***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 outcome of different treatment modalities after 7 years was investigated in a selected group of 50 patients with craniom and ibular disorders of muscular origin . To minimize the possible effects of selection on the clinical material , the selected treatment group was compared to a consecutive group of patients in terms of age , gender , intensity/ duration of pain , and socioeconomic profile . Both groups were comparable in most respects , but the selected group had a longer duration and a higher intensity of pain at baseline . There were more men in the consecutive group than in the selected group . A combined treatment approach result ed in a better outcome than single treatments . Sixty-five percent of all patients in the selected group reported improvement at the 7-year follow-up . All of the 19 patients who received counseling combined with different occlusal treatments improved . Forty-three percent of the patients treated otherwise showed improvement . Patients who were aware of stress responded better to treatment 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 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 & NA ; This paper reports the development of a scale for assessing the quality of reports of r and omised controlled trials for psychological treatments .  The Delphi method was used in which a panel of 15–12 experts generated statements relating to treatment and design components of trials . After three rounds , statements with high consensus agreement were review ed by a second expert panel and rewritten as a scale . Evidence to support the reliability and validity of the scale is reported . Three expert and five novice raters assessed sets of 31 and 25 published trials to establish scale reliability ( ICC ranges from 0.91 to 0.41 for experts and novices , respectively ) and item reliability ( Kappa and inter‐rater agreement ) . The total scale score discriminated between trials globally judged as good and poor by experts , and trial quality was shown to be a function of year of publication . Uses for the scale are suggested In a r and omized trial the effects of occlusal appliance and relaxation therapy , each combined with brief information , were compared with brief information only , in adolescents with temporom and ibular disorder ( TMD ) pain . One-hundred- and -twenty-two adolescents ( 93 F and 29 M aged 12 - 18 years ) were r and omly assigned to one of the following 3 groups : brief information + occlusal appliance ( BI + OA ) , brief information + relaxation therapy ( BI + RT ) , or brief information ( BI ) . Included were subjects reporting pain once a week or more often , in addition to receiving a diagnosis of TMD according to the Research Diagnostic Criteria ( RDC/TMD ) . They were evaluated before and after treatment and at a 6-month follow-up by means of self-reports and clinical assessment . The result revealed a significantly higher reduction in frequency of pain , in pain intensity ( visual analog scale [ VAS ] ) , and in a composite pain index ( intensity x frequency ) for patients treated with BI + OA compared with those treated with BI alone . In the BI + OA group , 60 % of the patients attained a clinical ly significant improvement ( at least 50 % or more ) on the pain index , a significantly higher proportion compared to that obtained in the other 2 treatment groups . Analgesic consumption was also significantly more reduced in the BI + OA group compared to the BI group . However , no significant differences were found between the treatment groups in jaw opening or in muscle and TMJ tenderness scores . Occlusal appliance was found to be superior to both relaxation therapy and brief information regarding pain reduction and can therefore be recommended when treating adolescents with TMD pain & NA ; The course of pain associated with temporom and ibular disorders ( TMD ) and other chronic pain conditions is typically episodic . Its expression may influence when a person seeks treatment , for example , when the level of pain flares up or exceeds its characteristic severity . Improvement in pain status subsequent to entering treatment may be due to : ( 1 ) specific effects of treatment ; ( 2 ) non‐specific effects of treatment ( ‘ placebo effects ’ ) ; or ( 3 ) regression to the mean . Due to regression to the mean , uncontrolled evaluation of treatment in persons self‐selected by a pain flare‐up may lead to erroneous conclusions concerning effects of treatment by patients , providers , and /or research ers . For this report , the magnitude of regression to the mean due to self‐ selection for treatment is estimated by comparing subjects who sought treatment for TMD pain ( n = 147 ) to a r and om sample of subjects with TMD pain not seeking treatment ( n = 95 . Among subjects seeking treatment , a significant 14.7‐point reduction in VAS pain intensity was observed at 1‐year follow‐up . A control group of TMD subjects not seeking treatment  showed no mean reduction in pain intensity but reported lower pain intensity at baseline than the group seeking care . When both groups of subjects were stratified on baseline VAS pain values , the reduction in pain increased as the baseline pain level increased , but no differences between comparable treated and untreated cases in the extent of improvement were observed . The before‐after differences in both groups may be attributed to regression to the mean . We conclude that before‐after differences in pain intensity can be large and that such improvement may be largely due to regression to the mean . This suggests the need for research which differentiates change due to regression to the mean ( due to homeostatic processes , r and om within‐subject variation , or measurement error ) from change due to specific and non‐specific effects of treatment . In clinical practice , the personal experience of patients and clinicians who observe improvement after initiation of treatment should be regarded as an unreliable guide to treatment efficacy due to regression to the mean . This phenomenon may contribute to the proliferation and continued use of treatments of unproven efficacy for pain management and suggests caution in the use of costly or risky pain treatments the efficacy of which is unknown AIMS To test the usefulness of tailoring cognitive-behavioral therapy ( CBT ) for patients with temporom and ibular disorders ( TMD ) who demonstrated poor psychosocial adaptation to their TMD condition , independent of physical diagnosis . METHODS A r and