is the citing authors’ own assessment, not a result attributed to this source. (LLM, conf=0.90)

  cites [49] Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, BMJ source

In the paper

“Our recent analysis of health scales used to evaluate methodological quality determined that none of these scales are adequate for use alone.44,111”

What the sources say

• ?Not checked — no full text of the sourcecites [44] Hartling, 2012, Testing the risk of bias tool showed low reliability between individual reviewers and across consensus assessments of reviewer pairs, J Clin Epidemiol source
• Partly supported

  The Discussion (page unavailable) identifies substantial variation among quality-assessment tools and questions whether many of their items indicate bias. The Conclusion (page unavailable) calls for clearer constructs and thorough validation, but does not determine that none of the scales is adequate for use alone. (LLM, conf=0.84)

  cites [111] Armijo-Olivo, 2013, Inconsistency in the items included in tools used in general health research and physical therapy to evaluate the methodological quality of randomized controlled trials: a descriptive analysis, BMC Med Res Method sourceExperimental — accuracy not yet measured

In the paper

“Manual therapy techniques such as mobilization of the cervical spine could have an influence on orofacial pain and movement in the jaw through the connections of these 2 systems in the trigeminocervical nucleus.108”

What the sources say

• Partly supported

  The Brainstem and Thalamocortical Mechanisms section (page not supplied) says cervical nerve afferents may synapse in the trigeminal brainstem complex, supporting a neural connection. The Neuroplasticity section (page not supplied) links activity in subnucleus caudalis with jaw-muscle changes. Neither section addresses cervical-spine mobilization or shows that manual therapy influences orofacial pain or jaw movement. (LLM, conf=0.85)

  cites [108] Sessle, 1999, Neural mechanisms and pathways in craniofacial pain, Can J Neurol Sci sourceExperimental — accuracy not yet measured

In the paper

“The overall evidence for this systematic review was considered low.”

In the paper

“The trials included in this review had unclear or high risk of bias.”

• Also stated in: § Data Synthesis · plain

  “The trials included in this review had unclear or high risk of bias.”

In the paper

“Most of the effect sizes were low to moderate”

In the paper

“There was considerable diversity in the clinical presentations and diagnoses of participants with TMD among the included studies (eTab. 1).”

In the paper

“and 19 studies examined the effectiveness in patients with mixed diagnoses of TMD (including both myogenous and arthrogenous TMD).”

In the paper

“No high-quality evidence was found”

In the paper

“14 studies examined the effectiveness in patients with articular TMD (arthrogenous TMD)”

In the paper

“Independent review (in duplicate) of these 106 articles led to the inclusion of 58 articles representing 50 studies”

In the paper

“Therefore, a total of 48 studies were included in the final analysis (Fig. 1).”

In the paper

“with no clear indication of superiority of exercises versus other conservative treatments for TMD.”

In the paper

“Thus, 45 studies were included for this review from the search of the databases.”

In the paper

“In addition, only 12 (25%) of the studies used blinded assessment of outcomes”

In the paper

“Risk of bias assessments using the risk of bias tool determined that none of the studies was considered as low risk of bias.”

In the paper

“Most of the studies did not accomplish items with important methodological indicators of risk of bias, such as randomization, allocation concealment, blinding, and intention to treat (ITT).”

In the paper

“The SMD for pain intensity pooling 5 studies 57,58,62,63,66 was 0.43 (95% CIϭϪ0.02,0.87)”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
• ?Not checked — no full text of the sourcecites [63] Gavish, 2006, Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study, Cranio source
• ?Not checked — no full text of the sourcecites [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

In the paper

“with only 20 (41.6%) and 4 (8.3%) of the studies meeting these criteria, respectively.”

In the paper

“Five of them did not find significant differences between a general physical therapy exercise program targeted to the jaw 56,62,79,80 or jaw and neck 57 compared with a control or other active treatments, such as biofeedback, TENS, use of the TheraBite Jaw Motion Rehabilitation System (ATOS Medical AB, Hörby, Sweden), or oral splint therapy.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] Magnusson, 1999, Therapeutic jaw exercises and interocclusal appliance therapy: a comparison between two common treatments of temporomandibular disorders, Swed Dent J
• ?Not checked — no full text of the sourcecites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
• ?Not checked — no full text of the sourcecites [79] Crockett, 1986, A comparison of treatment modes in the management of myofascial pain dysfunction syndrome, Biofeedback Self Regul source
• ?Not checked — no full text of the sourcecites [80] Kraaijenga, 2014, Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise, Cranio source
• ?Not matched

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

In the paper

“The SMD in symptoms and disturbance of symptoms with daily life was 1.13 (95% CIϭ0.48, 1.78)”

In the paper

“However, 3 studies 58,63,66 showed better outcomes, especially on pain and ROM, compared with control groups.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [63] Gavish, 2006, Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study, Cranio source
• ?Not checked — no full text of the sourcecites [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

In the paper

“Furthermore, patients treated with postural training had significantly fewer symptoms and disturbance with daily living compared with a control group.”

