Short term effects of a novel combined approach compared with physical therapy alone among older patients with temporomandibular degenerative joint disease: a prospective cohort study

Abstract

Background There is a lack of consensus regarding the best treatment option, including physical exercise, available for temporomandibular degenerative joint disease (DJD) that affect the older patients. Herein, we aimed to study and compare the efficacy of a combined approach using injection and home physical exercise with physical therapy alone as well as explored an optimal treatment strategy for older patients with DJD. Methods We included 213 older patients with DJD treated at our medical centre from June 2020 to June 2021, 64 of whom were selected for analysis. Of these 64 patients, 32 received injections combined with home physical exercise, and the other 32 received physical therapy alone. Propensity score matching was used to ensure that the two groups did not differ significantly in categorical and continuous variables. Measurements included pain intensity, maximum mouth opening, joint crepitus, jaw functional limitation scale (JFLS) scores, treatment times, and treatment durations. Improvement in each measurement was compared between the two groups 2, 4, and 12 weeks after the treatment commenced, as were the final treatment times and durations. Results Pain intensity, maximum mouth opening, and JFLS scores in the two groups improved 2, 4, and 12 weeks after treatment (all p < 0.05). The crepitus ratio improved significantly only in the combined treatment group after 12 weeks. Compared with the physical therapy group, pain while opening the mouth improved after 2, 4, and 12 weeks in the combined treatment group. Furthermore, 2 weeks after treatment, the physical therapy group showed significant improvement in maximal mouth opening compared with the combined treatment group. No significant between-group differences were observed regarding improvement in joint crepitus and JFLS scores at each observation point. The combined treatment group had a significantly lower number of visits than the physical therapy group; however, the treatment duration was longer. Conclusion Compared with physical therapy, pain while opening the mouth is significantly improved by the combined treatment within 12 weeks, and the number of required visits is fewer. Physical therapy improves the patients’ mouth-opening capabilities in a short time (2 weeks), and the treatment cycle is short.

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis

“…Also, conservative approaches (e.g., physical therapy, splint therapy) were shown to improve pain and functionality, but there is evidence that minimally invasive procedures, including HA injections, may be more effective than conservative treatments for both pain reduction and the improvement of maximum mouth opening. In this context, a recent RCT compared the efficacy of HA injection combined with home physical exercise to physical exercise alone [85]. The crepitus ratio in the combined treatment group improved significantly compared to the baseline (p < 0.05), whereas no significant improvement was observed in the physical treatment group [85].…”

“…In this context, a recent RCT compared the efficacy of HA injection combined with home physical exercise to physical exercise alone [85]. The crepitus ratio in the combined treatment group improved significantly compared to the baseline (p < 0.05), whereas no significant improvement was observed in the physical treatment group [85].…”