- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05607823
Adding Core Stabilization Training to Manuel Therapy in Temporomandibular Disorders
Adding Core Stabilization Training to Orofacial Manuel Therapy in Individuals With Temporomandibular Disorders: A Randomized Controlled Study
Study Overview
Status
Intervention / Treatment
Detailed Description
Primary aim of this study is to determine whether core stabilization training in addition to orofacial manual therapy is more effective on Temporomandibular Disorders (TMD) symptoms than orofacial manual therapy alone in patients with TMD. These secondary aim is to determine the effectiveness of orofacial manual therapy on TMD symptoms in patients with TMD. The patients to be included in the study will be randomly divided into three groups and it is planned to include 15 people in each group. Home exercises and patient education will be provided to all patients.
- Group 1 (CST group): Orofacial manual therapy + core stabilization training (CST) + home exercise and patient education
- Group 2 (OMT group): Orofacial manual therapy (OMT) + home exercise and patient education
- Group 3 (Control group): Home exercise and patient education.
Pain intensity, pressure pain threshold, joint range of motion, posture, flexibility, stabilization of core muscles, functionality and sleep quality will be evaluated by using Visual Analog Scale (VAS), digital algometer, ruler, Palpation Meter (PALM), bubble inclinometer, tape measure, Finger-to-floor distance (EPZM) and sit-reach test, pressure biofeedback unit, "Helkimo Index", "Pittsburgh Sleep Quality Index (PUKI)" respectively. Patients will be treated for 10 sessions once a week, for a total of 10 weeks. Evaluation was planned to be done twice, at the beginning and end of the treatment.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sultan Igrek, MSc
- Phone Number: +05372100654
- Email: sultanigrek@gmail.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Volunteered to participate,
- Aged between 18-60 years old,
- Having the diagnosis of Temporomandibular Disorders (TMB),
Exclusion Criteria:
- Having a malignant condition, trauma and surgery of the cranial and cervical region,
- Not being cooperative,
- Regular use of analgesic and anti-inflammatory drugs,
- Having dentofacial anomalies,
- Having active inflammatory arthritis,
- Having lumbal pathology,
- Having metabolic diseases (Gout, osteoporosis, Cushing's disease and hyper/hypo-parathyroidism),
- Having connective tissue, rheumatological (Systemic lupus erythematosus and scleroderma) and hematological disorders (Anemia and leukemia),
- Having a diagnosed psychiatric illness,
- Receiving TMD-related physical therapy less than 6 months ago
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: CST Group
The core stabilization group.
Participants in this group will be received core stabilization training, orofacial manuel therapy and conventional physiotherapy (Home exercise program and patient education) as treatment.
The number of participants is planned to be 15.
|
Core Stabilization training will be based on dynamic neuromuscular stabilization and consists of three stages.
In the first session, it is to teach the simultaneous activation of the transversus abdominis, pelvic floor, multifidus and diaphragm muscles and to improve muscle coordination and proprioception in the entire spinal region.
In the second and third phases, exercises will be made more intense to improve muscular endurance and stability.
The difficulty of the exercises will be increased by working in different positions, using resistance bands, exercise balls and body weight, and adding movements to the extremities.
A total of 10 sessions of treatment program will be applied to the patients for ten weeks, once a week.
As orofacial manual therapy, soft tissue (intraoral and extraoral trigger point therapy and myofascial release of painful muscles) and joint mobilization (caudal and ventro-caudal traction, ventral and mediolateral translation), muscle energy technique, fascia mandibularis release, occipital release and ligamentous treatment was planned.
Conventional physiotherapy consists of home exercise and patient education.
Patient education consists of parafunctional behaviors, habits, a diet with soft food, and posture education.
The exercises consist of exercises for the mandible, cervical and thoracic region and breathing.
All movements are planned to be done at home 3 times a day, every day of the week.
|
Experimental: OMT Group
The orofacial manuel therapy group.
Participants in this group will be received orofacial manuel therapy and conventional physiotherapy (Home exercise program and patient education) as treatment.
The number of participants is planned to be 15.
|
As orofacial manual therapy, soft tissue (intraoral and extraoral trigger point therapy and myofascial release of painful muscles) and joint mobilization (caudal and ventro-caudal traction, ventral and mediolateral translation), muscle energy technique, fascia mandibularis release, occipital release and ligamentous treatment was planned.
Conventional physiotherapy consists of home exercise and patient education.
Patient education consists of parafunctional behaviors, habits, a diet with soft food, and posture education.
The exercises consist of exercises for the mandible, cervical and thoracic region and breathing.