omized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists . For study inclusion , Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) , Axis II criteria , were used to target patients with elevated levels of TMD pain-related interference with daily activities , independent of physical diagnosis ( i.e. , Axis I ) . RESULTS At the post-treatment assessment , about 4 months after the baseline evaluations , the comprehensive care group , when compared to the usual treatment group , showed significantly lower levels of characteristic pain intensity , significantly higher self-reported ability to control their TMD pain , and a strong trend ( P = .07 ) toward lower pain-related interference in daily activities . From post-intervention to 1-year follow-up , all subjects showed improvement . At the 1-year follow-up , the comprehensive care group , while not losing any of its early gains , was not significantly different from the usual care group with regard to reported levels of pain , ability to control pain , and levels of interference in activities . For many of these psychosocially disabled TMD patients , pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate r and omized clinical trial on the basis of better psychosocial adaptation . CONCLUSION The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment , but was too brief an intervention to result in further improvement after the sessions ended . Patient ratings of treatment satisfaction and helfulness were high for both groups , but they were significantly higher for the comprehensive care group OBJECTIVE The purpose of this study was to identify the appropriate treatment element for initial anterior disc displacement without reduction subjects . STUDY DESIGN Sixty-nine consecutive patients with temporom and ibular joint disc displacement without reduction confirmed on magnetic resonance images were r and omly divided into 3 experimental treatment groups . The treatment of group 1 consisted of short-term nonsteroidal anti-inflammatory drugs and self-care instructions ( palliative care group ) ; group 2 , nonsteroidal anti-inflammatory drugs , self-care instructions , and occlusal appliance and mobilization therapy ( physical medicine group ) ; and group 3 , no treatment ( control group ) . Outcomes were assessed by means of a 5-item question naire that evaluated ( 1 ) symptom improvement , ( 2 ) difficulty of treatment , and ( 3 ) satisfaction with treatment during the 8-week observation period . RESULTS Improvement scores in the palliative care group were significantly better than those in the physical medicine group or the no-treatment group . Satisfaction scores showed no significant difference among the 3 groups . Difficulty from treatment for the physical medicine group was significantly greater than that for other 2 groups . CONCLUSION These data suggest that palliative care would be more appropriate as the initial therapy to treat painful anterior disc displacement without reduction AIMS To compare the short-term efficacy of patient education only versus the combination of patient education and home exercises for the treatment of myofascial pain of the jaw muscles . MATERIAL S AND METHODS Seventy myogenous temporom and ibular disorder patients were assigned to 2 treatment groups . One group received patient education supplemented by general information about self-care of the jaw musculature . The other group received both education and a home physical therapy program . Treatment contrast , calculated from the mean normalized relative changes in anamnestic and clinical scores , was used to determine treatment success . Clinical outcome measures included pressure pain threshold ( PPT ) of the masseter , anterior temporalis , and Achilles tendon ; pain-free maximal jaw opening ; and pain on chewing , spontaneous muscle pain , and headache as rated on visual analog scales . RESULTS After 3 months the success rate was 57 % for the group that received education only and 77 % for the group that received both education and home physical therapy ( P = .157 ) . The patients were then redivided into 2 groups : successfully treated patients and unsuccessfully treated patients . In the unsuccessfully treated group , pain-free maximal jaw opening increased significantly more among those who had been in the education and physical therapy group than among those who had been in the education-only group ( P = .019 ) . The change in PPT was significantly greater in successfully treated patients than in unsuccessfully treated patients ( .009 < P < .039 ) , independent of the treatment modality , with higher PPTs among successful patients . There were no significant differences between the successfully and unsuccessfully treated groups or between treatment modalities for any other variable . CONCLUSION Over a period of 3 months , the combination of education and a home physical therapy regimen , as used in this protocol , is slightly more clinical ly effective than education alone for the treatment of myofascial pain of the jaw muscles Forty-eight dysfunctional patients ( i.e. , high levels of pain , interference , and affective distress and low levels of perceived control ) with temporom and ibular disorders ( TMDs ) were r and omly assigned either to a treatment consisting of an intraoral appliance ( IA ) and stress management with biofeedback ( SM ) plus nondirective , supportive counseling ( SC ) -- IA + SM + SC -- or to a customized treatment that included cognitive therapy ( CT ) with the IA and SM -- IA + SM + CT . Both treatment groups reported statistically significant reductions on a set of physical , psychosocial , and behavioral measures posttreatment and at a 6-month follow-up . However , the intervention that included CT demonstrated significantly greater reductions in pain , depression , and medication use . Only 
    Output:
    
1 ) In the disc displacement group with pain , multimodal therapy was not superior to explanation and advice .
There was no superiority of multimodal therapy  including splints as compared with simple care .
A slightly better outcome was reported for a combination of education and home physical therapy regimen than for patient education alone . (
3 ) In temporom and ibular pain patients with major psychological disturbances , patients benefited more from a combined therapeutic approach compared with simple care .
Current research suggests that individuals without major psychological symptoms do not require more than simple therapy .
In contrast , patients with major psychological involvement need multimodal , interdisciplinary therapeutic strategies .