The Diagnostic Validity of Clinical Tests in Temporomandibular Internal Derangement: A Systematic Review and Meta-analysis

Abstract

Purpose: To assess the diagnostic validity of clinical tests for temporomandibular internal derangement relative to magnetic resonance imaging (MRI). Methods: MEDLINE and Embase were searched from 1994 through 2009. Independent reviewers conducted study selection; risk of bias was assessed using Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews (QUADAS); b9/14) and data abstraction. Overall quality of evidence was profiled using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Agreement was measured using quadratic weighted kappa (kw). Positive (þ) or negative (À) likelihood ratios (LR) with 95% CIs were calculated and pooled using the DerSimonian-Laird method and a random-effects model when homogeneous (I 2 b 0.40, Q-test p a 0.10). Findings of this review will assist clinicians in deciding which diagnostic tests to use when internal derangement is suspected. The literature search revealed a lack of high-quality studies; further research with adequate description of patient populations, blinded assessments, and both sagittal and coronal MRI planes is therefore recommended.Key Words: diagnosis; magnetic resonance imaging; predictive value of tests; temporomandibular joint disorders. RÉ SUMÉObjectif : É valuer la validité du diagnostic ré sultant de tests cliniques en imagerie de ré sonance magné tique (IRM) pour le dé pistage du dé rangement interne de l'articulation temporo-mandibulaire (ATM). Mé thode : Une recherche a é té effectué e dans les bases de donné es MEDLINE et Embase pour les anné es 1994 à 2009. Des examinateurs indé pendants ont procé dé au choix des é tudes ré pertorié es ; les risques de biais ont é té é valué s à l'aide de l'é chelle QUADAS (Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews ), visant à é valuer la qualité des é tudes sur la fiabilité diagnostique incluses dans les revues systé matiques (le pointage obtenu a é té b9/14) et à l'aide d'abstraction des donné es. Le profil de la qualité globale des preuves a é té é tabli avec l'é chelle GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Le degré d'accord a é té mesuré à l'aide du coefficient quadratique kappa pondé ré (kw). Les rapports de vraisemblance (RV) positifs ( þ ) ou né gatifs ( À ) avec intervalles de confiance de 95 % ont é té calculé s et groupé s suivant la mé thode de DerSimonian-Laird et à l'aide d'un modè le à effets alé atoires lorsque les donné es é taient homogè nes (I 2 b 0,40, test-Q p a 0,10). Ré sultats : Nous avons retenu 8 des 36 é tudes identifié es. Les preuves voulant que les tests individuels de dé viation (RVþ : 6,37 [95 % IC : 2,(13)(14)(15)(16)(17)(18)(19)03]) et de cré pitation ([RV : 5,) soient fiables é taient de trè s faible qualité , alors qu'un ensemble de tests regroupant cré pitation, dé viation, douleur et ouverture limité e de la bouche sont les plus valables au moment de dé terminer s'il y a effectivement dé rangement interne sans ré duction (RVþ : 6,37 [95 % IC :...

International consensus on the most useful assessments used by physical therapists to evaluate patients with temporomandibular disorders: A Delphi study

“…Recent studies highlighted that clinicians should look at a combination of assessment tests and functional tests for the diagnosis of musculoskeletal conditions such as patellofemoral pain syndrome, 25 cervicogenic headache26,39 or shoulder pain 27. This was in accordance with the literature, where combinations of symptoms and a clinical test were considered to have a moderate to high reliability (k-values >0.4).This combination of tests assisted the clinician to sub-classify the patients' presentation into arthrogenic, myogenic or neurogenic TMD 24,28. For example, when assessing cervical impairment, expertspreferred the craniocervical flexion test (endurance) and cervical spine screening with manual techniques.…”

Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction

“…Palpation-tests in other body areas, however, are considered as subjective with low reliability (Billis et al, 2003;Seffinger et al, 2004;Robinson et al, 2007). Previously Chaput et al (2012) have suggested that a cluster of clinical…”

“…The present study was planned in accordance with the present recommendations (Chaput et al, 2012); describing the patient population, blinded assessments for both the clinical tests and MRIs and a definition of the diagnostic test. All of which are important to avoid systematic error.…”

“…The time between the clinical examination and the MRI examination is reported and within the recommendations (de Vet, 2011). By using both sagittal and coronal MRI views, we have ensured high accuracy of the reference standard (Schwaighofer et al, 1990;Chaput et al, 2012).…”

“…A literature search concerning diagnostic validity of clinical tests in temporomandibular ID revealed a lack of high-quality studies (Chaput et al, 2012). Moreover, there are gaps in our knowledge about how well clinical tests or cluster of tests perform in identification of ADDWOR (Strøm 2013).…”