All movements are planned to be done at home 3 times a day, every day of the week.
|
Experimental: Control Group
Participants in this group will be received only conventional physiotherapy (Home exercise program and patient education) as treatment.
The number of participants is planned to be 15.
|
Conventional physiotherapy consists of home exercise and patient education.
Patient education consists of parafunctional behaviors, habits, a diet with soft food, and posture education.
The exercises consist of exercises for the mandible, cervical and thoracic region and breathing.
All movements are planned to be done at home 3 times a day, every day of the week.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain severity: VAS
Time Frame: Change from Baseline pain severity at 10 weeks.
|
Pain will be defined with Visual Analog Scale (VAS).
A 10-cm long horizontal visual analog scale (VAS) with marks 0 point (no pain) and 10 point (unbearable pain) will be used for evaluating the pain severity.
The patients will be asked to mark the representing point of their pain levels.
The values will be recorded in cm.
In the study, the pain felt by the patients at rest, at maximum mouth opening and during clenching will be evaluated separately according to this scale.
|
Change from Baseline pain severity at 10 weeks.
|
Pain Threshold: Digital algometer
Time Frame: Change from Baseline pain threshold at 10 weeks.
|
The algometer is a reliable instrument for measuring the sensitivity of the masticatory muscles.
The measurement will be made at 8 points.
A force (Newton in force) of 1 kg (weight in kilogram) per square centimeter (surface area in centimeter square) is applied to the patient for 3 seconds, and this is continued until the patient feels pain (weight and surface area will be combined to report Newton in kg/ cm2).
The physiotherapist will passively support the individual's head with the other hand.
This process will be repeated three times and the average value will be calculated.
|
Change from Baseline pain threshold at 10 weeks.
|
Range of Motion
Time Frame: Change from Baseline range of motion at 10 weeks.
|
Mouth opening, protrusion and right and left lateral deviation will be measured starting from 0 using a 15 cm ruler.
Repeated measuring reduces the standard error of measurement, hence repeated measurements were also included in our study (three times) with the largest recorded range taken.
|
Change from Baseline range of motion at 10 weeks.
|
Facial asymmetry
Time Frame: Change from Baseline facial asymmetry at 10 weeks.
|
For facial asymmetry evaluation, the distance between the anterior notch of the chin and the mandible line will be measured with a tape measure.
|
Change from Baseline facial asymmetry at 10 weeks.
|
Degree of pelvic tilt
Time Frame: Change from Baseline degree of pelvic tilt at 10 weeks.
|
Palpation Meter (PALM), (Salt Lake City, United Kingdom, USA) will be used for pelvic tilt evaluation.
The Palpation Meter has an angle inclinometer and two 360-swivel arms, one of arms will be placed in the Spina iliaca Anterior Superior (SIAS) and the other in the Spina iliaca Posterior Superior (SIPS).
In this position, the angle indicated by the inclinometer will be recorded as the pelvic tilt angle.
|
Change from Baseline degree of pelvic tilt at 10 weeks.
|
Degree of lordosis
Time Frame: Change from Baseline degree of lordosis at 10 weeks.
|
Bubble inclinometer (White Plains, New York 10602 USA) will be used for lumbar lordosis evaluation.
The degree of lordosis will be determined by measuring the spinous processes of the T12-L1 and S2-3 vertebrae with a bubble inclinometer and adding the degrees found.
|
Change from Baseline degree of lordosis at 10 weeks.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Flexibility of lumbal extensor muscles
Time Frame: Change from Baseline Finger-to-floor distance (EPZM) at 10 weeks.
|
Finger-to-floor distance (EPZM) will be used for flexibility of lumbal extensor.
In the EPZM test, individuals will stand on a stool and are asked to bend their torso forward to reach as far as possible with both hands without bending the knees.
The distance between the stool level and the middle finger will be measured by the therapist and and this distance will be recorded in cm.
The individual will be asked to repeat this movement three times and the highest value will be taken as the test score.
|
Change from Baseline Finger-to-floor distance (EPZM) at 10 weeks.
|
Flexibility of hamstring muscles
Time Frame: Change from Baseline sit-reach test at 10 weeks.
|
Sit-reach test will be used for flexibility of hamstring muscles.
For the sit-and-reach test, the individual will be seated without shoes in a long sitting position on the floor, with his feet propped on a 30 cm bench that is scaled by dividing the top into cm.
The body will be asked to lie forward on the coffee table as much as possible without bending the knees, wait 2 seconds at the extreme point where the fingers are extended, and this distance will be recorded in cm.
