An Implementation and Biobehavioral Study of TMJMD

描述(由申请人提供)：由于慢性颞下颌关节和肌肉疾病(TMJMD)患者的巨大经济成本和传统上较差的结果，在急性状态下治疗患者变得重要，以防止这些更慢性的残疾问题。这是过去两个资助项目的目标。初步项目结果隔离危险因素，成功预测慢性病的发展，准确率达91%。在第二个项目中，开发了一种统计算法，用于筛选“高危”患者。这些患者随后被随机分配到早期干预组或非干预组。一年的随访评估记录了早期干预的治疗效果和成本效益。这些结果对这一普遍存在的疼痛和残疾问题的有效早期干预和显著的医疗成本节约具有重大意义。对于目前提议的项目，我们计划实施这一治疗计划，以评估其在更多基于社区的牙科实践中的有效性。这是对NIH要求实施循证治疗方法的要求，该方法是在受控临床环境中开发的，适用于社区中不同实践的“现实世界”。急性TMJMD患者将从两家社区诊所招募。根据我们的“风险”筛选算法，高危患者将被随机分配到两组中的一组(n=225/组)：早期生物行为干预组或注意控制组。研究假设，在一年的随访期中，注意力控制组的“高危”患者将比“高危”的早期干预患者表现出更多的慢性TMJMD问题。该项目的另一个目标是评估新技术的潜在效用，这些新技术将导致在检测TMJMD患者之间的个体差异方面更加精确。评估的指标包括咀嚼性能、皮质醇水平和其他生物心理社会结果。这代表了全面了解TMJMD大脑行为模式的下一步。此外，还将使用结构方程建模方法。这种多层次、多系统的方法还没有被应用于更好地理解TMJMD的生物、心理和社会基础。该项目这一部分的结果将极大地有助于刺激未来的研究，从而更好地了解TMJMD，以及更好地定制处方治疗方案。项目简介：颞下颌关节和肌肉紊乱症(TMJMD)在美国是一个非常普遍且代价高昂的公共卫生问题，特别是当它变成慢性疾病的时候。这项研究将进一步评估预防慢性TMJMD的早期生物行为干预计划的治疗和成本效益。此外，这一循证计划将在以社区为基础的实际牙科实践中实施，使其更容易为普通人群所接受。

DESCRIPTION (provided by applicant): With the great economic costs and traditionally poor outcomes among chronic temporomandibular joint and muscle disorder (TMJMD) patients, it has become important to treat patients in the acute state, in order to prevent these more chronic disability problems. This has been the goal of two past funded grant projects. Results of the initial project isolated risk factors that successfully predicted the development of chronicity, with a 91% accuracy rate. A statistical algorithm was developed which was used in the second project to screen out "high-risk" patients. These patients were then randomly assigned an early intervention or non-intervention group. One-year follow-up evaluations documented the treatment efficacy and cost effectiveness of early intervention. These results have major implications for effective early intervention and significant health-care cost savings for this prevalent pain and disability problem. For the present proposed project, we plan to implement this treatment program in order to evaluate its effectiveness in more community-based dental practices. This is in response to NIH's request for the implementation of evidence-based treatment approaches, developed in controlled clinical settings, to the "real world" of diverse practices in the community. Acute TMJMD patients will be recruited from two community clinics. Based upon our "risk" screening algorithm, high-risk patients will be randomly assigned to one of two groups (n=225/group): an early biobehavioral intervention or an attention-control group. It is hypothesized that the attention control "high-risk" patients will display more chronic TMJMD problems, relative to the "high-risk" early intervention patients, at one-year follow-up. Another aim of the project is to evaluate the potential utility of new technologies that will lead to even greater precision in detecting individual differences among TMJMD patients. Measures evaluated include chewing performance, cortisol levels, and other biopsychosocial outcomes. This represents the next step in comprehensively understanding brain-behavior patterns in TMJMD. Also, structural equation modeling methodology will be used. Such a multi-level, multi-systems approach has not been applied to better understand the biopsychosocial underpinnings of TMJMD. Results from this component of the project will greatly aid in stimulating future research leading to the better understanding of TMJMD, as well as better tailoring of prescribed treatment regimens. Project Narrative: Temporomandibular joint and muscle disorder (TMJMD) is a highly prevalent and costly public health problem in the United States, especially when it becomes chronic in nature. This study will further evaluate the treatment- and cost-effectiveness of an early biobehavioral intervention program for preventing chronic TMJMD. Moreover, this evidence-based program will be implemented in actual community-based dental practices to make it more accessible to the general population.