RT  - Journal of Oral & Facial Pain and Headache
ID  - 10.11607/jofph.24.1.06
T1  - The Research Diagnostic Criteria for Temporomandibular Disorders. V: Methods Used to Establish and Validate Revised Axis I Diagnostic Algorithms
A1  - Eric L. Schiffman
A1  - Richard Ohrbach
A1  - Edmond L. Truelove
A1  - Feng Tai
A1  - Gary C. Anderson
A1  - Wei Pan
A1  - Yoly M. Gonzalez
A1  - Mike T. John
A1  - Earl Sommers
A1  - Thomas List
A1  - Ana M. Velly
A1  - Wenjun Kang
A1  - John O. Look
K1  - reference standard;reliability;research diagnostic criteria;temporomandibular disorders;temporomandibular muscle and joint disorders;validity
YR  - 2010
SP  - 63
AB  - <p><b>Aims:</b> To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. <b>Methods: </b>The multisite RDC/TMD Validation Project’s dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by two TMD experts using criterion examination data, including temporomandibular joint imaging. Cutoff points for target validity were sensitivity k≥ 0.70 and specificity k≥ 0.95. Reliability of revised algorithms was assessed in 27 study participants. <b>Results: </b>Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as “any joint pain.” Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other disc displacement diagnoses, osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was k≥ 0.63. <b>Conclusion: </b>Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements as well as osteoarthritis and osteoarthrosis.</p>