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A reliability study of dynamic and static pain tests in temporomandibular disorder patients
Corine M Visscher1, Frank Lobbezoo, Machiel Naeije
1Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. c.visscher@acta.nl
Aim:
To determine the interexaminer reliability of dynamic and static pain tests in patients with temporomandibular disorders (TMD).
Methods:
One hundred fifteen consecutive TMD patients participated in the study. At intake, pain on dynamic and static pain tests was scored on a 4-point ordinal scale by 1 of 5 dentists. Pressure was applied to the mandible during mandibular opening, closing, and protrusive movements (dynamic tests) and while the mandible was kept motionless by the patient in an open, closed, or protrusive position (static tests). After this examination, the dynamic and static pain tests were performed a second time by 1 of 2 physical therapists blinded to the outcome of the first examination. Prior to the study, all examiners took part in a yearly training session, while 3 examiners (2 dentists and 1 physical therapist) were trained on a more regular basis.
Results:
The interexaminer reliability of dynamic and static pain tests ranged from "poor" to "fair to good" (intraclass correlation coefficient [ICC]: 0.29-0.54) but reached the "excellent" level (ICC: 0.34-0.92) when only the data gathered by the more extensively trained examiners were considered. The reliability was higher when the data were analyzed on the 4-point scale as compared to a dichotomized pain scale.
Conclusion:
The reliability of dynamic and static pain tests for the temporomandibular region is fair to good when rated on an ordinal pain scale. Thorough training of examiners can improve the reliability considerably.
