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- Sundqvist, Bertil, 1950, et al.
(författare)
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Comparison of individual prediction of treatment outcome made by a TMD specialist and a TMD-trained general dental practitioner in patients with temporomandibular disorders.
- 2007
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Ingår i: Swedish dental journal. - 0347-9994. ; 31:2, s. 55-63
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate if a TMD-trained general dental practitioner could individually predict actual treatment outcome in selected patients diagnosed with temporomandibular disorders (TMD) with similar results as a TMD specialist. The patients were examined, individually predicted, treatment planned, treated and had their treatment outcome evaluated by the therapist, respectively. Out of 2618 patients referred to a TMD specialist clinic, 1086 patients started treatment. They were all divided into Muscle or Mainly TMJ symptoms. Prediction of the treatment outcome as Good or Dubious was based on the patient's history, the clinical and, sometimes, radiological findings. The degree of improvement was graded using a Numeric Rating Scale 0-100. A clinical important improvement, defined as an improvement of initial complaints of 50% or more, was judged as a correct prediction of Good treatment outcome. Seven-hundred-sixty-nine patients treated by the TMD specialist (Sample 1) was compared with 164 patients treated by the TMD-trained general dental practitioner (Sample 2). For patients with Muscle symptoms in Sample 1, a 50% improvement or more was reached by 93% of those predicted Good and 57% of those predicted Dubious. The corresponding figures in Sample 2 were 100% and 82%, respectively. In Sample 1, patients with Mainly TMJ symptoms reached a 50% improvement or more in 94% of those with prediction Good and 73% of those predicted Dubious. In Sample 2 the figures were 100% and 87%, respectively. ATMD-trained general dental practitioner could individually predict treatment outcome with similar results as a TMD specialist in selected patients diagnosed with TMD. Whether the method is possible to generalize has to be investigated further.
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| 2. |
- Sundqvist, Bertil, 1950
(författare)
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Individual prediction of treatment outcome in patients with temporomandibular disorders. A quality improvement model.
- 2007
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Ingår i: Swedish dental journal. Supplement. - 0348-6672. ; :186
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Tidskriftsartikel (refereegranskat)abstract
- The general aim of this thesis was to create and evaluate a quality improvement model for prediction of treatment outcome in patients diagnosed with Temporomandibular Disorders (TMD) of either Muscle or Mainly TMJ (Temporomandibular Joint) origin, treated with interocclusal appliances and/or occlusal adjustment. The model was assumed to generate negative predictors of treatment outcome through evaluating all patients predicted Good reaching an objective treatment goal but not having an improvement of 50% or more. The model was created and evaluated by one TMD specialist. The questions were: (I) Was it possible for the TMD specialist to predict treatment outcome individually in patients diagnosed with TMD and, from the results, create a quality improvement model? (II) Was it possible for eight TMD-trained general dental practitioners, under the supervision of the TMD specialist, to treat TMD patients with similar results to the TMD specialist if the TMD specialist had examined, treatment planned, and individually predicted the treatment outcome? (III) Was it possible for the TMD specialist to improve the possibility to predict individual treatment outcome overtime? (IV) Was it possible for one TMD-trained general dental practitioner to copy the clinical part of the model and achieve the same results as the TMD specialist, in patients selected by the TMD specialist? Out of 5165 patients subjected to a functional examination of the masticatory system, 3602 were diagnosed with TMD and subgrouped as either Muscle or Mainly TMJ symptoms. The patients were predicted to have a Good, Dubious, or Poor possibility to have an improvement of 50% or more after treatment. Patients predicted Poor were not offered any treatment. A correct prediction of actual treatment outcome Good was defined as an improvement of 50% or more for muscle and/or TMJ symptoms. A total of 2625 patients began treatment at the specialist clinic for TMD and 2128 completed the full course of treatment. The patients were treated with counseling, interocclusal appliances and/or occlusal adjustment. Treatment outcome was evaluated at an objective treatment goal as improvement in percent using a verbal Numeric Rating Scale ranging from 0 to 100. The results suggest that (I) individual treatment outcome can be predicted in patients with TMD treated by one specialist in TMD and a quality improvement model could be created, (II) eight TMD-trained general dental practitioners could, under the supervision of the TMD specialist, treat TMD patients with similar results to the TMD specialist, (III) the TMD specialist could improve the possibility to predict individual treatment outcome over time, and (IV) the clinical part of the model could be copied by one TMD-trained general dental practitioner with similar results to the TMD specialist. In conclusion, the model works in the hand of one TMD specialist and the clinical part for one general dental practitioner, but it needs to be evaluated by other clinics/clinicians before it can be claimed to be generalizable. The model has identified new negative predictors for treatment outcome in patients with TMD. These predictors need to be investigated further in well controlled clinical trials. The created model is a PDSA cycle.
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| 3. |
- Sundqvist, Bertil, 1950, et al.
(författare)
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Validation and improvement of a predictive model for treatment outcome in patients with temporomandibular disorders.
- 2007
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 65:2, s. 109-18
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine whether it was possible to improve individual prediction of treatment outcome in patients with temporomandibular disorders (TMD) through continuous quality improvement registrations and implementation of changes in clinical routines. MATERIAL AND METHODS: All 5777 patients referred to a specialist clinic for stomatognathic physiology; 2187 TMD patients started treatment. The patients were divided into Muscle or Mainly TMJ symptom groups. Actual treatment outcome was predicted as Good or Dubious based on patient history and clinical findings. The degree of improvement of initial symptoms was graded using a numeric rating scale 0-100. Improvement in initial complaints of 50% or more was judged as a clinically important difference (CID); 989 patients (76%) completed treatment 1992-1998 (Sample 1) and 769 (86%) treatment 1999-2004 (Sample 2). RESULTS: For patients with Muscle symptoms in Sample 1, CID was reached by 90% of those predicted Good and by 56% of those predicted Dubious. In Sample 2, the figures were Good 93% and Dubious 57%. In subgroup Mainly TMJ symptoms, CID was reached by 94% of those predicted Good and by 88% if predicted Dubious in Sample 1. In Sample 2, the figures were the same for those predicted Good, i.e. 94%, and Dubious, 73%. CONCLUSION: Continuous quality improvement registrations and implementation of changes in clinical routines improved the ability to predict individually the actual treatment outcome between patients predicted Good or Dubious, respectively. Rheumatic disease turned out not to be a negative predictor for treatment outcome.
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