RCT for TMD Utilizing Case Manager: Long TermTreatment Outcomes

Objectives: This study investigates use of a self-care intervention alone or in combination with a Case Manager in reducing Temporomandibular Disorders (TMD) signs and symptoms compared with usual treatment. Methods: 272 TMD patients were recruited into this RCT after an initial clinical evaluation using RDC/TMD criteria. Subjects were randomized into Usual Treatment alone (UT, n=91), or UT+Self-Care (SC, n=93, a single-session educational intervention) or UT+Self-Care +Case Manager (CM, n=88, SC intervention plus case manager follow up if significant pain continued). Self-report follow up was conducted at 12mo on UT=83, SC=81, CM=75 subjects and 24mo on UT=73, SC=76 and CM 72 subjects. Treatment outcomes were compared using self report measures of characteristic pain intensity (CPI, 0-10), pain interference in past month, worry over TMD condition (0-10), and treatment satisfaction (0-10). Intent-to-treat, GEE logistic linear regression analyses were adjusted for baseline levels. Results: Reduction in mean CPI occurred for all groups across time (baseline/12mo/24mo values), (UT=5.4/3.7/3.5; SC=5.4/3.6/3.0.; CM= 5.8/3.0/2.6) p<.05, but the CM group had significantly lower CPI scores at 12mo and 24mo than UT and SC groups (p<.01). The CM group was less likely to have pain-related interference with activities of living than UT and SC groups at 12mo/24mo follow ups (UT=57%/53%; SC=55%/53%, CM=40%/34%) p=0.01. The CM group also reported least worry regarding their condition at 12mo and 24mo than UT and SC groups (UT=3.4/3.2; SC=3.3/ 2.8; CM=2.7/1.9) p<0.01. Treatment satisfaction was high in all groups at 12mo and 24mo (UT=7.5/7.2; SC=6.9/6.7; CM= 8.2/8.0) with CM reporting greatest satisfaction, p<0.01. Conclusion: Based on decreased pain, interference with daily activities, and worry and heightened satisfaction with usual clinical care, these data suggest that the addition of a self-treatment group session to usual treatment improves outcomes, and these outcomes are improved further with the addition of a Case Manager. Supported by NIDCR #DE08773.