Efeitos de diferentes terapias conservadoras sobre a dor, aspectos psicossociais, relacionados ao sono e à qualidade de vida em indivíduos com disfunção temporomandibular: ensaio clínico randomizado
Temporomandibular Disorder (TMD) consists of a set of conditions that involve the temporomandibular joints (TMJ), masticatory muscles and associated structures. It is very prevalent in Brazil and worldwide, has a multifactorial and self-limiting character, which has allowed the development of a g...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Brasil
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/28207 |
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| Resumo: | Temporomandibular Disorder (TMD) consists of a set of conditions that involve the
temporomandibular joints (TMJ), masticatory muscles and associated structures. It is very
prevalent in Brazil and worldwide, has a multifactorial and self-limiting character, which has
allowed the development of a great variety of therapies to manage its main signs and
symptoms. This blinded randomized clinical trial evaluated the physical, functional,
psychological, sleep-related and quality of life symptoms in patients diagnosed with TMD
after different therapies: occlusal splint (OS), counseling (C), manual therapy (TM) and
associated OS to C and if psychological and sleep disturbances interfere in the pain control
of these patients after the therapeutic conducts. The sample consisted of 87 individuals
diagnosed with TMD by the Research Diagnostic Criteria for Temporomandibular Disorders
(RDC-TMD) randomly assigned between the treatment groups. Anxiety symptoms were
diagnosed by the Trait-State Anxiety Index (IDATE), Hospital Anxiety and Depression Scale
(HADS), and Beck Anxiety Inventory (BAI). Symptoms of depression were assessed using
the HADS and Beck Depression Inventory (BDI). The subjective quality of sleep, general
quality of life and related to oral health, function and intensity of pain were investigated
through the Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of
Life Questionnaire - bref (WHOQOL ), Oral Health Impact Profile (OHIP 14) and Visual
Analogue Scale (VAS), respectively. The assessments were performed at the baseline, 1
month and 3 months after completion of the therapies by a blind and trained investigator. The
SPANOVA test was used to analyze the effect of therapies over time and between groups
with a confidence level of 95% and Friedman and Mann Whitney tests to assess intra- and
intergroup pain levels at all times with a significance level of 5%. It was observed that no
therapy had a statistically significant difference in relation to the other, and that all had
significant effects on the improvement of the indexes evaluated (anxiety IDATE p=0.002 –
HADS p<0.001 – BAI p<0.001 and depression BDI p=0.001 symptoms, subjective sleep
quality PSQI p=0.005, general quality of life WHOQOL p=0.029, oral health related quality
of life OHIP p <0.001 and pain intensity p<0.001) over time, except for the HADS depression
(p = 0.106). It was found that all patients with altered symptoms significantly reduced their
pain levels after the therapies (HADS p <0.001; BAI p <0.001; BDI p <0.001; PSQI p = 0.010), but that anxious patients (BAI p = 0.021) had a statistically significant greater
reduction (delta = 2.84) when compared to normal individuals (delta = 1.10) and also the
altered QS (p = 0.006). It was concluded that all conservative therapies generated positive
outcomes regarding physical, psychological, sleep-related and quality of life symptoms and
there were no elements to state that the treatments were not equal. And although anxious,
depressed patients with low QS had higher levels of pain in the baseline and these factors did
not negatively influence their reduction after DO, AC, FT, DO + AC and TMD therapies,
and that anxiety and altered sleep may even have a greater effect on this reduction. |
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