Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.
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DOI：
10.11607/jop.1151
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发表时间：
2014
影响因子：
2.5
通讯作者：
Orofacial Pain Special Interest Group, International Association for the Study of Pain
中科院分区：
文献类型：
--
作者：
Schiffman E;Ohrbach R;Truelove E;Look J;Anderson G;Goulet JP;List T;Svensson P;Gonzalez Y;Lobbezoo F;Michelotti A;Brooks SL;Ceusters W;Drangsholt M;Ettlin D;Gaul C;Goldberg LJ;Haythornthwaite JA;Hollender L;Jensen R;John MT;De Laat A;de Leeuw R;Maixner W;van der Meulen M;Murray GM;Nixdorf DR;Palla S;Petersson A;Pionchon P;Smith B;Visscher CM;Zakrzewska J;Dworkin SF;International RDC/TMD Consortium Network, International association for Dental Research;Orofacial Pain Special Interest Group, International Association for the Study of Pain
原始的颞下颌关节紊乱病研究诊断标准（RDC/TMD）轴I诊断算法已被证明是可靠的。然而，验证项目确定RDC/TMD轴I有效性低于目标灵敏度（≥ 0.70）和特异性（≥ 0.95）。因此，这些实证结果支持修订的RDC/TMD轴I诊断算法的发展，随后被证明是有效的最常见的疼痛相关的TMD和颞下颌关节（TMJ）关节内疾病。原始RDC/TMD Axis II仪器被证明是可靠和有效的。根据这些发现和修订，召开了两次国际共识研讨会，并从中获得了最终确定新的第一轴诊断算法和新的第二轴仪器的建议。通过一系列的研讨会和座谈会，一个由临床和基础科学疼痛专家组成的小组通过全面检索已发表的TMD诊断文献，然后通过正式的结构化过程进行审查和达成共识，修改了修订后的RDC/TMD轴I算法。通过使用验证项目的数据集评估了专家组对轴I诊断算法进一步修订的建议的有效性，并通过使用正在进行的TMJ影响项目（验证项目的后续研究）新收集的数据评估了其可靠性。通过全面检索文献，识别出了新的Axis II工具，这些工具提供了有效工具，相对于RDC/TMD，长度更短，可在公共领域获得，目前正在医疗环境中使用。新推荐的TMD诊断标准（DC/TMD）轴I方案包括用于检测任何疼痛相关TMD的有效筛选器以及用于区分最常见的疼痛相关TMD（灵敏度≥ 0.86，特异性≥ 0.98）和一种关节内疾病（灵敏度为0.80，特异性为0.97）的有效诊断标准。其他常见关节内疾病的诊断标准缺乏足够的有效性，但可用于临床诊断的筛选目的。与经验证的DC/TMD疼痛相关TMD标准相关的临床评估的检查者间可靠性极佳（kappa ≥ 0.85）。最后，一个全面的分类系统，包括常见的和不太常见的TMD。Axis II方案保留了选定的原始RDC/TMD筛查工具，并增加了新工具，以评估下颌功能以及行为和其他心理社会因素。Axis II协议分为筛查和综合自我报告工具集。筛选工具的41个问题评估疼痛强度，疼痛相关的残疾，心理困扰，下颌功能限制和功能异常行为，疼痛绘图用于评估疼痛的位置。由81个问题组成的综合工具进一步详细评估了下颌功能限制和心理困扰以及焦虑和共病疼痛状况的存在的其他结构。推荐的基于证据的新DC/TMD方案适用于临床和研究环境。更全面的仪器增加了第一轴和第二轴的短而简单的筛选仪器。这些经过验证的仪器允许识别具有一系列简单到复杂TMD表现的患者。
The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self-report instrument sets. The screening instruments’ 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
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