Title Uloga psiholoških čimbenika i fizikalne terapije u liječenju pacijenata s kroničnom mialgijom žvačnih mišića Title (english) The role of psychological factors and physical therapy in the treatment of patients with chronic myalgia of masticatory muscles Author Afrim Fetai Mentor Stjepan Špalj (mentor)Mentor Vlatka Lajnert (komentor)Committee member Tomislav Badel (predsjednik povjerenstva)Committee member Senka Meštrović (član povjerenstva)Committee member Iva Alajbeg (član povjerenstva)Committee member Dalibor Karlović (član povjerenstva)Committee member Renata Gržić (član povjerenstva)Granter University of Zagreb Defense date and country 2021-05-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616.31 - Stomatology Abstract Cilj ovoga istraživanja bio je ispitati djelotvornost dva modaliteta fizikalne terapije kronične mialgije maseteričnog mišića. Dodatno se ispitalo u kojoj mjeri su psihološki čimbenici moderatori uspjeha terapije. Istraživanje je bilo randomizirani kontrolirani pokus. Korišten je instrument Dijagnostički kriteriji za temporomandibularne poremećaje za izbor ispitanika i praćenje ishoda liječenja.
Pozvane su sudjelovati 54 osobe s mialgijom masetera dužom od tri mjeseca, a 42 slučaja su bila na kraju na raspolaganju za analizu. Raspon dobi bio je 16-67 (medijan 33, interkvartilni raspon 25-53), a 62% su bile žene. Testirana je djelotvornost dva tipa terapije: 1. savjetovanje o problemu s kućnim samomasažama i toplo-vlažnim oblozima, 2. biostimulacijskog lasera u trajanju od mjesec dana. Obje skupine imale su po 21 ispitanika koji su praćeni mjesec dana nakon početka terapije te tri mjeseca nakon.
Laser i savjetovanje o problemu s kućne samomasaže i oblozima kratkoročno smanjuju simptome kronične mialgije masetera – samoreportiranog ograničenja funkcija čeljusti (žvakanje, mobilnost, verbalna i neverbalna komunikacija) i smanjuju intenzitet boli (p<0,05). Laser nije djelotvorniji od savjetovanja o problemu sa samomasažama i oblozima u poboljšavanju klinički izmjerene mandibularne dinamike. Učinak terapije je dugotrajniji u laserskoj skupini. Psihološke karakteristike značajnije utječu na djelotvornost liječenja kod smanjenja ograničenja funkcije čeljusti nego kod smanjenja intenziteta boli. Na slabiju djelotvornost liječenja utječu sklonost katastrofiziranju i sklonost somatosenzoričkoj amplifikaciji (p<0,05). Zaključno, oba tipa terapije su djelotvorna no laser ima jači i duži efekt. Kognitivna distorzija u vidu sklonosti pretjeranoj negativnoj orjentaciji te preuveličavanju i pogrešnoj interpretaciji tjelesnih senzacija smanjuje djelotvornost liječenja.
Abstract (english) Temporomandibular disorders (TMD) are a set of conditions concerning the temporomandibular joints and the masticatory muscles and involve musculoskeletal pain, disturbances in the mandibular movement patterns and function. The aim of this study was to explore the efficiency of two modalities of physical treatment of chronic myalgia of masseter muscle and the role of psychological factors in success of treatment. The hypothesis is that both therapeutic modalities significantly reduce pain and disturbance of the mandibular function, where laser is more efficient. It is expected that is the most powerful moderator of success of treatment is the health competence, i.e. the degree to which an individual feels capable of effectively managing his or her health outcomes. Materials and methods: The research was randomized controlled trial. The instrument Diagnostic Criteria for TMD was used to select subjects and monitor treatment outcome. 54 subjects with masseter myalgia of more than 3 months in duration were invited to participated and 42 cases were available at the end and analysed. Age range was 16-67 years (median 33, interquartile range 25-53) and there were 62% females. Efficiency of two treatments modalities in subjects with diagnosed masseter myalgia were tested: 1) self-management (counselling
about the problem, parafunctional behaviour identification, monitoring and avoidance, home self-massages of painful muscle points and thermal therapy with moist warm wraps) and 2) biostimulatory diode laser for one month. Each group had 21 participants. During treatment participants did not use analgesics. Subjects were monitored one months after the start of treatment and three months after that. Results: Laser and self-management reduce symptoms of chronic myalgia of the massager: self-reported limitation of jaw function (chewing, mobility, verbal and non-verbal communication) in the short term and reduce pain intensities (p<0.05). Characteristic pain intensity decreased significantly in both treatment groups, with larger effect size in the laser group than self-management group (p<0.001; η2 = 0.954 and 0.453). Disability score also
decreased significantly in both groups, more significantly in the laser-treated group (p≤0.035; η2=0.751 and 0.154). Self-management group demonstrated reduction of effect after three months, which was not the case after laser therapy.Mouth opening, laterotrusion movements and protrusions increased in both groups after therapy. The difference was always statistically significant in the laser-treated group with large effect size (p<0.001; η2=0.786-0.861). In self-management group the difference was significant only in maximum assisted opening with medium effect size (p=0.014; η2=0.217). There were
no significant differences between groups at any time points. Psychological characteristics significantly affect the ffectiveness of treatment, more in reducing the limitation of jaw function than in reducing the intensity of pain. Poor treatment efficacy was not influenced by the health competence, but with somatosensory amplification and catastrophizing (p <0.05). Conclusion: Both self-management and laser are effective in treatment of chronic masseter myalgia but the laser has a stronger and longer effect. The cognitive distortion, seen in tendency to exaggerate and misinterpret bodily sensations, diminishes the effectiveness of treatment.
Keywords
lice
bol
žvačni mišići
temporomandibularni zglob
fizikalna terapija
Keywords (english)
Facial pain
Masticatory muscles
Temporomandibular Joint
Physical therapy
Language croatian URN:NBN urn:nbn:hr:127:155292 Promotion 2021 Study programme Title: dental medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-07-08 09:34:10
