Background. Orofacial pain is one of the most frequent clinical manifestations of temporomandibular disorders (TMD), mainly affected by female subjects, aged between twenty and forty years old. Temporo-mandibular pain has a negative and sometimes disabling impact on the life of those who suffer from it, leading to alterations in the main functions of the stomatognathic apparatus. For the treatment of this problem, physiotherapy is one of the many possible ways, as it provides various therapeutic approaches, including manual therapy and therapeutic exercise. Objective. The aim of this thesis is to identify whether, in the scientific literature, the studies carried out so far have shown greater efficacy on the reduction of temporomandibular pain of manual therapy compared to therapeutic exercise or if it is precisely the combination of these two different approaches that guarantees a better treatment in terms of long-term management of the symptom. Materials and methods. The sources of information used for the literature review, including PubMed, PEDro and Cochrane Library, made it possible to identify several systematic reviews, with and without meta-analyses, randomized and controlled clinical trials. The study selection process, which started from the analysis of the titles and abstracts corresponding to the research question, was followed by an in-depth reading of the articles. The information collected was organized into summary tables that allowed 21 articles to be chosen. Results. Some authors have shown that manual therapy is effective for the reduction of temporomandibular pain, especially in the short term, others, however, have concluded that therapeutic exercise is more valid in maintaining the analgesic effect in the medium term. Only a small number of studies have linked the two therapeutic approaches to each other, indicating that the use of both can guarantee the best treatment of orofacial pain in the medium and long term. Conclusions. Further studies are needed, with larger and more homogeneous samples, to affirm, based on scientific evidence, which is the most effective rehabilitation treatment for the reduction of temporo-mandibular pain, especially in the long term. In addition, it would be desirable to identify, with greater precision, the type and the appropriate dosage of exercises for the management and treatment of orofacial pain.
Background. Il dolore oro-facciale risulta una delle manifestazioni cliniche più frequenti dei disordini temporo-mandibolari (TMD), ne soffrono principalmente i soggetti di sesso femminile, di età compresa tra i tra i venti e i quarant’anni circa. Il dolore temporo-mandibolare ha un impatto negativo e, talvolta, invalidante sulla vita di chi ne soffre, comportando alterazioni delle principali funzioni dell’apparato stomatognatico. Per il trattamento di questa problematica, la fisioterapia risulta una delle numerose strade percorribili, poiché mette a disposizione vari approcci terapeutici, tra cui la terapia manuale e l’esercizio terapeutico. Obiettivo. L’obiettivo di questa tesi è quello di individuare se, in letteratura scientifica, gli studi finora effettuati hanno evidenziato una maggiore efficacia sulla riduzione del dolore temporo-mandibolare della terapia manuale rispetto all’esercizio terapeutico o se è proprio la combinazione di questi due diversi approcci che garantisce un miglior trattamento in termini di gestione del sintomo a lungo termine. Materiali e metodi. Le fonti d’informazione utilizzate per la revisione bibliografica, tra cui PubMed, PEDro e Cochrane Library, hanno permesso di identificare diverse revisioni sistematiche, con e senza metanalisi, e studi clinici randomizzati e controllati. Il processo di selezione degli studi, partito dall’analisi dei titoli e degli abstract corrispondenti al quesito di ricerca, è stato seguito da una approfondita lettura completa degli articoli. Le informazioni raccolte sono state organizzate in tavole riassuntive che hanno permesso di scegliere 21 articoli. Risultati. Alcuni autori hanno evidenziato che la terapia manuale risulta efficace per la riduzione del dolore temporo-mandibolare, soprattutto nel breve termine, altri, invece, hanno concluso che l’esercizio terapeutico risulta maggiormente valido nel mantenimento dell’effetto analgesico nel medio termine. Solo un numero ridotto di studi ha messo in relazione i due approcci terapeutici tra di loro, indicando che proprio l’utilizzo di entrambi può garantire il miglior trattamento del dolore oro-facciale nel medio e lungo termine. Conclusioni. Sono necessari ulteriori studi, con campioni più ampi ed omogenei, per poter affermare, sulla base di evidenze scientifiche, qual è il trattamento riabilitativo più efficace per la riduzione del dolore temporo-mandibolare, soprattutto a lungo termine. Inoltre, sarebbe auspicabile individuare, con maggiore precisione, la tipologia e la posologia più appropriata di esercizi per la gestione e la cura del dolore oro-facciale.
Terapia manuale ed esercizio terapeutico a confronto nel trattamento del dolore temporomandibolare: revisione della letteratura.
GOMIS, MATTIA
2022/2023
Abstract
Background. Orofacial pain is one of the most frequent clinical manifestations of temporomandibular disorders (TMD), mainly affected by female subjects, aged between twenty and forty years old. Temporo-mandibular pain has a negative and sometimes disabling impact on the life of those who suffer from it, leading to alterations in the main functions of the stomatognathic apparatus. For the treatment of this problem, physiotherapy is one of the many possible ways, as it provides various therapeutic approaches, including manual therapy and therapeutic exercise. Objective. The aim of this thesis is to identify whether, in the scientific literature, the studies carried out so far have shown greater efficacy on the reduction of temporomandibular pain of manual therapy compared to therapeutic exercise or if it is precisely the combination of these two different approaches that guarantees a better treatment in terms of long-term management of the symptom. Materials and methods. The sources of information used for the literature review, including PubMed, PEDro and Cochrane Library, made it possible to identify several systematic reviews, with and without meta-analyses, randomized and controlled clinical trials. The study selection process, which started from the analysis of the titles and abstracts corresponding to the research question, was followed by an in-depth reading of the articles. The information collected was organized into summary tables that allowed 21 articles to be chosen. Results. Some authors have shown that manual therapy is effective for the reduction of temporomandibular pain, especially in the short term, others, however, have concluded that therapeutic exercise is more valid in maintaining the analgesic effect in the medium term. Only a small number of studies have linked the two therapeutic approaches to each other, indicating that the use of both can guarantee the best treatment of orofacial pain in the medium and long term. Conclusions. Further studies are needed, with larger and more homogeneous samples, to affirm, based on scientific evidence, which is the most effective rehabilitation treatment for the reduction of temporo-mandibular pain, especially in the long term. In addition, it would be desirable to identify, with greater precision, the type and the appropriate dosage of exercises for the management and treatment of orofacial pain.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/56871