The Effectiveness of Physiotherapy in the Management of Temporomandibular Disorders: A Systematic Review and Meta-analysis

Abstract

Aims: To analyze the methodologic quality, summarize the findings, and perform a meta-analysis of the results from randomized controlled trials that assessed the effects of physiotherapy management of temporomandibular disorders. Methods: A literature review was performed using the electronic databases PubMed, Science Direct, and EBSCO. Each article was independently assessed by two investigators using the Physiotherapy Evidence Database (PEDro), Jadad scales, and the Cochrane Risk of Bias tool. A meta-analysis was conducted by using the DerSimonian-Laird random-effects method to obtain summary estimates of the standardized mean differences (SMD) and the corresponding 95% confidence intervals (95% CI). Between-study heterogeneity was computed and publication bias was assessed. Results: Seven articles met the inclusion criteria and were used in the analysis, corresponding to nine estimates of SMD. The meta-analysis showed that for pain reduction, the summary SMD favored physiotherapy (SMD = -0.63; 95% CI: -0.95 to -0.31; number of studies = 8; I² = 0.0%), while for active range of movement (ROM) the differences between the intervention and control groups were not statistically significant (SMD = 0.33; 95% CI: -0.07 to 0.72; number of studies = 9; I² = 61.9%). Conclusion: Physiotherapy seems to lead to decreased pain and may improve active ROM. However, the results are not definitive and further studies and meta-analyses are needed before these results can be considered fully generalizable.