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目的:评价认知行为疗法治疗颞下颌关节紊乱病的疗效。方法:计算机检索PubMed(1990～2009)、OV-ID(1960～2009)、EMbase(1974～2009)、Cochrane图书馆临床对照试验资料库(2009年第3期)、中国生物医学文献数据库(CBM,1978～2009),和中国期刊全文数据库(CNKI,1994～2009),收集认知行为疗法治疗颞下颌关节紊乱病的随机对照试验和半随机对照试验。由两名评价者独立评价研究质量和提取数据,对同质研究采用RevMan5.0软件进行Meta分析,对异质性研究不能进行Meta分析者,则进行描述性的定性分析。结果:共检索到相关文献323篇,评价后纳入5个研究,其中3个随机对照试验和2个半随机对照试验。质量评价结果为2个研究被评为B级,3个研究被评为为C级,纳入研究的方法学质量普遍不高。由于纳入研究存在疗程不一,随访期不一,以及对照组干预措施等临床异质性,无法用Meta分析方法合并效应量,只做了描述性的定性分析。分析结果显示CBT对TMD的治疗效果较其对照组并无明显优势,各研究随访结果也有差异,其疗效还无法确定。结论:基于目前的证据无法得出CBT治疗TMD的确切疗效。因此尚需要开展设计严谨,方法学质量更高的临床试验以获得更可靠的证据。
Objective: To evaluate the efficacy of cognitive behavioral therapy in the treatment of temporomandibular disorders. METHODS: We searched PubMed (1990-2009), OV-ID (1960-2009), EMbase (1974-2009), Cochrane Library Clinical Trials Database (2009), Chinese Biomedical Literature Database , 1978-2009), and Chinese Journal Full-text Database (CNKI, 1994-2009) were randomized controlled trials and semi-randomized controlled trials of cognitive behavioral therapy for temporomandibular disorders. Two reviewers independently assessed the quality of the study and extracted the data. Meta-analysis was conducted using RevMan 5.0 software for homogenous studies and descriptive qualitative analysis was conducted for those who were not able to perform meta-analysis for heterogeneity studies. Results: A total of 323 articles were retrieved. Five studies were included in the evaluation, including three randomized controlled trials and two semi-randomized controlled trials. The quality evaluation results were rated as Grade B for two studies, Grade C for three studies and generally poorly studied methodologies. Due to the existence of different treatment courses, different follow-up periods, and clinical heterogeneity in the control group, Meta-analysis was unable to incorporate the effects and only a descriptive qualitative analysis. The results of the analysis showed that the therapeutic effect of CBT on TMD had no obvious advantage over the control group. The follow-up results of each study also differed, and the curative effect was still uncertain. Conclusions: The exact efficacy of CBT in the treatment of TMD can not be drawn on the current evidence. There is therefore still a need to conduct well-designed, methodologically better clinical trials in order to obtain more reliable evidence.