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：
7912322
负责人：
ROBERT Joseph GATCHEL
金额：
$ 8.75万
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 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7912322
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）：慢性颞下颌关节和肌肉障碍（TMJMD）患者的经济成本巨大，传统上的结果较差，以防止这些更慢性的残疾问题，以治疗急性状态的患者变得很重要。这是两个过去的资助赠款项目的目标。初始项目的结果隔离风险因素，成功地预测了慢性的发展，精度为91％。开发了一种统计算法，该算法在第二个项目中用于筛选“高风险”患者。然后将这些患者随机分配为早期干预或非干预组。一年的随访评估记录了早期干预的治疗功效和成本效益。这些结果对有效的早期干预和大量医疗保健成本具有重大影响，以节省这种普遍的疼痛和残疾问题。对于本提议的项目，我们计划实施该治疗计划，以评估其在更基于社区的牙科实践中的有效性。这是对NIH的要求，要求在受控临床环境中开发的基于证据的治疗方法，以对社区中各种实践的“现实世界”开发。急性TMJMD患者将从两个社区诊所招募。根据我们的“风险”筛查算法，高危患者将被随机分配给两组之一（n = 225/组）：早期生物行为干预或注意力控制组。假设在一年的随访中，相对于“高风险”早期干预患者，注意力控制“高危”患者将显示出更多的慢性TMJMD问题。该项目的另一个目的是评估新技术的潜在效用，这将在检测TMJMD患者中的个体差异方面提高精度。评估的措施包括咀嚼性能，皮质醇水平和其他生物心理社会结果。这代表了TMJMD中全面理解脑行为模式的下一步。此外，还将使用结构方程建模方法。这种多层次的多系统方法尚未应用于更好地了解TMJMD的生物心理社会基础。该项目的这一组成部分的结果将极大地有助于刺激未来的研究，从而更好地理解TMJMD，并更好地对处方治疗方案进行更好的调整。项目叙述：颞下颌关节和肌肉障碍（TMJMD）在美国是一个高度普遍且昂贵的公共卫生问题，尤其是当它变得长期存在时。这项研究将进一步评估早期生物行为干预计划的治疗和成本效益，以防止慢性TMJMD。此外，该基于循证的计划将在实际的基于社区的牙科实践中实施，以使其更容易被普通人群使用。