Effects of Rocabado's Approach Versus Kraus Exercise Therapy

Study Overview
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Brief Summary
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TMJ dysfunction is linked to trauma, joint overloading owing to para-functional behaviors, mechanical stress, and metabolic issues. Myofascial pain and dysfunction, functional derangement, and osteoarthrosis are the three most frequent TMJ-related disorders. Temporomandibular joint disorders are a type of craniofacial problems. They affect the temporomandibular joint, muscles of mastication, and other musculoskeletal tissues. The most common clinical sign and symptoms associated with TMJ dysfunction are orofacial pain and clicking. The aim of study will be to compare the effects of Rocabado's approach versus Kraus therapy on Pain and Disability in patients with temporomandibular dysfunction.

Detailed Description
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A Randomized Clinical Trial will be conducted at FMH Physiotherapy Clinic and Boston Physiotherapy Clinic Lahore through consecutive sampling technique on 40 patients which will be allocated using random sampling through opaque sealed enveloped into Group A and Group B. Group A will be treated with Rocabado's approach and Group B will be treated with Kraus exercises. Outcome measures tools will be conducted through NPRS, TMD disability index, Fonseca questionnaire after four weeks. Data will be analyzed during SPSS software version 21. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non-parametric test will be used within a group or between two groups.

Official Title
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Effects of Rocabado's Approach Versus Kraus Exercise Therapy on Pain and Disability in Patients With Temporomandibular Dysfunction

Conditions
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Temporomandibular Dysfunction

Intervention / Treatment
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* Other: Rocabado's approach
* Other: Kraus exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female between the ages of 30 to 60 years Patients with jaw pain Patients with limited jaw range of motion and associated joint pain Patients with TMJ clicking sounds Patients with pain upon muscle and joint palpation Exclusion Criteria: Diagnosis of ear, nose, and throat medical pathology underlying the tinnitus; Neurological problems that could potentially cause the tinnitus Inability to read, understand, and complete the questionnaires or understand and follow commands (e.g., illiteracy, dementia, or blindness)

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group: A Rocabado's approach<br>Rest position of the tongue: The anterior 1/3 of the tongue is placed at the palate with mild pressure. Control of TMJ rotation: The jaw is repeatedly opened and closed with the anterior 1/3 of the tongue on the palate. Rhythmic stabilization technique: Gentle isometrics in the resting position are performed for jaw opening, closing, and lateral deviation. Axial extension of the neck: Combined upper cervical flexion with lower cervical extension. | Other: Rocabado's approach<br>* Group A will be treated with Rocabado's approach. Rocabado' approach will be comprised of six exercises. Rest position of the tongue Control of TMJ rotation Rhythmic stabilization technique Axial extension of the neck The patients will receive Rocabado's approach consisting 6 repetitions six times a day thrice per week for four weeks<br>|
| Experimental: Group B: Kraus exercises<br>Group B will be treated with Kraus exercises. Kraus exercises will be comprised of eight exercise programs. Tongue position at rest: The patient will be instructed to maintain a resting tongue position except during function, which involves the tip of the tongue sitting on the palate with the tip resting just posterior to the upper incisors Teeth apart: the patient will be educated to maintain the teeth apart can be therapeutic, which facilitates the resting tongue position Nasal-diaphragmatic breathing: The patient will be instructed in nasal breathing to facilitate function of the diaphragm, which reinforces positioning of both the tongue and teeth Tongue up and wiggle: Place the tongue to the palate, then move the jaw from side to side. Strengthening: Resisted closing via self-manual resistance using tongue depressor between lower incisors: 5-10-second contractions. | Other: Kraus exercises<br>* Group B will be treated with Kraus exercises. Kraus exercises will be comprised of eight exercise programs. Tongue position at rest Teeth apart: the patient will be educated to maintain the teeth apart can be therapeutic, which facilitates the resting tongue position Nasal-diaphragmatic breathing Tongue up and wiggle Strengthening Touch and bite: Proprioceptive re-education: Lateral deviation The patients will receive Kraus exercises with the frequency of 2 sets and 10 repetitions twice a day three times per week for four weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | The Numerical Rating Scale (NPRS-11) is an 11-point scale for self-report of pain. It is the most commonly used unidimensional pain scale. The respondent selects a whole number (integers 0-10) that best reflects the intensity (or other quality if requested of his/her pain. pre and post followup on 4th week | 4th week | 
| Temporomandibular Joint Disability Index Questionnaire: | The TMD Disability Index is a ten-question questionnaire that is based on the Oswestry Back Pain Questionnaire and the Neck Pain and Disability Questionnaire. 12 It is TMJ-specific, comprising specialized TMJ tasks (instrument playing, speech, dental care, and so on); it delivers a score ranging from 20 to 100. pre and post followup on 4th week | 4th week | 
| Fonseca's Questionnaire for severity | TMD diseases are classified using the Fonseca questionnaire into mild, moderate, severe, or no disease. It consists of ten questions about temporomandibular joint pain, head, back, and chewing discomfort, parafunctional habits, movement limits, joint clicking, perception of malocclusion, and emotional stress sensation. pre and post followup on 4th week | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rocabado's Approach, Kraus exercises, Disability