To systematically appraise the evidence on ED and SM interventions on pain and disability in adults with TMDs.
An electronic search was conducted up to March 2024, using terms related to ED and SM interventions including at-home exercise programs and TMD. Outcome measures included the evaluation of pain and disability. Methodological quality of studies was assessed with the Cochrane Risk of Bias tool-1. Random effect model meta-analyses were performed and standardized mean differences (SMD) were calculated. GRADE approach was used to synthesize the quality and certainty of the evidence.
We were able to pool nine RCTs evaluating ED or SM with adult participants (n=452) with various TMD diagnostics (myogenous, discs displacements, arthrogenous). RCTs compared ED and SM to the use of splint, Kinesio taping, low level laser therapy or manual therapy, either as a stand-alone intervention or in conjunction. Overall, ED interventions were given either orally or with written instructions and SM involved the prescription of at-home therapeutic exercises. Published evidence was only available for short-term outcomes and pooled in our analysis. Evidence regarding disability presented excessive heterogeneity for pooling purposes. Based on low certainty, the use of splints compared to ED alone was superior for the reduction of pain (SMD=1.09, 95%CI: 0.76 - 0.89, 2 studies, 90 patients). But based on low certainty, the use of splint in conjunction with ED was not superior to ED alone (SMD= 0.46 ,95%CI: -0.33 – 1.25, 4 studies, 197 patients). Based on low certainty evidence, therapeutic interventions including splints, Kinesio taping, low-level laser therapy or manual therapy in conjunction to SM were not superior to SM alone (SMD= 0.29, 95%CI: -0.04 – 0.62, 4 studies, 203 patients). A subgroup analysis of only manual therapy revealed that, based on very low certainty, its conjunction to SM was not superior to SM alone (SMD=0.22, 95%CI: -0.41 – 0.85, 2 studies, 79 patients).
Findings from this meta-analysis suggest that although ED results in improved outcome in terms of pain, the relative effectiveness of ED when compared to splints alone or in conjunction remains uncertain. More high-quality trials are needed to conclude on the potential benefits of ED in terms of pain and disability. Similarly, SM interventions, incorporating at-home exercise programs, demonstrate promising results for pain management as a stand-alone intervention. However, the evidence remains of low certainty and further high-quality trials are needed to confirm these findings. More trials are needed to conclude on the effectiveness of ED and SM on disability in adults with TMDs.
Physiotherapists may consider the use of ED and SM interventions to help reduce pain with TMD patients. These interventions offer the opportunity to provide care to patients with limited financial resources or limited access to physiotherapy care.
Physiotherapy
education and self-management interventions
