Manual therapy and dry needling improve mobility, pain and reduce fear of COVID-19 in temporomandibular disorder patients: Randomized controlled trial

Background and Purpose The COVID-19 pandemic exacerbated pain and joint mobility outcomes in patients with temporomandibular disorders (TMD), being that effective treatments are of clinical interest. We aimed to evaluate the effects of manual therapy (MT) and dry needling (DN), compared to cognitive-behavioral therapy/control (CO), on pain, articular mobility, and fear of COVID-19 in patients with TMD. Materials and methods Sixty participants with myofascial TMD were randomly assigned to three groups: MT, DN, and CO. Participants received four weeks of treatment (30 minutes per week). The participants completed the Fear of COVID- 19 Scale, the Visual Analog Scale, and mandibular mobility was assessed. Data were collected before the intervention (T1), after the last treatment session (T2), and 30 days after the end of treatment (T3). The data were analyzed using two-way Mixed-Design ANOVA, considering the group effect (DN x MT x CO), time (T1, T2, and T3), and the interaction time*group in the observed variance of outcomes. Results We observed an interaction effect of time*group for maximum mouth opening, protrusion, and pain. The maximum mouth opening increased in the DN and MT groups (p=0.005), while protrusion increased in the DN group (p=0.007; test power=97%, large effect size). A decrease in pain scores over time was observed in the DN and MT groups (p<0.001; test power>99%, large effect size). The fear of COVID-19 score decreased in the DN and MT groups after 30 days (p=0.033). Conclusion DN and MT improve pain, joint mobility, and fear of COVID-19 in patients with TMD.