R. Emshoff

Clinically important difference thresholds of the visual analog scale: A conceptual model for identifying meaningful intraindividual changes for pain intensity

Summary A range of clinically important difference values is provided according to the patients’ baseline pain severity and duration of pain. Abstract The aim of this study was to estimate a range of clinically important difference (CID) values of the visual analog scale for pain intensity (VAS‐PI), and to assess the effect of patient baseline characteristics on VAS change scores. Data from a prospective cohort study with 678 patients with subacute and chronic temporomandibular disorder pain were analyzed. Patients were divided into 9 cohorts on the basis of the baseline VAS score and the duration of pain. The CID was estimated over a 12‐week period, and 2 different methods were used: (1) mean change scores, and (2) optimal cutoff point in receiver operator characteristic curves. The patients global impression of change was used as an external criterion. The general linear model univariate analysis was applied to assess the effect of baseline pain level and duration of pain on the raw VAS change scores, while adjusting for age and sex. The CID mean change ranged from 20.9 to 57.5 mm (64.1–76.3%), and the CID optimal cutoff point from 11.5 to 28.5 mm (29.9–47.7%). For the VAS change scores, the main effect of the variable baseline pain level was significant (F = 107.09, P < .001). However, there was no significant baseline pain level by duration of pain interaction effect (F = 1.13, P = .340). On the basis of the results, we advocate the choice of a single CID value according to the context of the patients baseline level of pain.

Structural Characteristics of Bilateral Temporomandibular Joint Disc Displacement Without Reduction and Osteoarthrosis Are Important Determinants of Horizontal Mandibular and Vertical Ramus Deficiency: A Magnetic Resonance Imaging Study

PURPOSE To estimate in patients with temporomandibular joint (TMJ) arthralgia whether magnetic resonance (MR) imaging findings of bilateral TMJ disc displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of horizontal mandibular and vertical ramus deficiencies. PATIENTS AND METHODS Bilateral MR imaging of the TMJ was performed in 68 consecutive patients with TMJ arthralgia to identify those with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were performed to apply selected criteria of horizontal mandibular (gonion-menton [Go-Me] <73 mm and articulare-pogonion [Ar-Pog] <105 mm) and vertical ramus (articulare-gonion [Ar-Go] <45 mm) deficiencies. Logistic regression analysis was used to estimate the association between selected MR imaging and cephalometric parameters. RESULTS In the age- and gender-adjusted analysis, significant increases in the risk of horizontal mandibular (odds ratio, 7.5:1; P = .031) and vertical ramus (odds ratio, 9.5:1; P = .003) deficiencies occurred with bilateral DDwoR and OA. CONCLUSION In patients with TMJ arthralgia, the MR imaging parameters of DDwoR and OA seem important determinants of horizontal mandibular and vertical ramus deficiencies.

Are temporomandibular joint disk displacements without reduction and osteoarthrosis important determinants of mandibular backward positioning and clockwise rotation

OBJECTIVE The aim of this study was to estimate whether, in patients with temporomandibular joint (TMJ) arthralgia, the magnetic resonanace imaging (MRI) findings of bilateral TMJ disk displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of mandibular backward positioning and/or clockwise rotation. STUDY DESIGN Bilateral MRI of the TMJ was performed in 50 consecutive TMJ arthralgia patients to identify individuals with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were taken to apply selected criteria of mandibular backward positioning (FH to Na-Pog <84°, Na-A-Pog >5°, and SNB <75°) and clockwise rotation (FH to OP >13°, MP to FH >35°, and S-Gn to FH >64°). Logistic regression analysis was used to estimate the association between selected MRI and cephalometric parameters. RESULTS In the age- and gender-adjusted analyses, significant increases in risk of mandibular backward positioning and clockwise rotation occurred with bilateral DDwoR and OA (9.5:1; P = .040). CONCLUSION In patients with TMJ arthralgia the MRI parameters of DDwoR and OA seem to be important determinants of mandibular backward positioning and clockwise rotation.