In the paper

“Data from these studies 56,58,62,66 indicated that there was a trend to favor exercise therapy for pain-free maximum mouth opening and pain intensity compared with a control group.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] Magnusson, 1999, Therapeutic jaw exercises and interocclusal appliance therapy: a comparison between two common treatments of temporomandibular disorders, Swed Dent J
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
• ?Not checked — no full text of the sourcecites [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

In the paper

“Only 3 of the studies used a double-blinded design and could blind participants.”

In the paper

“Two studies 59,60 evaluated the effectiveness of posture correction exercises for patients with myofascial pain.”

What the sources say

• ?Not checked — no full text of the sourcecites [59] Komiyama, 1999, Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [60] Wright, 2000, Usefulness of posture training for patients with temporomandibular disorders, J Am Dent Assoc source

In the paper

“Only a few studies reported these items (11, 17, and 3 studies, respectively).”

In the paper

“it was uncertain if sample size was adequate in 30 of the studies”

In the paper

“The MD for pain-free maximum mouth opening was 5.94 mm (95% CIϭϪ1.0,12.87)”

In the paper

“Most of them were classified as either unclear (58.4%) or high risk of bias (41.6%).”

In the paper

“only 17 of the analyzed studies included information regarding the reasons of withdrawals and dropouts”

In the paper

“Testing participants' adherence to intervention and having adequate adherence was another issue that was not met by many studies (only 11 and 7 studies, respectively).”

In the paper

“only 64.6% (nϭ30) of the studies described the main intervention to be tested.”

In the paper

“Only a few studies reported these items (11, 17, and 3 studies, respectively).”

In the paper

“Only 6 studies accomplished more than 60% of the items listed in eTable 2. 57,66,67, 76 -78”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [67] La Touche, 2013, Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain: a randomized-controlled trial, Clin J Pain source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [77] Kalamir, 2012, Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial, J Manipulative Physiol Ther source
• ?Not checked — no full text of the sourcecites [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

In the paper

“with only 20 (41.6%) and 4 (8.3%) of the studies meeting these criteria, respectively.”

In the paper

“When pooling the data for these 2 studies, which had similar interventions, diagnoses, and outcomes, maximum pain-free mouth opening significantly increased in patients receiving postural training compared with a control group.”

In the paper

“and only 16 studies used intention-to-treat analysis.”

In the paper

“Only 6 studies met this item.”

In the paper

“and only 18 studies reported an evaluation of the clinical significance of their results.”

In the paper

“When performing sensitivity analyses, grouping studies comparing exercise therapy and education, 62,66 a nonsignificant effect was found on pain-free maximum mouth opening (1.92 mm; 95% CIϭϪ0.57,4.41).”

What the sources say

• ?Not checked — no full text of the sourcecites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
• ?Not checked — no full text of the sourcecites [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

In the paper

“and none of the studies blinded the therapist.”

In the paper

“The results of these studies were equivocal.”

In the paper

“The MD in maximum painfree mouth opening was 5.54 mm (95% CIϭ2.93, 8.15) (Fig. 2)”

In the paper

“Eight studies 56 -58,62,63,66,79,80 looked at the effect of exercises alone or combined with other therapies for myogenous TMD.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] Magnusson, 1999, Therapeutic jaw exercises and interocclusal appliance therapy: a comparison between two common treatments of temporomandibular disorders, Swed Dent J
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [62] Craane, 2012, One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial, Eur J Pain source
• ?Not checked — no full text of the sourcecites [63] Gavish, 2006, Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: a pilot study, Cranio source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [79] Crockett, 1986, A comparison of treatment modes in the management of myofascial pain dysfunction syndrome, Biofeedback Self Regul source
• ?Not checked — no full text of the sourcecites [80] Kraaijenga, 2014, Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise, Cranio source

In the paper

“Both studies showed positive results of postural exercises for improving symptoms of muscular TMD.”

In the paper

“Testing participants' adherence to intervention and having adequate adherence was another issue that was not met by many studies (only 11 and 7 studies, respectively).”

In the paper

“When pooling the studies that considered the comparison of MT versus a waiting list only, similar results were obtained (1.31 cm; 95% CIϭ0.86, 1.76).”

