The Reproducibility and Responsiveness of a Patient-Specific Approach: A New Instrument in Evaluation of Treatment of Temporomandibular Disorders

Aims: To evaluate the choice of activities on the Patient Specific Approach (PSA) in a sample of temporomandibular disorder (TMD) patients and to determine the clinimetric properties of the visual analog scale (VAS) scores of the PSA, in terms of reproducibility and responsiveness. Methods: At treatment start, TMD patients reported the PSA activity which represents the most important activity that is impaired due to their TMD complaints. The amount of hindrance during this activity was rated on a VAS. During two follow-up measurements, patients used the VAS to rate the amount of hindrance and appraised their overall complaints in terms of “much worsened,” “slightly worsened,” “remained stable,” “slightly improved,” or “much improved.” To determine the reproducibility and responsiveness, an intraclass cor-relation coefficient and receiver operating characteristics-curve were then calculated. Results: Of the 132 patients who fulfilled baseline measurements, 13% reported an activity that is not included in existing TMD-disability questionnaires. The reproducibility of the VAS scores of the 78 patients who reported that their complaints had “remained stable” at second measurement was good (intraclass correlation coefficient k= 0.73). The respon-siveness of the PSA was high, and the cutoff score for important improvement, where sensitivity (0.85) and specificity (0.84) were as much as possible the same, was 58%. Conclusion: The PSA for TMD patients is a new and easy-to-use tool in treatment evalua-tion. Moreover, the VAS score of the PSA has good reproducibility and responsiveness. J OROFAC PAIN 2010;24:101–105

patient specific approach;reproducibility;responsiveness;TMD;treatment effect

1. Feine JS, Widmer CG, Lund JP. Physical therapy: A critique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:123–127.

2. Ferrari R, Russell AS. Regional musculoskeletal condi-tions: Neck pain. Best Pract Res Clin Rheumatol 2003; 17:57–70.

3. Ostelo RW, van Tulder MW, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2005:CD002014.

4. Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 2005; 19:593–607.

5. Beurskens AJ, de Vet HC, Koke AJ, van der Heijden GJ, Knipschild PG. Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires. Spine 1995;20:1017–1028.

6. Vernon H, Mior S. The neck disability index: A study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–415.

7. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

8. Stegenga B, de Bont LG, de Leeuw R, Boering G. Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. J Orofac Pain 1993;7:183–195.

9. Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: A comparison of different instruments. Pain 1996;65:71–76.

10. Beurskens AJ, de Vet HC, Koke AJ, et al. A patient-specific approach for measuring functional status in low back pain. J Manipulative Physiol Ther 1999;22:144–148.

11. Shrout PE, Fleiss J. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 1979;86:420–428.

12. Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: An analogy to diagnostic test performance. J Chronic Dis 1986;39:897–906.

13. Swets JA. Measuring the accuracy of diagnostic systems. Science 1988;240:1285–1293.

14. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–158.

15. Giraudeau B, Rozenberg S, Valat JP. Assessment of the clinically relevant change in pain for patients with sciatica. Ann Rheum Dis 2004;63:1180–1181.

16. Newcombe RG. Two-sided confidence intervals for the single proportion: Comparison of seven methods. Stat Med 1998;17:857–872.

17. Chatman AB, Hyams SP, Neel JM, et al. The patient-specific functional scale: Measurement properties in patients with knee dysfunction. Phys Ther 1997;77:820–829.

18. Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: Which are reliable and valid? Arch Phys Med Rehabil 2004;85:815–822.

19. Green C, Brazier J, Deverill M. Valuing health-related quality of life. A review of health state valuation techniques. Pharmacoeconomics 2000;17:151–165.

20. Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med 2003;10:1128–1130.

21. ten Klooster PM, Drossaers-Bakker KW, Taal E, van de Laar MA. Patient-perceived satisfactory improvement (PPSI): Interpreting meaningful change in pain from the patient’s perspective. Pain 2006;121:151–157.