Method: Data were from examinations of individuals in OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment): n=1630 examinations for presence or absence of chronic TMD, and n=633 examinations for presence or absence of acute TMD. Adults aged 18-44 years from four U.S. study sites were examined by trained research staff using an augmented RDC/TMD protocol that evaluated pain in response to jaw maneuver and digital palpation of eight bilateral masticatory muscle groups and both TMJs. The examiner also questioned whether elicited pain was “familiar” to pain symptoms experienced in the preceding 30 days. Presence or absence of TMD was classified using both OPPERA RDC/TMD and augmented criteria. Paired case-classifications were cross-classified with the augmented classification nominated as the "reference standard". Kappa statistics and 95% confidence limits (95%CLs) were computed as an overall measure of concordance.
Result: Overall diagnosis of chronic TMD exhibited K=0.99 (95%CL: 0.98-1.00), while the Kappa for myalgia and arthralgia diagnoses were 0.97 (0.94-0.99) and 0.79 (0.74-0.85), respectively. The RDC/TMD protocol yielded 2% false positives and 0% false negatives for overall TMD diagnosis. Overall diagnosis of acute TMD exhibited K=0.87 (0.83-0.91), while the Kappa for myalgia and arthralgia diagnoses were 0.82 (0.78-0.87) and 0.54 (0.46-0.61), respectively. The RDC/TMD protocol yielded 10% false positives and 4% false negatives for overall TMD diagnosis.
Conclusion: Case status congruence across methods is consistent with familiar pain face validity. Greater arthralgia misclassification rate of the RDC/TMD protocol suggests patients' sensitization to joint palpation/maneuver during early symptom development, highlighting support for the new DC/TMD criteria and OPPERA heuristic.