***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation ( TENS ) with the flat occlusal splint in the treatment of temporom and ibular joint ( TMJ ) disk displacement without reduction . Thirty-one patients were included and r and omly selected to be treated 6 weeks with either TENS ( 90 Hz , 30 min , three times/day ) or with a flat occlusal splint ( 24 h/day . Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle . The splint group used a conventional flat occlusal splint with cuspid guidance . Both treatment groups visited the clinic once a week . Symptoms and signs were registered before and after treatment . The intensity of pain was recorded with a visual analogue scale ( VAS ) and with an electronic pocket-sized recorder ( Pain-Track ) carried 1 week before and also the last week of treatment for continuous registration of pain . Measured with the VAS , half of the patients treated with splints became pain-free or their TMJ pain improved at least 50 % both at rest and with jaw function compared with only 6 % in the TENS-treated group . With regard to strictly chewing pain , the VAS-registered pain improved in two-thirds of the splint group , compared with 50 % of the TENS group . With the Pain-Track device it was found that in most individuals pain was aggrevated at mealtimes . The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction A study of the effectiveness of physical therapy for patients with myofacial pain dysfunction syndrome was performed . Clinical evaluation of 120 patients revealed marked male preponderance , distribution according to age showed a great prevalence of the third decade , and most common chief complaints were pain and muscle tenderness . Patients were classified r and omly into three equal groups treated by muscle relaxant drugs , shortwave diathermy , and ultrasonic therapy , respectively . Regular follow-up was carried out for 6 to 12 months to assess patients ' responses to different forms of treatment . Evaluation revealed marked relief of symptoms by the use of physical therapy , and the best results were obtained by the use of ultrasonic therapy This study evaluated the effectiveness of interferential current stimulation ( ICS ) to decrease  recurrent jaw pain  and to increase maximum vertical jaw opening .  Forty subjects with either a history of recurrent jaw pain of three months ' duration or of constant , chronic jaw pain that recurred within the preceding two months participated in the study . Twenty subjects received three 20-minute treatments of ICS , and 20 other subjects received three 20-minute treatments with a placebo procedure . The intensity of jaw pain and the amount of maximum vertical jaw opening were the dependent measures . Scatter diagrams indicated no relationship between the intensity of jaw pain and amount of vertical jaw opening before or after treatment . Statistical tests ( p less than .05 ) showed no significant differences in the level of jaw pain or the amount of maximum vertical jaw opening between the ICS and Placebo Groups . We concluded that a short-term ICS treatment proved no more effective than a placebo treatment for decreasing jaw pain or for increasing vertical jaw opening AIMS To determine whether Rocabado 's 6 x 6 exercise program has an added benefit to self-care alone in reducing myofascial jaw pain and improving forward head posture ( FHP ) in subjects with myofascial pain and FHP at the end of 4 weeks . METHODS In this double-blinded trial , 45 subjects ( 43 female and 2 male , mean age 24 years ) were r and omly assigned to self-care or self-care + 6 X 6 exercises . The primary outcome measure was intensity of jaw pain on a numerical graphic rating scale ( NGRS ) . Secondary outcome measures were jaw pain on a verbal rating scale ( VRS ) , neck pain ( NGRS and VRS ) , and change in head posture .  Twenty-one subjects per group result ed in 80 % power to detect a difference of 2 in the NGRS for intensity of jaw pain . Alpha was set at .05 for statistical significance . RESULTS Both groups showed significant statistical ( P = .001 ) and clinical ( > 2 on NGRS ) improvement in jaw pain intensity . Jaw pain and neck pain improved significantly ( P < .01 ) in both groups . There were no differences between groups for any of the measures . A significant change in head posture was not detected in either group . CONCLUSION The 6 x 6 exercises were not significantly more beneficial in reducing the intensity of jaw and neck pain than self-care alone . Furthermore , they were not beneficial in improving head posture within the 4-week duration of this study A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Abstract This r and omized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy ( PRFE ) in patients with temporom and ibular joint arthralgia . Forty subjects ( age range 22 to 55 yrs . ) were assigned r and omly into two equal groups : ( 1 ) Experimental group received PRFE using the Energex unit ( Energex , Inc. Emerson , New Jersey ) and ( 2 ) Control group received PRFE placebo treatment using a sham device . Both groups received six applications to the TMJ area over two weeks . Data were analyzed for the following times : baseline , first and second follow-up visits . Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group ( mean = 6.13 to 3.05 , p<0.001 ) . There was also a significant effect for the controls ( mean = 5.35 to 4.20 , p=0.01 ) . The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls . The significant reduction in controls was attributed to the placebo effect . The experimental group showed a significant increase in mouth opening ( mean = 34.95 to 41.70 mm , p=0.002 ) , right lateral movement ( mean = 7.85 to 10.80 mm , p=0.001 ) and left lateral movement ( mean = 7.65 to 10.85 mm , p<0.0001 ) . No significant ( p>0.1 ) change in the control group occurred for mouth opening ( mean = 38.50 to 39.65 mm ) , right lateral movement ( mean = 8.60 to 8.75 mm ) and left lateral movement ( mean = 8.50 to 8.80 mm ) . No side effects were reported during the treatment and the two week follow-up . These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing m and ibular range of motion Twenty-four patients were selected to participate in this study . Twelve patients were r and omly selected to receive occlusal splint therapy and the other 12 to receive a simplified relaxation therapy technique .  