Short-term Clinical Outcomes and Patient Compliance with Temporomandibular Disorder Treatment Recommendations

Aims: To evaluate short-term patient compliance with 5 conserva-tive temporomandibular disorder (TMD) treatments (jaw relax-ation, jaw stretching, heat application, cold application, and occlusal splint use) and the association of compliance with changes in pain intensity, pain-related activity interference, and jaw use limitations. Methods: Eighty-one TMD patients were given 1 to 5 treatment recommendations as part of usual care in a TMD specialty clinic. Compliance with each recommendation and pain, pain-related activity interference, and jaw use limitation measures were calculated from electronic interviews conducted 3 times daily for 2 weeks. Results: Median compliance with individ-ual treatment modalities ranged from 7.7% for heat application to 92.7% for jaw relaxation; median overall compliance was 54.8%. Participants with higher initial pain intensity and jaw use limita-tions were significantly more compliant with their recommended treatment regimen (P ＜ .05). The authors controlled for age, gen-der, education, and initial jaw use limitations. Overall compliance was associated significantly and positively with 2-week jaw use limitations (P = .03). A trend toward a statistically significant pos-itive association was found between compliance and 2-week pain intensity (P = .09). Conclusion: Compliance varied widely across patients and therapies. Patients with higher initial pain and jaw use limitation levels were more compliant with treatment recom-mendations. Although compliance was associated with slight increases in pain and jaw use limitations in this preliminary study, further research is needed to evaluate the longer-term effects of compliance with recommended therapies.

compliance; limitation of activities; limitation of jaw use; pain; temporomandibular disorders

1. Dworkin SF. Personal and societal impact of orofacial pain. In: Fricton JR, Dubner R (eds). Orofacial Pain and Temporomandibular Disorders. New York: Raven Press, 1995:15–32.

2. Von Korff M, Dworkin SF, LeResche L, Kruger A. An epidemiologic comparison of pain complaints. Pain 1988;32:173–183.

3. Dworkin SF, Huggins KH, LeResche L, et al. Epidemiology of signs and symptoms in temporomandibular disorders: Clinical signs in cases and controls. J Am Dent Assoc 1990;120:273–281.

4. LeResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291–305.

5. Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The prevalence and treatment needs of subjects with temporo-mandibular disorders. J Am Dent Assoc 1990;120: 295–303.

6. Lipton JA, Ship JA, Larach–Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115–121.

7. Ferrario VF, Sforza C, Tartaglia GM, Dellavia C. Immediate effect of a stabilization splint on masticatory muscle activity in temporomandibular disorder patients. J Oral Rehabil 2002;29:810–815.

8. De Boever JA, Carlsson GE, Klineberg IJ. Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part I. Occlusal interferences and occlusal adjustment. J Oral Rehabil 2000;27:367–379.

9. Stohler CS. Clinical perspectives on masticatory and related muscle disorders. In: Sessle BJ, Bryant PS, Dionne RA (eds). Temporomandibular disorders and related pain conditions, progress in pain research and management. Seattle: IASP Press, 1995:3–30.

10. Dworkin SF, LeResche L. Research Diagnostic Criteria for Temporomandibular Disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

11. Clark GT, Seligman DA, Solberg WK, Pullinger AG. Guidelines for the examination and diagnosis of temporo-mandibular disorders. J Craniomandib Disord 1989; 3:7–14.

12. Forssell H, Kalso E. Application of principles of evidence-based medicine to occlusal treatment for temporo-mandibular disorders: Are there lessons to be learned? J Orofac Pain 2004;18:9–22.

13. Syrop SB. Initial management of temporomandibular dis-orders. Dent Today 2002;2:52–57.

14. Clark GT. A critical evaluation of orthopedic interocclusal appliance therapy: Design, theory, and overall effectiveness. J Am Dent Assoc 1984;108:359–364.

15. Oakley ME, McCreary CP, Clark GT, Holston S, Glover D, Kashima K. A cognitive-behavioral approach to tem-poromandibular dysfunction treatment failures: A controlled comparison. J Orofac Pain 1994;8:397–401.

16. Carlsson SG, Gale EN, Ohman A. Treatment of temporo-mandibular joint syndrome with biofeedback training. J Am Dent Assoc 1975;91:602–605.

17. Carlsson SG, Gale EN. Biofeedback in the treatment of long-term temporomandibular joint pain: An outcome study. Biofeedback Self Regul 1977;2:161–171.

18. Peck CL, Kraft GH. Electromyographic biofeedback for pain related to muscle tension. A study of tension head-ache, back, and jaw pain. Arch Surg 1977;112:889–895.

19. Moss RA, Wedding D, Sanders SH. The comparative efficacy of relaxation training and masseter EMG feedback in the treatment of TMJ dysfunction. J Oral Rehabil 1983; 10:9–17.

20. Rudy TE, Turk DC, Kubinski JA, Zaki HS. Differential treatment responses of TMD patients as a function of psychological characteristics. Pain 1995;61:103–112.

