INVESTIGATION AND COMPARISON OF THE EFFECTS OF POSTURE EXERCISES ON DYSFUNCTION, POSTURE AND BALANCE IN INDIVIDUALS WITH POSTERIOR EDENTULOUS AND FULL-TOOTHED TEMPOROMANDIBULAR DISORDER

Study Overview
=================
Brief Summary
-----------------
The aim of this study is to investigate the relationship between neck posture and balance in patients with posterior edentulous and full-toothed temporomandibular disorder and to compare the effectiveness of the physiotherapy program to be applied.

Detailed Description
-----------------
The study was planned as a quasi-experimental controlled study. A total of 26 patients with temporomandibular disorder, aged between 18-70 years, 13 of whom were in the Posterior Edentulous Group (PDG) and 13 were in the Fully Toothed Group (TDG), were included. Posture exercises and manual therapy were applied to both groups twice a week for six weeks. Mandibular range of motion, pain, muscle strength, deep neck flexor endurance, flexibility, shortness, range of motion (ROM), pressure pain threshold (BAE), psychological state, posture and balance were evaluated before and after exercise. The results of the study showed that six weeks of postural exercises and manual therapy provided significant improvement in all values (p<0.05). A significant difference was found in pain, muscle strength, ROM, BAE and balance in PDG compared to TDG (p<0.05). The results of the study showed that symptoms can be improved by giving posture exercises in patients with tempromandibular disorder. It was concluded that the improvement in PDG was higher than in TDG.

Official Title
-----------------
INVESTIGATION AND COMPARISON OF THE EFFECTS OF POSTURE EXERCISES ON DYSFUNCTION, POSTURE AND BALANCE IN INDIVIDUALS WITH POSTERIOR EDENTULOUS AND FULL-TOOTHED TEMPOROMANDIBULAR DISORDER

Conditions
-----------------
Temporomandibular Disorder

Intervention / Treatment
-----------------
* Other: Physiotherapy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Being diagnosed with Myofascial Temporomandibular Disorder according to The Research Diagnostic Criteria for Temporomandibular Disorders Complaining of head or neck pain Having temporomandibular joint pain for at least 3 months Not having used an intraoral plaque before Able to follow the treatment protocol regularly Ability and willingness to communicate verbally Exclusion Criteria: Being positive for COVID-19 Sports injuries Presence of trauma Whiplash Degenerative changes Signs or symptoms of disc displacement, osteoarthrosis or osteoarthritis of temporomandibular joint Post-operative conditions involving the cervical or temporomandibular region Burn involving the cervical region and the temporomandibular region Patients using analgesics or muscle relaxants up to 8 hours before the physical therapy procedure Those with hypermobility in cervical movements Those who have received physiotherapy or other treatment from the head / neck area in the last 12 months Acute infections or any systemic disorder Osteoporosis

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A total of 26 patients with temporomandibular disorder, aged between 18-70 years, 13 of whom were in the Posterior Edentulous Group (PDG) and 13 were in the Fully Toothed Group (TDG), received same treatment.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Posterior Edentulous Group<br>Posture exercises, manual therapy and kinesio taping were applied twice a week for six weeks. | Other: Physiotherapy<br>* Posture exercises, myofascial release techniques, sternocleidomastoideus and upper trapezius kinesio taping, trigger point ischemic compression, suboccipital release technique, cervical traction, deep neck flexors endurance exercises, massage<br>* Other names: Kinesio taping;|
| Experimental: Fully Toothed Group<br>Posture exercises, manual therapy and kinesio taping were applied twice a week for six weeks. | Other: Physiotherapy<br>* Posture exercises, myofascial release techniques, sternocleidomastoideus and upper trapezius kinesio taping, trigger point ischemic compression, suboccipital release technique, cervical traction, deep neck flexors endurance exercises, massage<br>* Other names: Kinesio taping;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mandibular Range of Motion | Maximal mouth opening, protrusion and both lateral excursions was recorded in millimeters. Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 
| Posture | Posture evaluated with New York Posture Rating Chart. Possible scores range from 13 (bad posture) to 65 (very good posture) Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 
| Balance | Balance evaluated with TETRAX® Interactive Balance System. Possible scores range from 0 (minimum fall risk) to 100 (high fall risk). Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Score with Numeric Pain Rating Scale (NPRS) | NPRS is a validated, self-reported instrument assessing average pain intensity. Possible scores range from 0 (no pain) to 10 (worst possible pain). Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 
| Active Cervical Range of Motion | Measured by a phone app named Clinometer. Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 
| Beck Depression Inventory | Beck Depression Inventory, which is a validated, self-reported scale, consists of 21 questions. According to the total result, 0-9 points indicates minimal depression, 10-16 points mild depression, 17-29 moderate depression, 30-63 severe depression. Change = ( Week 6 Score - Baseline Score) Comparison = (Posterior Edentulous Group Change Score - Fully Toothed Group Change Score) | Baseline and week 6 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
temporomandibular joint, physiotherapy, posture exercises, posterior tooth loss