In the paper

“However, when comparing exercises and splint therapy, 56,58 a statistically and clinically meaningful effect was found (12.31 mm; 95% CIϭ7.73, 16.89).”

What the sources say

• ?Not checked — no full text of the sourcecites [56] Magnusson, 1999, Therapeutic jaw exercises and interocclusal appliance therapy: a comparison between two common treatments of temporomandibular disorders, Swed Dent J
• ?Not checked — no full text of the sourcecites [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

In the paper

“The MD for active mouth opening was 3.13 mm (95% CIϭϪ1.96,8.23).”

In the paper

“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.”

In the paper

“This preliminary study showed that mobilizations targeted to the cervical spine drastically decreased pain intensity and pain sensitivity (via PPT evaluation) in patients with cervico-craniofacial pain of myofascial origin immediately after the application of the technique compared with placebo treatment.”

In the paper

“When pooling the results from the studies with homogeneous interventions and similar outcomes, diagnoses, and available data, 69,78,87,88,90 we found that pain was significantly reduced in patients receiving MT combined with exercises compared with splint therapy, self-care, or medications.”

What the sources say

• ?Not checked — no full text of the sourcecites [69] Ismail, 2007, Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [88] Haketa, 2010, Randomized clinical trial of treatment for TMJ disc displacement, J Dent Res source
• ?Not checked — no full text of the sourcecites [90] Minakuchi, 2001, Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction, J Dent Res source

In the paper

“The MD was Ϫ1.01 mm (95% CIϭϪ5.43,3.42)”

In the paper

“A recent RCT conducted by La Touche et al 67 testing a more specific approach directed to the cervical spine to treat patients with cervico-craniofacial pain of myofascial origin was performed.”

What the sources say

• ?Not checked — no full text of the sourcecites [67] La Touche, 2013, Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain: a randomized-controlled trial, Clin J Pain source

In the paper

“Five of these studies 69,78,87,88,91 favored the use of MT in conjunction with exercises compared with splints 69,87,88 or with medications 91 or other nonconservative treatments for arthrogenous TMD, such as arthroscopy and arthroplasty.78”

What the sources say

• ?Not checked — no full text of the sourcecites [69] Ismail, 2007, Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [88] Haketa, 2010, Randomized clinical trial of treatment for TMJ disc displacement, J Dent Res source
• ?Not checked — no full text of the sourcecites [91] Yoshida, 2005, Simple manipulation therapy for temporomandibular joint internal derangement with closed lock, Asian J Oral Maxillofac Surg source

In the paper

“In addition, facial manipulation had an equivalent effect as botulinum toxin.”

In the paper

“When looking at active mouth opening, 69,87,88,90 we found that MT plus exercises significantly increased active mouth opening compared with splint therapy, self-care, or medications.”

What the sources say

• ?Not checked — no full text of the sourcecites [69] Ismail, 2007, Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [88] Haketa, 2010, Randomized clinical trial of treatment for TMJ disc displacement, J Dent Res source
• ?Not checked — no full text of the sourcecites [90] Minakuchi, 2001, Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction, J Dent Res source

In the paper

“Although the results were mixed, most of the studies favored the use of exercises alone or as part of a general regimen to treat people with arthrogenous TMD, including disk displacements with or without reduction.58,68,84 -86”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [68] de Felicio, 2008, Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy, Cranio source
• ?Not checked — no full text of the sourcecites [84] Yoda, 2003, A randomized controlled trial of therapeutic exercise for clicking due to disk anterior displacement with reduction in the temporomandibular joint, Cranio source
• ?Not checked — no full text of the sourcecites [85] Yoshida, 2011, Evaluation of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation, Br J Oral Maxillofac Surg source
• ?Not checked — no full text of the sourcecites [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

In the paper

“The MD for pain intensity was 1.35 cm (95% CIϭ0.91, 1.78).”

In the paper

“A trend favoring exercises was observed based on the 95% CI values.”

In the paper

“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.”

In the paper

“Nevertheless, there was a trend to favor the exercise group compared with the control group.”

In the paper

“Exercises did not show superiority over other treatments for treating mixed TMD.”

In the paper

“The rest of the evidence was considered low.”

In the paper

“No adverse events regarding exercise therapy or MT treatments were reported among the trials included.”

In the paper

“Thus, we can say that the total evidence was considered low.”

In the paper

“The MD for mouth opening was Ϫ0.25 mm (95% CIϭϪ2.08,1.57) (Fig. 4).”