21. Rugh JD, Montgomery GT. Physiological reactions of patients with TM disorders vs symptom-free controls on a physical stress task. J Craniomandib Disord 1987;1: 243–250.

22. Anderson B. Stretching and sports. In: Appenzeller O, Atkinson R (eds). Sports Medicine, Fitness, Training, Injuries. Baltimore: Urban and Schwarzenberg, 1983.

23. Burgess JA, Sommers EE, Truelove EL, Dworkin SF. Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system. J Prosthet Dent 1988;60:606–610.

24. Davis MS. Variations in patients’ compliance with doctors’ advice: An empirical analysis of patterns of communication. Am J Public Health Nations Health 1968; 58:274–288.

25. Haynes RB, Taylor DW, Sackett DL (eds). Compliance in Health Care. Baltimore: Johns Hopkins University Press, 1979.

26. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: A meta-analysis. Med Care 2002;40:794–811.

27. Epstein LH. The direct effects of compliance on health outcome. Health Psychol 1984;3:385–393.

28. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: A meta-analysis. Med Care 1998; 36:1138–1161.

29. Brown JC. Patient compliance: A neglected topic in dentistry. J Am Dent Assoc 1981;103:567–569.

30. Demetriou N, Tsami-Pandi A, Parashis A. Compliance with supportive periodontal treatment in private periodontal practice. A 14-year retrospective study. J Periodontol 1995;66:145–149.

31. Mendoza AR, Newcomb GM, Nixon KC. Compliance with supportive periodontal therapy. J Periodontol 1991;62:731–736.

32. Egolf RJ, BeGole EA, Upshaw HS. Factors associated with orthodontic patient compliance with intraoral elastic and headgear wear. Am J Orthod Dentofacial Orthop 1990; 97:336–348.

33. Strack BB, McCullough MA, Conine TA. Compliance with oral hygiene instruction and hygienists’ empathy. Dent Hyg (Chic) 1980;54:181–184.

34. Lutz RW, Silbret M, Olshan N. Treatment outcome and compliance with therapeutic regimens: Long-term follow–up of a multidisciplinary pain program. Pain 1983;17:301–308.

35. Riley JL III, Robinson ME, Wise EA, Campbell LC, Kashikar–Zuck S, Gremillion HA. Predicting treatment compliance following facial pain evaluation. Cranio 1999;17:9–16.

36. Whitney CW, Dworkin SF. Practical implications of non-compliance in randomized clinical trials for temporo-mandibular disorders. J Orofac Pain 1997;11:130–138.

37. Stone AA, Shiffman S. Capturing momentary, self-report data: A proposal for reporting guidelines. Ann Behav Med 2002;24:236–243.

38. Affleck G, Zautra A, Tennen H, Armeli S. Multilevel daily process designs for consulting and clinical psychology: A preface for the perplexed. J Consult Clin Psychol 1999; 67:746–754.

39. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50:133–149.

40. Von Korff M. Epidemiological and survey methods: Assessment of chronic pain. In: Turk DC, Melzack R (eds). Handbook of Pain Assessment. New York: Guilford Press, 2001:603–618.

41. Dworkin SF, Turner JA, Mancl L, et al. A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. J Orofac Pain 2002;16:259–276.

42. Underwood MR, Barnett AG, Vickers MR. Evaluation of two time-specific back pain outcome measures. Spine 1999;24:1104–1112.

43. Longe SE, Wise R, Bantick S, et al. Counter-stimulatory effects on pain perception and processing are significantly altered by attention: An fMRI study. Neuroreport 2001; 12:2021–2025.

44. Peyron R, Laurent B, Garcia-Larrea L. Functional imaging of brain responses to pain. A review and meta–analysis. Neurophysiol Clin 2000;30:263–288.

45. Massur FT. Adherence to health care regimens. In: Prokop C, Bradley LA (eds). Medical Psychology: Contributions to Behavioral Medicine. New York: Academic Press, 1981:441–462.

46. Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients—Relapse, noncompliance, and adherence enhancement. Pain 1991;44:5–28.

47. Maixner W, Fillingim R, Booker D, Sigurdsson A. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 1995;63: 341–351.

48. Swenson C, Sward L, Karlsson J. Cryotherapy in sports medicine. Scand J Med Sci Sports 1996;6:193–200.

49. MacAuley DC. Ice therapy: How good is the evidence? Int J Sports Med 2001;22:379–384.

50. Stone AA, Broderick JE, Schwartz JE, Shiffman S, Litcher-Kelly L, Calvanese P. Intensive momentary reporting of pain with an electronic diary: Reactivity, compliance, and patient satisfaction. Pain 2003;104:343–351.

51. Peters ML, Sorbi MJ, Kruise DA, Kerssens JJ, Verhaak PF, Bensing JM. Electronic diary assessment of pain, disability, and psychological adaptation in patients differing in duration of pain. Pain 2000;84:181–192.