The individual will be asked to repeat this movement three times and the highest value will be taken as the test score.
|
Change from Baseline sit-reach test at 10 weeks.
|
Performance of stabilizer muscles
Time Frame: Change from Baseline lumbopelvic stabilization at 10 weeks.
|
Lumbopelvic stabilization will be assessed using a pressure biofeedback unit (Stabilizer Pressure Biofeedback Unit, Chattanooga Group Inc., Hixson, Tennessee, USA).
Individuals will be asked to lie on their back in a hooked position.
The pressure cell of the instrument will be placed under the lumbar vertebrae.
The subjects will be asked to perform the abdominal drawing-in maneuver as previously taught, with no spinal or pelvic movement.
The change in pressure will be recorded in mmHg and the time that the contraction can be maintained in seconds.
|
Change from Baseline lumbopelvic stabilization at 10 weeks.
|
Functionality
Time Frame: Change from Baseline Helkimo Index at 10 weeks.
|
"Helkimo Index" will be used to evaluate Temporomandibular Joint (TMJ) pain and dysfunction.
This index evaluates the clinical dysfunction of the stomatognathic system based on the 5 signs of TMD.
Pain during mandible movement, TMJ pain, pain in masticatory muscles, TMJ sound and maximum mouth opening are evaluated with different questions between 0-5.
The total dysfunction score ranges from 0 to 25. 0 no dysfunction; Values 1-4 are mild dysfunction; Values from 4 to 9 indicate moderate dysfunction; Values above 9 indicate severe dysfunction.
|
Change from Baseline Helkimo Index at 10 weeks.
|
Sleep
Time Frame: Change from Baseline Pittsburgh Sleep Quality Index (PUKI) at 10 weeks.
|
"Pittsburgh Sleep Quality Index (PUKI)" will be used to assess sleep quality and impairment.
It consists of 7 subscales that assess subjective sleep quality, sleep latency and duration, habitual sleep efficiency, sleep disorders, use of sleep medication, and loss of daytime functionality.
A high total score indicates poor sleep quality.
|
Change from Baseline Pittsburgh Sleep Quality Index (PUKI) at 10 weeks.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Tugba Kuru Colak, Asst. Prof, Marmara University Institute of Health Sciences
Publications and helpful links
General Publications
- Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.
- Tuncer AB, Ergun N, Tuncer AH, Karahan S. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial. J Bodyw Mov Ther. 2013 Jul;17(3):302-8. doi: 10.1016/j.jbmt.2012.10.006. Epub 2012 Nov 16.
- Kalamir A, Pollard H, Vitiello A, Bonello R. Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study. J Man Manip Ther. 2010 Sep;18(3):139-46. doi: 10.1179/106698110X12640740712374.
- Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW Jr. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011 Mar-Apr;27(3):268-74. doi: 10.1097/AJP.0b013e31820215f5.
- Sakpal TV. Sample size estimation in clinical trial. Perspect Clin Res. 2010 Apr;1(2):67-9.
- Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013 Jul;57(3):465-79. doi: 10.1016/j.cden.2013.04.006.
- Helkimo M. Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state. Sven Tandlak Tidskr. 1974 Mar;67(2):101-21. No abstract available.
- Anastassaki Kohler A, Hugoson A, Magnusson T. Prevalence of symptoms indicative of temporomandibular disorders in adults: cross-sectional epidemiological investigations covering two decades. Acta Odontol Scand. 2012 May;70(3):213-23. doi: 10.3109/00016357.2011.634832. Epub 2011 Nov 30.
- Nekora-Azak A, Evlioglu G, Ordulu M, Issever H. Prevalence of symptoms associated with temporomandibular disorders in a Turkish population. J Oral Rehabil. 2006 Feb;33(2):81-4. doi: 10.1111/j.1365-2842.2006.01543.x.
- Lee KC, Wu YT, Chien WC, Chung CH, Chen LC, Shieh YS. The prevalence of first-onset temporomandibular disorder in low back pain and associated risk factors: A nationwide population-based cohort study with a 15-year follow-up. Medicine (Baltimore). 2020 Jan;99(3):e18686. doi: 10.1097/MD.0000000000018686.
- Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics (Sao Paulo). 2009;64(1):61-6. doi: 10.1590/s1807-59322009000100011.
- Gangloff P, Louis JP, Perrin PP. Dental occlusion modifies gaze and posture stabilization in human subjects. Neurosci Lett. 2000 Nov 3;293(3):203-6. doi: 10.1016/s0304-3940(00)01528-7.