In the paper

“the MD in mouth opening between control and MT groups was 17.33 mm (95% CIϭϪ10.39,45.06).”

In the paper

“There remain limited RCTs of high quality that have investigated the effectiveness of MT and exercises to treat TMD.”

In the paper

“The results of our systematic review are consistent with previous reviews, 19,23 showing positive effects when using exercises to treat myogenous and arthrogenous TMD.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [23] McNeely, 2006, A systematic review of physical therapy intervention for temporomandibular disorders, Phys Ther source

In the paper

“Niemela et al 73 reported that pain on TMJ palpation increased significantly in the splint group compared with the control group.”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Niemela, 2012, Efficacy of stabilisation splint treatment on temporomandibular disorders, J Oral Rehabil source

In the paper

“The mouth opening between control and MT groups was 6.10 mm (95% CIϭ1.11, 11.09) favoring MT groups.”

In the paper

“A general exercise program was effective compared with arthrocentesis or arthrography for treatment of arthrogenous TMD”

In the paper

“When pooling results for mouth opening, 55,71,73,92,94,95,97 nonsignificant differences were obtained between general jaw exercises and splint therapy, global re-education posture, splint plus counseling, or standard conservative care.”

What the sources say

• ?Not checked — no full text of the sourcecites [55] Burgess, 1988, Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system, J Prosthetic Dent source
• ?Not checked — no full text of the sourcecites [71] de Felicio, 2010, Effects of orofacial myofunctional therapy on temporomandibular disorders, Cranio source
• ?Not checked — no full text of the sourcecites [73] Niemela, 2012, Efficacy of stabilisation splint treatment on temporomandibular disorders, J Oral Rehabil source
• ?Not checked — no full text of the sourcecites [92] Raustia, 1985, Acupuncture compared with stomatognathic treatment for TMJ dysfunction, part I: a randomized study, J Prosthet Dent source
• ?Not checked — no full text of the sourcecites [94] Grace, 2002, The use of an oral exercise device in the treatment of muscular TMD [erratum in: Cranio. 2003;21:A–5], Cranio source
• ?Not checked — no full text of the sourcecites [95] Klobas, 2006, Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders, Acta Odontol Scand source
• ?Not checked — no full text of the sourcecites [97] Tegelberg, 1996, A 3-year follow-up of temporomandibular disorders in rheumatoid arthritis and ankylosing spondylitis, Acta Odontol Scand source

In the paper

“When pooling data from the 2 studies that looked at similar manual techniques, TMD diagnoses, and outcomes, 101,103 although there was no significant difference between mobilization of atlantoaxial joint or control group receiving no mobilization”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“From the 14 analyses performed, most of the evidence was considered moderate (9 analyses).”

In the paper

“The MD for active mouth opening at 4 weeks to 3 months was 3.58 mm (95% CIϭ1.46, 5.70).”

In the paper

“Adverse effects were reported in only 10 of the 48 included trials.”

In the paper

“Mobilization of the cervical spine resulted in decreases in pain intensity and pain sensitivity (via PPT evaluation) in patients with myogenous TMD that exceed suggested values for minimum clinically important differences for pain and treatment of the cervical spine.”

In the paper

“A combination of MT for the orofacial region plus MT of the cervical spine was more effective than home exercises or treatment to cervical spine alone in people with mixed TMD.”

In the paper

“Exercises did not show clear superiority over other conservative treatments for TMD.”

In the paper

“The minimal important difference for PPTs has been reported to be Ն1.10 kg/cm 2 /s.39,40”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Chesterton, 2003, Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects, Pain source
• ?Not checked — no full text of the sourcecites [40] Fuentes, 2011, A preliminary investigation into the effects of active interferential current therapy and placebo on pressure pain sensitivity: a random crossover placebo controlled study, Physiotherapy source

In the paper

“Most of these early systematic reviews highlighted the positive effects of exercises and MT to improve symptoms and function in people with TMD.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [23] McNeely, 2006, A systematic review of physical therapy intervention for temporomandibular disorders, Phys Ther source
• ?Not checked — no full text of the sourcecites [25] Brantingham, 2013, Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review, J Manipulative Physiol Ther source

In the paper

“indicating that an important change of at least 5 mm can be considered clinically relevant.35”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kropmans, 1999, Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint, J Dent Res source

In the paper

“Another recent systematic review 25 combined pathologies of the upper extremity and TMD.”

What the sources say

• ?Not checked — no full text of the sourcecites [25] Brantingham, 2013, Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review, J Manipulative Physiol Ther source

In the paper

“which implies that the information from earliest reviews is now outdated.”

