Giacomo Asquini, Giulia Pisacane, Filippo Maselli, Firas Mourad, Paolo Bizzarri, Edoardo Balli, Cecilia Bagnoli, Anna Manzari, Marco Pernici, Andrea Giusti, Deborah Falla
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引用次数: 0
Abstract
Background: Evidence supports the use of exercise for patients with temporomandibular disorders (TMDs). However, previous studies have mainly focused on combined treatment strategies or undefined exercise modalities.
Objective: This systematic review aims to evaluate the effectiveness of Resistance Training (RT) as a standalone treatment for managing pain and improving neuromuscular performance in individuals with TMDs.
Methods: This systematic review followed a pre-established and published protocol, which was registered with PROSPERO (CRD42023476269). The literature search was conducted from March 1st 2024 to March 31st 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomised controlled trials or nonrandomised studies of interventions were included when they compared the effect of RT targeting masticatory muscles on pain, neuromuscular performance, and maximum mouth opening in patients with TMDs versus other treatment modalities. Two independent reviewers screened articles for inclusion, extracted data, assessed the risk of bias using the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.
Results: From an initial 2177 articles, only three met the inclusion criteria and involved 108 participants. All the included studies demonstrated a decrease in pain intensity and an improvement in neuromuscular performance following RT, even if the superiority of RT over other interventions remains uncertain. However, the combination of moderate risk of bias, significant heterogeneity and small sample sizes resulted in a very low quality of evidence.
Conclusions: Clinicians managing patients with TMDs should consider RT as an effective, conservative option in conjunction with other treatment modalities. Future methodologically robust studies with large sample sizes and clearly defined exercise protocols are needed to investigate the role of RT for reducing TMD-related pain by increasing load tolerance and addressing potential bruxism-related muscle overload.
背景：有证据支持对颞下颌紊乱（TMDs）患者进行运动治疗。然而，先前的研究主要集中在联合治疗策略或未定义的运动方式上。目的：本系统综述旨在评估阻力训练（RT）作为一种独立治疗方法对tmd患者疼痛管理和改善神经肌肉功能的有效性。方法：本系统评价遵循预先建立并公布的方案，该方案已在PROSPERO注册（CRD42023476269）。文献检索时间为2024年3月1日至2024年3月31日，检索的电子数据库为：MEDLINE （OVID接口）、EMBASE （OVID接口）、SCOPUS、Web of Science、PubMed、Cochrane Central Register of Controlled Trials （Central）。随机对照试验或干预措施的非随机研究包括比较针对咀嚼肌的RT与其他治疗方式对tmd患者疼痛、神经肌肉表现和最大张嘴的影响。两名独立审稿人筛选文章纳入，提取数据，使用修订后的Cochrane随机试验偏倚风险工具评估偏倚风险，并使用推荐、评估、发展和评估分级方法评估证据的整体质量。结果：在最初的2177篇文章中，只有3篇符合纳入标准，涉及108名参与者。所有纳入的研究都表明，即使RT优于其他干预措施仍不确定，但RT后疼痛强度降低，神经肌肉功能改善。然而，中等偏倚风险、显著异质性和小样本量的结合导致证据质量非常低。结论：临床医生在管理tmd患者时应考虑将放疗作为一种有效的、保守的选择，并结合其他治疗方式。未来需要大样本量的方法学研究和明确定义的运动方案来研究RT通过增加负荷耐受性和解决潜在的磨牙相关肌肉过载来减少tmd相关疼痛的作用。
期刊介绍：
Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function.
Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology.
The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.
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