- Espinosa de Santillana IA, Garcia-Juarez A, Rebollo-Vazquez J, Ustaran-Aquino AK. [Frequent postural alterations in patients with different types of temporomandibular disorders]. Rev Salud Publica (Bogota). 2018 May-Jun;20(3):384-389. doi: 10.15446/rsap.V20n3.53529. Spanish.
- Saito ET, Akashi PM, Sacco Ide C. Global body posture evaluation in patients with temporomandibular joint disorder. Clinics (Sao Paulo). 2009;64(1):35-9. doi: 10.1590/s1807-59322009000100007.
- Fischer MJ, Riedlinger K, Gutenbrunner C, Bernateck M. Influence of the temporomandibular joint on range of motion of the hip joint in patients with complex regional pain syndrome. J Manipulative Physiol Ther. 2009 Jun;32(5):364-71. doi: 10.1016/j.jmpt.2009.04.003.
- Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H. The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation. Cranio. 2003 Jul;21(3):202-8. doi: 10.1080/08869634.2003.11746252.
- de Oliveira-Souza AIS, de O Ferro JK, Barros MMMB, Oliveira DA. Cervical musculoskeletal disorders in patients with temporomandibular dysfunction: A systematic review and meta-analysis. J Bodyw Mov Ther. 2020 Oct;24(4):84-101. doi: 10.1016/j.jbmt.2020.05.001. Epub 2020 May 11.
- von Piekartz H, Hall T. Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial. Man Ther. 2013 Aug;18(4):345-50. doi: 10.1016/j.math.2012.12.005. Epub 2013 Feb 14.
- Wright EF, Domenech MA, Fischer JR Jr. Usefulness of posture training for patients with temporomandibular disorders. J Am Dent Assoc. 2000 Feb;131(2):202-10. doi: 10.14219/jada.archive.2000.0148.
- Urbanski P, Trybulec B, Pihut M. The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders. Int J Environ Res Public Health. 2021 Dec 8;18(24):12970. doi: 10.3390/ijerph182412970.
- von Piekartz H, Ludtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study. Cranio. 2011 Jan;29(1):43-56. doi: 10.1179/crn.2011.008.
- Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013 Feb;8(1):62-73.
- Gur G, Turgut E, Dilek B, Baltaci G, Bek N, Yakut Y. Validity and Reliability of Visual Analog Scale Foot and Ankle: The Turkish Version. J Foot Ankle Surg. 2017 Nov-Dec;56(6):1213-1217. doi: 10.1053/j.jfas.2017.06.001. Epub 2017 Aug 30.
- Walker N, Bohannon RW, Cameron D. Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler. J Orthop Sports Phys Ther. 2000 Aug;30(8):484-92. doi: 10.2519/jospt.2000.30.8.484.
- Tuzun C, Yorulmaz I, Cindas A, Vatan S. Low back pain and posture. Clin Rheumatol. 1999;18(4):308-12. doi: 10.1007/s100670050107.
- Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther. 2011 Dec;16(6):646-8. doi: 10.1016/j.math.2011.04.006. Epub 2011 Jun 11.
- Perret C, Poiraudeau S, Fermanian J, Colau MM, Benhamou MA, Revel M. Validity, reliability, and responsiveness of the fingertip-to-floor test. Arch Phys Med Rehabil. 2001 Nov;82(11):1566-70. doi: 10.1053/apmr.2001.26064.
- Mayorga-Vega D, Merino-Marban R, Viciana J. Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis. J Sports Sci Med. 2014 Jan 20;13(1):1-14. eCollection 2014 Jan.
- Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995 Nov;1(1):2-10. doi: 10.1054/math.1995.0243.
- Hodges P, Richardson C, Jull G. Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiother Res Int. 1996;1(1):30-40. doi: 10.1002/pri.45.
- Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002 Apr;72(2):146-54. doi: 10.1043/0003-3219(2002)0722.0.CO;2.
Helpful Links
- Investigation of the Relationship Between Temporomandibular Disorder and Postural Analysis.
- Assessment of Temporomandibular Joint Dysfunctions and the Position of Pelvis
- Manual Therapy for Temporomandibular Disorders: A Review of the Literature. J Body Mov Ther.
- Effects of Core Stability Exercises, Lumbar Lordosis and Low- Back Pain: A Systematic Review.
- Pressure Pain Threshold and Pain Perception in Temporomandibular Disorder Patients: Is There Any Correlation?
- The prevalence of symptoms and signs of temporomandibular dysfunctions in patients with the posttraumatic stress disorder
- The Validity and Reliability of the Pittsburgh Sleep Quality Index
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 09.2022.951
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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