Browsing by Subject "Temporomandibular Joint Disorders"
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Item Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder(2011-10-03) Ingram, Megan Elizabeth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThe current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups.Item Efficacy of an Early Biopsychosocial Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: A Long-Term Follow-Up Study(2007-08-08) Robinson, Kelly; Stowell, Anna W.A long-term follow-up (LTF) study was conducted to further evaluate the efficacy of a biopsychosocial intervention for acute high risk (HR) temporomandibular disorder (TMD) patients. Subjects from Gatchel and colleagues' one-year outcome study (Gatchel, Stowell, Wildenstein, Riggs,&Ellis, 2006) were contacted to assess pain and psychosocial measures at LTF (two to six years post intake). An early-intervention (EI) group had received cognitive behavioral skills training and biofeedback, while a nonintervention group (NI) had received no intervention. Similar to one-year follow-up findings, EI group subjects had significantly lower levels of self-reported pain and depression at LTF as compared to intake. The EI group was also associated with significantly lower pain and depression scores, relative to the NI group. EI group subjects continued to show a decreasing trend on jaw pain-related health care visits relative to NI group subjects, providing further evidence for reduced costs associated with early interventions. The present study supports and extends the findings of the earlier one-year outcome study, indicating that an early biopsychosocial intervention is beneficial for patients with acute TMD. By receiving treatment during the acute stage of TMD, patients are less likely to develop chronic TMD, and to be impacted long-term by the physical, emotional and financial aspects of TMD.Item Efficacy of an Early Biopsychosocial Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: a Six- to Ten-Year Follow Up Study(2011-12-09) Fraley, Sarah Elizabeth; Gatchel, Robert J.; Stowell, Anna W.; Chiu, Chung-YiA long-term follow up study was conducted to further evaluate the efficacy of an early biopsychosocial intervention for patients with acute high risk (HR) temporomandibular disorder (TMD). Subjects from Gatchel and colleagues’ one-year outcome study (Gatchel, Stowell, Wildenstein, Riggs, & Ellis, 2006), and two- to six-year follow up study (Gatchel, Potter, Hinds, & Ingram, 2011) were contacted to assess pain and psychosocial measures six to ten years post intake. An early intervention (EI) group had received cognitive behavioral skills training and biofeedback, while a nonintervention (NI) group had received no intervention. EI group subjects demonstrated significant improvement as well as maintenance of gains in several psychosocial domains, including coping skills and reduction in depression scores relative to NI group subjects. EI group subjects also showed a decreasing trend in jaw pain-related healthcare visits relative to NI group subjects, providing further evidence for reduced costs associated with early interventions. The present study supports the findings of the earlier one-year outcome study and two- to six-year follow up study, indicating that an early biopsychosocial intervention is beneficial for patients with acute TMD. In utilizing this approach to treat patients in the acute stage of TMD, these patients are less likely to develop chronic TMD, and to be impacted long-term by the physical, emotional, and financial aspects of TMD.Item The Prevalence of Temporomandibular Disorder in African Americans(2011-12-09) Doyle, Nicole J.; Gatchel, Robert J.; Chiu, Chung-Yi; Haggard, RobbieThis pilot study collected a convenience sample of adult residents of the Dallas, Texas metropolitan area to estimate the prevalence of temporomandibular disorder (TMD) in African Americans. Additionally, the study also collected the same data on Caucasians for comparisons against the African American numbers on all measures. At the conception of this study, there existed no prior studies focusing primarily on prevalence of TMD in African Americans. The study administered a survey of acute jaw pain symptoms to a convenience sample of 274 participants 18 years and older, 129 African Americans, 116 Caucasians and 29 of other races. The survey assessed TMD symptoms using 19 questions derived from the Research Diagnostic Criteria for TMD. The overall prevalence of TMD for total sample of 274 was 22.3%, with a higher prevalence of TMD in women (25.3%) than in men (16%). The prevalence of TMD among African Americans was 22% with a higher prevalence among females (24.4%) than males (15.6%). Among Caucasians, the prevalence of TMD was 22.5%, with a higher prevalence among females (23.7%) than males (20%). Caucasians reported greater rates of tinnitus, low back pain (p<.05), clenching and grinding (p<.1), while African Americans reported greater rates of teeth problems (p<.1). For all-participants, African American and Caucasian samples, discriminant analysis showed the ability of the symptoms listed on the survey to classify correctly the participants as having TMD or as not having TMD approached 100%. Among the top predictors of TMD for African Americans were earache and sounds around ears, while among top predictors for Caucasians were a diagnosis of TMD and joint locking. Distinct symptom clusters found within the overall sample as well as a 2-symptom cluster within both African American and Caucasian samples, yielded highly significant differences. In treatment seeking for TMD symptoms, both African Americans and Caucasians with private insurance types sought treatment at the same rates (60%). TMD rates for this sample were notably higher than found in other national studies (about 4-8%). However, where definitions of and measurement instruments for TMD differ among prevalence studies, it appears that prevalence rates tend to differ.Item Two Efficacy Studies for Acute TMJ Related Headaches and Chronic Headaches(2011-10-03) Hinds, Christopher Worth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThis project focused on two efficacy studies. The aim of the first study conducted by Dr. Robert Gatchel at University of Texas at Arlington was to evaluate the efficacy of the Biobehavioral, Self-care, and Non-Intervention treatment groups on the presence and distress of the headache symptom related to acute temporomandibular joint disorder. The study consists of a cohort of 283 patients with acute TMD. Participants are being referred to UT Southwestern Medical Center in Dallas, Texas through the community dental clinics in the Dallas/Ft. Worth area. Questionnaires were administered to patients before and after treatment. At the time of data collection 283 participants were enrolled in the study. 238 participants (84%) of 283 met eligibility requirements and were placed in one of the three treatment groups.91 participants endorsed having regular headaches that are either new or different from headaches you had prior to the onset of your illness. A Pearson Chi-Square (χ2) found a significant difference in the presence of headaches before treatment (χ2 = 11.082, p =.004). No significant difference was found in the presence of headaches after treatment (χ2 = .335, p =.846). Non-Parametric analysis found a significant difference of improvement (.021) in the Biobehavioral group post-treatment. A significant difference of improvement (.023) was also found in the Self-care group post-treatment. Non- Parametric analysis found a significant improvement of distress of headache in each treatment group. This study shows a significant prevalence of 38% headaches related to TMD. It also shows that Biobehavioral and Self-care treatments significantly reduce headache presence. The study also finds a psychological effect of “attending the project” in decreasing levels of distress relating to headaches. The second study aimed to measure the effectiveness of a dental technique pioneered by Dr. Neeley DDS. Patients were referred through his private dental clinic in Dallas, TX. Qualitative analysis was used through a case study of 6 patients of an original 12. The data from the second study indicated that this treatment is very efficacious. All 6 participants showed a reduction in headache symptoms and all reported satisfaction with their treatment over a year later.Item [UT Southwestern Medical Center News](2007-02-05) Despres, Cliff