Home Exercises Program Compared With Physiotherapy Program in TMD
Condition: Temporomandibular Disorder
MeSH terms: Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      Introduction: Although there are physiotherapy programs that are widely used in the treatment
      of Temporomandibular Disorders (TMD), there are few studies investigating the effects of home
      exercises program specifically developed for TMD.

      Aim: Investigators aimed to investigate the effect of home exercise program on pain and
      quality of life in TMD treatment.

      Methods: 20 patients were included in our pilot study and were randomised into two groups.
      Home exercises program and physiotherapy program were applied to the intervention group
      (n=10; age 31.4±11.2 years), and only physiotherapy program to the control group (n=10, age
      35.3±18.1 years). Physiotherapy program included ultrasound (US), Transcutaneous Electrical
      Nerve Stimulation (TENS) and exercise. Investigators measured pain with the Visual Analogue
      Scale (VAS) and quality of life with the Short Form 36 (SF-36) before and after the
      treatment.
    

Detailed description: 
      This study was carried out on 20 patients who applied to Nigde Omer Halisdemir University Bor
      Physical Therapy and Rehabilitation Hospital and were diagnosed with TMD. Twenty patients
      were divided into two groups of ten each with randomisation (closed envelope method).
      Bilateral TMD were diagnosed according to the Research Diagnostic Criteria for TMD used by
      Department of Physical Medicine and Rehabilitation in Nigde Omer Halisdemir University Bor
      Physical Therapy and Rehabilitation Hospital . Ethical approval for the study was obtained
      from Nigde Omer Halisdemir University Bor Physical Therapy and Rehabilitation Hospital
      (63524359-915.03.03) and Nigde Omer Halisdemir University Ethics Committee (2017/10-05). All
      participants were given an informed consent form before the study.

      Visual Analogue Scale (VAS) for pain and SF-36 Quality of Life Questionnaire for quality of
      life were used as main outcome measurements. It was questioned whether each patient had pain
      in the head, neck, shoulder, lower back, jaw, teeth and back for the last 6 and the patients
      were asked to mark the severity of the existing pain on a 10 cm chart weeks (0=no pain, 10=
      worst imaginable pain). Then, these points were evaluated by measuring with a ruler (12). The
      SF-36 Quality of Life Questionnaire is a patient reported outcome measurement with 8
      sub-parameters, consisting of 36 items to obtain information about the health status of a
      person. These parameters are vitality, physical function, pain, general health, physical role
      difficulty, emotional function, social function and mental health. SF-36 total score ranges
      between 0-100, 0 means poor health while 100 means no health problem (13). Pain and quality
      of life were assessed before (BT) and after the treatment (AT).

      Treatment The physiotherapy program consisted of 1 session per day for 3 weeks, a total of 15
      sessions. Treatment for control group included Ultrasound for 5 minutes to both TMJ, TENS on
      both TMJ for 20 minutes, exercise for 30 minutes and patient education. In addition to the
      treatment for control group, intervention group received home exercises program.

      Ultrasound (Chattanooga Intellect Mobile Ultrasound) was applied for 5 minutes at a dose of
      1.5 watts/cm² with circular movements. Transcutaneous electrical stimulation (BTL-4000) was
      applied at a frequency of 100 Hz and at the current intensity that the patient clearly felt
      for 20 minutes. As exercise, Temporomandibular joint isotonic and isometric strengthening,
      posture, stretching and relaxation, and breathing exercises were taught to both groups.
      During the treatment period, the patients performed the exercises under the supervision of a
      physiotherapist after the US and TENS application.

      The intervention group was also taught home exercises program and asked to do 6 repetitions 6
      times a day. This exercise program was given to the patients in brochure form. These
      exercises were not given to the control group.

      Patient education was given to each patient by explaining the parafunctional habits and
      methods that they could apply in their daily life to reduce the pain, and a brochure
      containing this information was distributed.

      Rocabado's 6x6 Exercises:

        1. Tongue relaxation position: When the teeth are slightly open and the lips are closed,
           1/3 of the tongue applies gentle pressure to the palate. The tongue should never touch
           the teeth. Breathe through the nose using the diaphragm.

        2. Shoulder posture: The shoulders are moved downwards and backwards at the same time to
           bring the shoulder blades closer together.

        3. Fixing the position of the head: To fix the neck, the hands are clasped behind the neck
           and the head is moved forward and upward. (Distraction movement)

        4. Movement of the jaw joint: It is the movement of the jaw closer to the neck and away
           (anterior-posterior gliding to the cervical spines).

        5. Control of TMJ rotation: When the tongue is in the relaxation position, the index finger
           is placed on the TMJ and mouth opening and closing movements are performed. It prevents
           the jaw from sliding left and right. In this way, controlled chewing is taught to the
           patient.

        6. Rhythmic stabilization technique: While the tongue is in the relaxation position, the
           index fingers are placed on the TMJ and the chin is fixed. The patient is asked to apply
           a slight resistance and the movements of TMJ opening, closing, shifting to the right and
           left (lateral deviations) are taught.
    

Intervention name(s): Intervention Group: Physiotherapy program + home exercises program; Control Group : Physiotherapy program
Intervention type(s): Other; Other
Intervention description(s): Physiotherapy program: The physiotherapy program consisted of 1 session per day for 3 weeks, a total of 15 sessions. Treatment for control group included Ultrasound for 5 minutes to both TMJ, TENS on both TMJ for 20 minutes, exercise for 30 minutes and patient education. In addition to the treatment for control group, intervention group received home exercises program.The intervention group was also taught home exercises program and asked to do 6 repetitions 6 times a day. This exercise program was given to the patients in brochure form.; Physiotherapy program: The physiotherapy program consisted of 1 session per day for 3 weeks, a total of 15 sessions. Treatment for control group included Ultrasound for 5 minutes to both TMJ, TENS on both TMJ for 20 minutes, exercise for 30 minutes and patient education.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 20 patients were included in our pilot study and were randomised into two groups. Traditional physiotherapy program and home exercises program were applied to the intervention group (n=10; age 31.4±11.2 years), and only traditional physiotherapy to the control group (n=10, age 35.3±18.1 years). Traditional physiotherapy program included ultrasound (US), TENS and exercise.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: temporomandibular joint disorders; pain; quality of life; exercises