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Are jaw range of motion, muscle function and proprioception impaired in adults with persistent temporomandibular disorders? A systematic review and meta‐analysis
Author(s) -
Dinsdale Alana,
Liang Zhiqi,
Thomas Lucy,
Treleaven Julia
Publication year - 2020
Publication title -
journal of oral rehabilitation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.991
H-Index - 93
eISSN - 1365-2842
pISSN - 0305-182X
DOI - 10.1111/joor.13090
Subject(s) - medicine , proprioception , meta analysis , range of motion , cinahl , physical medicine and rehabilitation , medline , subgroup analysis , physical therapy , confidence interval , psychological intervention , psychiatry , political science , law
Background The nature of certain musculoskeletal impairments associated with temporomandibular disorders (TMD) is unclear. Understanding impairments within TMD subgroups is important to guide management. Objectives Characterise local musculoskeletal impairments in adults with persistent TMD. Methods PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane databases were searched from inception to 12 January 2020. Bibliographies were searched for additional articles, including grey literature. Case‐control and interventional studies reporting temporomandibular range of motion (ROM), muscle function (MF) or proprioception in TMD and control groups were included. Risk of bias was assessed using SIGN checklist for case‐control studies. Results were pooled using random‐effects model. Confidence in cumulative evidence was determined using American Academy of Neurology guidelines. Results Sixty‐six studies were included, most rated moderate risk of bias. Twelve primary outcomes were assessed, with partial scope for meta‐analysis. Significant reductions were found for active maximal mouth opening ( P < .00001, MD=−4.65 mm), protrusion ( P < .0001, MD=−0.76 mm) and maximum bite force ( P < .00001) in TMD versus controls. Subgroup analysis scope was limited. Reduced AMMO was found in myogenic TMD subgroups versus controls ( P = .001, MD= −3.28 mm). Few studies measured proprioception, with high methodological variability. Confidence in cumulative evidence ranged from high to very low. Conclusion ROM and bite force impairments accompany TMD. Insufficient data were available to investigate impairments within TMD subgroups. Implications Several musculoskeletal impairments have been identified, which may guide clinical management of TMD. Lack of subgroup data, and data for proprioception and MF, highlights future direction for research. PROSPERO CRD42020150734.