Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders

Abstract

Objective: Clinical tests used to examine patients with temporomandibular disorders vary in methodological quality, and some are not tested for reliability. The purpose of this cross-sectional study was to evaluate inter-tester reliability of clinical tests and a cluster of tests used to examine patients with long-lasting temporomandibular disorders.

Methods: Forty patients with pain in the temporomandibular area treated by health-professionals were included. They were between 18–70 years, had 65 symptomatic (33 right/32 left) and 15 asymptomatic joints. Two manual therapists examined all participants with selected tests. Percentage agreement and the kappa coefficient (k) with 95% confidence interval (CI) were used to evaluate the tests with categorical outcomes. For tests with continuous outcomes, the relative inter-tester reliability was assessed by the intraclass-correlation-coefficient (ICC3,1, 95% CI) and the absolute reliability was calculated by the smallest detectable change (SDC).

Results: The best reliability among single tests was found for the dental stick test, the joint-sound test (k = 0.80–1.0) and range of mouth-opening (ICC3,1 (95% CI) = 0.97 (0.95–0.98) and SDC = 4 mm). The reliability of cluster of tests was excellent with both four and five positive tests out of seven.

Conclusion: The reliability was good to excellent for the clinical tests and the cluster of tests when performed by experienced therapists. The tests are feasible for use in the clinical setting. They require no advanced equipment and are easy to perform.

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of Manual & Manipulative Therapy on 14 May 2017, available online: http://www.tandfonline.com/10.1080/10669817.2017.1322346