Journal of oral rehabilitation · 2026
Patient Education and Self-Management in Adults With Temporomandibular Disorders: Results From a Systematic Review With Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Ferland Geneviève, Vincent Raphaël, Desmeules François, Cormier Audrey-Anne, Huon Moira, Pitance Laurent
Аннотация
OBJECTIVE: To evaluate the efficacy of education and self-management (ED and SM) interventions delivered by a health care provider, either alone or in combination with other non-surgical interventions for improving pain, function, or health-related quality of life (HRQoL) in adults with temporomandibular disorders (TMDs).
DESIGN: Systematic review with meta-analysis.
LITERATURE SEARCH: Six databases were searched up to March 2025.
STUDY SELECTION CRITERIA: Randomized clinical trials (RCTs) comparing the efficacy of ED and SM with any non-surgical other interventions such as splints, manual therapy, electrotherapy or multimodal approaches in adults with TMDs. Eligible studies had to report outcomes on pain, function or HRQoL.
DATA SYNTHESIS: Risk of bias was assessed using the Cochrane RoB-1 tool. Pooled treatment effects were calculated using random-effects models with standardized mean differences. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS: Forty-seven RCTs (n = 3238 participants; 77% female; mean age: 34.4 ± 7.3 years) were included, and none had a low risk of bias. ED and SM interventions were generally delivered as standardized programs and often served as control conditions. Based on very low-certainty evidence, other non-surgical interventions may be more effective than ED and SM alone for short-term pain reduction (SMD = 0.67, 95% CI: 0.13-1.20, 6 studies, 323 patients) or HRQoL improvement (SMD = 0.61, 95% CI: 0.20-1.01, 2 studies, 124 patients). When combined with ED and SM, non-surgical interventions may also result in moderate additional HRQoL improvements (SMD = 0.50, 95% CI: 0.18-0.82, 3 studies, 154 patients). Other comparisons-such as ED and SM alone versus ED and SM combined with other non-surgical interventions-showed comparable effects between groups on pain, function and HRQoL over the short-, medium- and long-term. However, the certainty of evidence supporting these findings remains low to very low.
CONCLUSION: The certainty of evidence supporting ED and SM interventions for TMDs is very low to low across all outcomes. While some short-term clinically relevant benefits may favour other non-surgical treatments, no consistent superiority or inferiority of ED and SM was found. Combining ED and SM with other interventions did not consistently improve outcomes. High-quality trials are needed to determine the effectiveness of ED and SM and their optimal delivery in TMD care.
PROSPERO: CRD42024529862.
DESIGN: Systematic review with meta-analysis.
LITERATURE SEARCH: Six databases were searched up to March 2025.
STUDY SELECTION CRITERIA: Randomized clinical trials (RCTs) comparing the efficacy of ED and SM with any non-surgical other interventions such as splints, manual therapy, electrotherapy or multimodal approaches in adults with TMDs. Eligible studies had to report outcomes on pain, function or HRQoL.
DATA SYNTHESIS: Risk of bias was assessed using the Cochrane RoB-1 tool. Pooled treatment effects were calculated using random-effects models with standardized mean differences. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS: Forty-seven RCTs (n = 3238 participants; 77% female; mean age: 34.4 ± 7.3 years) were included, and none had a low risk of bias. ED and SM interventions were generally delivered as standardized programs and often served as control conditions. Based on very low-certainty evidence, other non-surgical interventions may be more effective than ED and SM alone for short-term pain reduction (SMD = 0.67, 95% CI: 0.13-1.20, 6 studies, 323 patients) or HRQoL improvement (SMD = 0.61, 95% CI: 0.20-1.01, 2 studies, 124 patients). When combined with ED and SM, non-surgical interventions may also result in moderate additional HRQoL improvements (SMD = 0.50, 95% CI: 0.18-0.82, 3 studies, 154 patients). Other comparisons-such as ED and SM alone versus ED and SM combined with other non-surgical interventions-showed comparable effects between groups on pain, function and HRQoL over the short-, medium- and long-term. However, the certainty of evidence supporting these findings remains low to very low.
CONCLUSION: The certainty of evidence supporting ED and SM interventions for TMDs is very low to low across all outcomes. While some short-term clinically relevant benefits may favour other non-surgical treatments, no consistent superiority or inferiority of ED and SM was found. Combining ED and SM with other interventions did not consistently improve outcomes. High-quality trials are needed to determine the effectiveness of ED and SM and their optimal delivery in TMD care.
PROSPERO: CRD42024529862.