Observable pain scores , maximum comfortable interincisal distance , and maximum interincisal distances were recorded for each group before and after treatment . The occlusal splint group showed a significant decrease in total mean observable pain scores ( decrease score of 10.5 , t = 3.124 ; P less than 0.1 ) . The relaxation group showed no significant decrease in total mean observable pain scores ( decrease score of 1.8 , t = 0.888 ; P = ns ) . The occlusal splint group showed a significant increase in the mean maximum comfortable opening ( an increase of 12.4 mm , t = 5.085 ; P less than .01 ) . The relaxation group showed no significant increase in the mean maximum comfortable opening ( an increase of 2.3 mm , t = 0.734 ; P = ns ) . The occlusal splint group showed a significant increase in the mean maximum opening ( an increase of 6.0 mm , t = 2.471 ; P less than .05 ) . The relaxation group showed no increase in the mean maximum opening ( decrease of 0.7 mm , t = 0.343 ; P = ns ) . This study suggests that occlusal splint therapy is a more effective treatment for the pain , tenderness , and limited m and ibular opening associated with temporom and ibular disorders than relaxation therapy . In this study , the relaxation technique used had no significant effect on the patients ' pain , tenderness , or limited opening To assess the differential efficacy of two commonly used treatments for temporom and ibular disorders ( TMD ) , intraoral appliances ( IAs ) and biofeedback ( BF ) , separately and in combination , two studies were conducted . The first study directly compared IA treatment , a combination of biofeedback and stress management ( BF/SM ) , and a waiting list control group in a sample of 80 TMD patients . Both treatments were determined to be equally credible to patients , ruling out this potential threat to the validity of the results obtained . The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment , but at a 6-month follow-up the IA group significantly relapsed , especially in depression , whereas the BF/SM maintained improvements on both pain and depression and continued to improve . The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients . The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone , particularly in pain reduction , at the 6-month follow-up . These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained BACKGROUND Many practitioners have found that posture training has a positive impact on temporom and ibular , or TMD , symptoms . The authors conducted a study to evaluate its effectiveness . METHODS Sixty patients with TMD and a primary muscle disorder were r and omized into two groups : one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only . Four weeks after the study began , the authors reexamined the subjects for changes in symptoms , pain-free opening and pressure algometer pain thresholds . In addition , pretreatment and posttreatment posture measurements were recorded for subjects in the treatment group . RESULTS Statistically significant improvement was demonstrated by the modified symptom severity index , maximum pain-free opening and pressure algometer threshold measurements , as well as by the subjects ' perceived TMD and neck symptoms . Subjects in the treatment group reported having experienced a mean reduction in TMD and neck symptoms of 41.9 and 38.2 percent , respectively , while subjects in the control group reported a mean reduction in these symptoms of 8.1 and 9.3 percent . Within the treatment group , the authors found significant correlations between improvements in TMD symptoms and improvements in neck symptoms ( P < .005 ) as well as between TMD symptom improvement and the difference between head and shoulder posture measurements at the outset of treatment ( P < .05 ) . CONCLUSIONS Posture training and TMD self-management instructions are significantly more effective than TMD self-management instructions alone for patients with TMD who have a primary muscle disorder . PRACTICE IMPLICATION S Patients with TMD who hold their heads farther forward relative to the shoulders have a high probability of experiencing symptom improvement as a result of posture training and being provided with selfmanagement instructions BACKGROUND Treatment recommendations for patients with painful temporom and ibular disorders ( TMDs ) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery . METHODS The authors r and omized 200 subjects diagnosed with TMD into three groups : usual conservative , dentist-prescribed self-care treatment without any intraoral splint appliance ( UT ) ; UT plus a conventional flat-plane hard acrylic splint ( HS ) ; and UT plus a soft vinyl ( a low-cost athletic mouth guard ) splint ( SS ) . Subjects completed question naires and clinical examinations at three , six and 12 months . RESULTS The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline ( BL ) or at any follow-up . The changes from BL were comparable for all three groups . The authors did not note any significant differences at any follow-up for compliance with study protocol s or for occurrences of adverse effects from either splint type . For HS versus SS , there were significant differences in rates of splint use , but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings . CONCLUSIONS All patients improved over time , and traditional splint therapy offered no benefit over the SS splint therapy . Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy . CLINICAL IMPLICATION S These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients Objective : To investigate the effectiveness of low‐level laser therapy in the treatment of temporom and ibular disorder and to compare treatment effects in myogenic and arthrogenic cases . Methods : Thirty‐five patients were evaluated by magnetic resonance imaging and r and omly allocated to active treatment ( n=20 ) and placebo treatment ( n=15 ) groups . In addition to a daily exercise program , all patients were treated with fifteen sessions of low‐level laser therapy .  Pain , joint motion , number of joint sounds and tender points were assessed 
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The analogy between quality assessment and the inspection of the 100 wooden planks of a walking bridge is interesting and I agree that the safety of the bridge is only guaranteed by the inspection of all 100 planks .
In our study , we indicated that the different criteria lists focus on different method ological aspects and it is unworkable to assess all these different aspects ( planks ) .
Fortunately , the impact of missing a method ological aspect is much lower than missing a plank .
Indeed , like Paly mentioned , low scores are corresponding with the objective of the lists to uncover problems of the trials .
I agree with Paly that no list can be considered as universally the best , unless it contains 100 % of all the method ological items .