In the paper

“The smallest detectable difference of maximal mouth opening in healthy people has been reported to be 5 mm”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kropmans, 1999, Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint, J Dent Res source

In the paper

“In addition, none of these systematic reviews provided a meta-analysis of the trials.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [23] McNeely, 2006, A systematic review of physical therapy intervention for temporomandibular disorders, Phys Ther source
• ?Not checked — no full text of the sourcecites [25] Brantingham, 2013, Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review, J Manipulative Physiol Ther source

In the paper

“indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.”

In the paper

“However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects.”

In the paper

“which is considered clinically relevant.35”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kropmans, 1999, Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint, J Dent Res source

In the paper

“with a moderate effect size according to Cohen's guidelines.48”

What the sources say

• ?Not matched

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

  cites [48] Cohen, 1988, The concepts of power analysis

In the paper

“indicating a large, clinically significant effect size for this pooled outcome.”

In the paper

“Manual therapy alone or in combination with exercises shows promising effects.”

In the paper

“Postural exercises are helpful.21”

What the sources say

• ?Not checked — no full text of the sourcecites [21] Rocabado, 1987, The importance of soft tissue mechanics in stability and instability of the cervical spine: a functional diagnosis for treatment planning, Cranio source

In the paper

“This difference was clinically relevant.35”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kropmans, 1999, Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint, J Dent Res source

In the paper

“This difference can be considered as a clinically relevant improvement in mouth opening favoring MT treatment.”

In the paper

“Thus, the evidence was generally downgraded for 3 reasons: (1) risk of bias, 2) level of heterogeneity (inconsistency), and (3) some imprecision surrounding the effect estimate.”

In the paper

“The overall rating of the evidence for this review was low.”

In the paper

“These issues are of importance for this study, as it is unclear if the effects on selected outcomes were due to the effect of exercise, MT, or other cointerventions.”

In the paper

“Research, to date, suggests that a mixed therapy involving MT techniques and exercises improves patient outcome.”

In the paper

“Although the overall level of evidence is low”

In the paper

“Thus, diagnoses used for the analyzed studies might not be appropriate.”

In the paper

“Manual therapy alone or in combination with exercises shows promising effects.”

In the paper

“Only 21 out of 48 studies included a diagnostic tool that had been demonstrated as being valid, reliable, and reproducible to diagnose TMD.”

In the paper

“Therefore, language-restricted metaanalyses do not appear to lead to biased estimates of intervention effectiveness.112,113”

What the sources say

• ?Not checked — no full text of the sourcecites [112] Moher, 2003, The inclusion of reports of randomised trials published in languages other than English in systematic reviews, Health Technol Assess source
• ?Not checked — no full text of the sourcecites [113] Moher, 2000, What contributions do languages other than English make on the results of meta-analyses?, J Clin Epidemiol source

In the paper

“could potentially be beneficial for patients with TMD”

In the paper

“The methodological biases common to the included studies could have an impact on results.”

In the paper

“Another important bias was the lack of blinding, especially of the patients and assessors.”

In the paper

“Studies did not report interventions in sufficient detail to be reproducible.”

In the paper

“However, because of the nature of the interventions investigated, blinding would not be possible in many of them.”

In the paper

“It is likely that lack of blinding could have affected the results of these studies.”

In the paper

“Moreover, different diagnostic criteria for TMD were used.”

In the paper

“The heterogeneity among studies, particularly with respect to TMD diagnosis, study intervention, and chosen control or comparison intervention was a challenge.”

In the paper

“In addition, it is unclear if the participants received enough dosage of treatments, as adequate adherence was accomplished by only a very small proportion of studies (15.2%).”

In the paper

“Other potential biases that could potentially have affected observed effects were inappropriate handling of withdrawals and dropouts (only 16 trials used ITT analysis).”

In the paper

“There is empirical evidence showing that trials without appropriate randomization, concealment of allocation, and blinding tend to report an inaccurate treatment effect compared with trials that include these features.109”

What the sources say

• ?Not checked — no full text of the sourcecites [109] Savovic, 2012, Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials, Ann Intern Med source

In the paper

“In addition, it has been reported that language-restricted meta-analyses only minimally overestimate treatment effects (ϳ2% on average) compared with language-inclusive meta-analyses.112”

What the sources say

• ?Not checked — no full text of the sourcecites [112] Moher, 2003, The inclusion of reports of randomised trials published in languages other than English in systematic reviews, Health Technol Assess source

In the paper

“This finding was due mainly to the risk of bias of the analyzed studies.”

In the paper

“Only 12 studies used blinded assessment of clinician-assessed outcomes such as mouth opening.”