An Implementation and Biobehavioral Study of TMJMD

TMJMD 的实施和生物行为研究

基本信息

批准号：
7662332
负责人：
ROBERT Joseph GATCHEL
金额：
$ 82.99万
依托单位：
UNIVERSITY OF TEXAS ARLINGTON
依托单位国家：
美国
项目类别：
财政年份：
1994
资助国家：
美国
起止时间：
1994-06-01 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7662332
关键词：
Academy Acute Address Adrenal Glands Adult Aftercare Algorithms American Attention Behavior Behavior Therapy Behavioral Sciences Biological Chronic Chronic Disease Clinic Clinical Clinical Research Clinical Trials Collaborations Communities Complex Control Groups Cost Savings Costs and Benefits Data Dental Dental Care Dental Clinics Dental General Practice Dentistry Development Diabetes Mellitus Diagnosis Dimensions Direct Costs Disease Early Diagnosis Early treatment Educational workshop Effectiveness Environment Equation Evaluation Evidence based program Evidence based treatment Evolution Facilities and Administrative Costs Funding Future General Population Goals Grant Health Care Costs Health Personnel Human Hydrocortisone Hypothalamic structure Individual Differences Intervention Lead Literature Managed Care Mastication Measures Medical Mental Health Methodology Modeling Myopathy Nature Obesity Orofacial Pain Outcome Outcome Study Pain Pathway interactions Patients Pattern Performance Pituitary Gland Population Prevalence Private Practice Process Public Health Randomized Randomized Controlled Trials Recruitment Activity Relative (related person)Reporting Research Research Personnel Risk Risk Factors Sampling Science Scientific Advances and Accomplishments Screening procedure Seminal Series Source Specific qualifier value Staging Surveys Symptoms System Technology Temporomandibular Joint Therapeutic Translating Treatment Cost Treatment Efficacy Treatment Protocols Unemployment United States Visit Woman base biobehavior biopsychosocial brain behavior chronic pain cohort college community setting cost cost effectiveness disability economic cost experience follow-up group intervention high risk hypothalamic-pituitary-adrenal axis intervention program men new technology post intervention prevent psychologic psychosocial response social treatment program trend

项目摘要

DESCRIPTION (provided by applicant): With the great economic costs and traditionally poor outcomes among chronic temporomandibular joint and muscle disorder (TMJMD) patients, it has become important to treat patients in the acute state, in order to prevent these more chronic disability problems. This has been the goal of two past funded grant projects. Results of the initial project isolated risk factors that successfully predicted the development of chronicity, with a 91% accuracy rate. A statistical algorithm was developed which was used in the second project to screen out "high-risk" patients. These patients were then randomly assigned an early intervention or non-intervention group. One-year follow-up evaluations documented the treatment efficacy and cost effectiveness of early intervention. These results have major implications for effective early intervention and significant health-care cost savings for this prevalent pain and disability problem. For the present proposed project, we plan to implement this treatment program in order to evaluate its effectiveness in more community-based dental practices. This is in response to NIH's request for the implementation of evidence-based treatment approaches, developed in controlled clinical settings, to the "real world" of diverse practices in the community. Acute TMJMD patients will be recruited from two community clinics. Based upon our "risk" screening algorithm, high-risk patients will be randomly assigned to one of two groups (n=225/group): an early biobehavioral intervention or an attention-control group. It is hypothesized that the attention control "high-risk" patients will display more chronic TMJMD problems, relative to the "high-risk" early intervention patients, at one-year follow-up. Another aim of the project is to evaluate the potential utility of new technologies that will lead to even greater precision in detecting individual differences among TMJMD patients. Measures evaluated include chewing performance, cortisol levels, and other biopsychosocial outcomes. This represents the next step in comprehensively understanding brain-behavior patterns in TMJMD. Also, structural equation modeling methodology will be used. Such a multi-level, multi-systems approach has not been applied to better understand the biopsychosocial underpinnings of TMJMD. Results from this component of the project will greatly aid in stimulating future research leading to the better understanding of TMJMD, as well as better tailoring of prescribed treatment regimens. Project Narrative: Temporomandibular joint and muscle disorder (TMJMD) is a highly prevalent and costly public health problem in the United States, especially when it becomes chronic in nature. This study will further evaluate the treatment- and cost-effectiveness of an early biobehavioral intervention program for preventing chronic TMJMD. Moreover, this evidence-based program will be implemented in actual community-based dental practices to make it more accessible to the general population.

描述（由申请人提供）：由于慢性颞下颌关节和肌肉疾病（TMJMD）患者的巨大经济成本和传统上较差的结果，在急性状态下治疗患者已变得非常重要，以预防这些更慢性的残疾问题。这是过去两个资助项目的目标。最初项目的结果隔离了风险因素，成功预测了慢性病的发展，准确率高达 91%。开发了一种统计算法，用于第二个项目来筛选“高风险”患者。然后将这些患者随机分配到早期干预组或非干预组。一年的随访评估记录了早期干预的治疗效果和成本效益。这些结果对于有效的早期干预和针对这种普遍的疼痛和残疾问题节省大量医疗费用具有重大意义。对于目前提出的项目，我们计划实施该治疗计划，以评估其在更多社区牙科诊所中的有效性。这是为了响应 NIH 的要求，即实施在受控临床环境中开发的循证治疗方法，以适应社区中不同实践的“现实世界”。将从两个社区诊所招募急性 TMJMD 患者。根据我们的“风险”筛查算法，高风险患者将被随机分配到两组中的一组（n=225/组）：早期生物行为干预组或注意力对照组。据推测，在一年的随访中，相对于“高风险”早期干预患者，注意力控制的“高风险”患者将表现出更多的慢性 TMJMD 问题。该项目的另一个目标是评估新技术的潜在效用，这些新技术将提高检测 TMJMD 患者个体差异的精度。评估的指标包括咀嚼能力、皮质醇水平和其他生物心理社会结果。这代表着全面理解 TMJMD 大脑行为模式的下一步。此外，还将使用结构方程建模方法。这种多层次、多系统的方法尚未应用于更好地理解 TMJMD 的生物心理社会基础。该项目这一部分的结果将极大地有助于促进未来的研究，从而更好地了解 TMJMD，并更好地定制处方治疗方案。项目叙述：颞下颌关节和肌肉疾病 (TMJMD) 在美国是一个非常普遍且代价高昂的公共卫生问题，尤其是当它变成慢性病时。这项研究将进一步评估预防慢性 TMJMD 的早期生物行为干预计划的治疗和成本效益。此外，这一基于证据的计划将在实际的社区牙科诊所中实施，以使其更容易为普通大众所接受。