Introduction
Patients and methods
Study design
Subjects
Clinical assessment
Section | Questionnaire | Description | Score range |
---|---|---|---|
Physical activity | International physical activity questionnaire [23] | Self-reported physical activity level | 1–3 |
Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD) [24] | Fear of movement and activity | 18–72 | |
General health | Short Form 36 (SF-36) [25] | Difficulties in various activities | 0–100 |
Composite Autonomic Symptom Score 31 (COMPASS 31) [26] | Autonomic symptoms | 0-100 | |
Short form McGill Pain Questionnaire (MPQ) [27] | Quality and intensity of pain | 0–45 | |
Sleep disturbance and fatigue | Pittsburgh Sleep Quality Index (PSQI) [28] | Quality of sleep | 0–21 |
Epworth Sleepiness Scale (ESS) [29] | Daytime sleepiness | 0–24 | |
Fatigue Assessment Instrument (FAI) [30] | Fatigue and related medical disorders | 1–7 | |
Insomnia Severity Index (ISI) [31] | Severity of insomnia | 0–28 | |
Morningness-eveningness questionnaire (MEQ) [32] | Preference of when to start sleep or wake up | 16–86 | |
Widespread pain | Symptom Severity (SS) scale | Widespread body pain and centralized pain characteristics | 0–12/0–19 |
Widespread Pain Index (WPI) [33] | |||
Fibromyalgia Impact Questionnaire (FIQ) [34] | Pain and functional impact of fibromyalgia | 0-100 | |
Psychologic disturbance | Symptom Checklist-90-Revised (SCL-90-R) [35] | Psychological problems | |
Beck Depression Index (BDI) [36] | Emotional and behavioral depression | 0–63 | |
Beck Anxiety Index (BAI) [37] | Emotional and physical anxiety | 0–63 | |
Pain Catastrophizing Scale (PCS) [38] | Negative thoughts and emotions about pain | 0–52 | |
Central Sensitization Inventory (CSI) [39] | Symptoms related to central sensitization | 0-100 | |
Pennebaker Index of Limbic Languidness (PILL) [40] | Tendency to notice physical symptoms and sensations | 0-216 | |
Perceived Stress Scale (PSS) [41] | Nonspecific perceived stress | 0–40 |
Physical activity assessment
Statistical analysis
Results
Clinical TMD indices
Low (n = 78) | High (n = 22) | P-value | |
---|---|---|---|
Age†† | 29.00 (24.00, 45.25) | 27.00 (24.00, 35.75) | 0.386 |
Sex (Female)‡‡ | 79.49% (62/78) | 86.36% (19/22) | 0.555 |
BMI† | 22.39 (3.31) | 21.94 (3.23) | 0.578 |
BMI ≥ 25‡‡ | 17.95% (14/78) | 13.64% (3/22) | 0.757 |
JFLS-20† | 1.65 (1.33) | 2.83 (1.75) | 0.001* |
OBC† | 17.17 (10.47) | 21.55 (9.91) | 0.099 |
OBC > 20‡ | 32.47% (25/77) | 54.55% (12/22) | 0.080 |
CMO (mm)† | 40.01 (9.88) | 37.55 (11.47) | 0.296 |
MMO (mm)† | 43.08 (8.92) | 43.32 (10.15) | 0.956 |
Masticatory muscle palpation (number of positive sites)†† | 1.00 (0.00, 5.50) | 1 (0.00, 9.75) | 0.262 |
Cervical muscle palpation (number of positive sites)†† | 0.00 (0.00, 1.00) | 0.00 (0.00, 0.00) | 0.583 |
Capsule palpation (number of positive sites)†† | 0.00 (0.00, 1.00) | 0 (0.00, 2.00) | 0.214 |
Pain on mouth opening‡ | 46.15% (36/78) | 68.18% (15/22) | 0.091 |
Pain on lateral movement‡ | 34.62% (27/78) | 40.91% (9/22) | 0.620 |
Pain on protrusive movement‡ | 25.64% (20/78) | 27.27% (6/22) | 1.000 |
Tooth attrition‡‡ | 16.88% (13/77) | 28.57% (6/21) | 0.230 |
Tongue ridging‡ | 43.42% (33/76) | 57.14% (12/21) | 0.326 |
Mucosal ridging‡ | 59.21% (45/76) | 80.95% (17/21) | 0.077 |
MPQ | |||
Total†† | 5.00 (2.00, 8.00) | 7.00 (4.25, 10.75) | 0.154 |
Average† | 0.34 (0.25) | 0.43 (0.19) | 0.126 |
Now†† | 1.00 (1.00, 2.00) | 2.00 (2.00, 2.00) | 0.010* |
Initial NRS† | 3.78 (2.27) | 5.05 (1.80) | 0.021* |
DJD‡‡ | 85.90% (67/78) | 81.82% (18/22) | 0.736 |
Physical activity and sleep indices
Low (n = 78) | High (n = 22) | P-value | |
---|---|---|---|
IPAQ | |||
Categorical‡ | 24.36% (19/78) | 23.81% (5/21) | 1.000 |
Continuous†† | 2006.25 (717.75, 4129.50) | 2112.00 (717.75, 5482.50) | 0.635 |
Average kcals per day† | 1226.12 (471.73) | 1173.86 (508.32) | 0.656 |
METs† | 2.15 (0.22) | 2.11 (0.24) | 0.422 |
Physical activity per week (min) | |||
Light† | 3790.28 (726.11) | 3462.86 (965.89) | 0.090 |
Moderate† | 1185.19 (556.88) | 1203.86 (571.11) | 0.033* |
Vigorous†† | 3.00 (1.00, 9.00) | 7.00 (3.00, 11.00) | 0.039* |
Total MVPA† | 1195.62 (561.02) | 1219.27 (587.09) | 0.035* |
Time in sedentary bouts per day† | 313.20 (87.95) | 324.19 (69.76) | 0.594 |
Time in sedentary breaks per day† | 1036.40 (103.12) | 1030.42 (77.53) | 0.803 |
Sedentary bouts per day† | 14.64 (4.06) | 15.23 (3.90) | 0.553 |
Sedentary bouts average length† | 21.44 (1.88) | 21.80 (2.73) | 0.582 |
Sedentary breaks average length†† | 74.10 (60.75, 84.70) | 66.15 (56.80, 75.53) | 0.241 |
Axis 1 CPM† | 864.64 (272.28) | 847.50 (265.39) | 0.796 |
Axis 2 CPM† | 888.85 (260.35) | 896.08 (257.81) | 0.860 |
Axis 3 CPM† | 981.29 (319.55) | 988.28 (308.45) | 0.928 |
Vector magnitude | |||
Average counts† | 1619.22 (470.77) | 1629.19 (482.40) | 0.931 |
CPM† | 1581.05 (487.66) | 1582.45 (475.18) | 0.991 |
Step counts per day† | 10383.96 (3080.31) | 10225.73 (3578.22) | 0.840 |
Lux average counts†† | 25.30 (7.18, 55.40) | 16.55 (4.65, 50.05) | 0.446 |
Minutes in bed†† | 449.81 (417.89, 513.33) | 480.92 (424.01, 529.54) | 0.318 |
Minutes in bed < 420‡ | 26.92% (21/78) | 22.73% (5/22) | 0.695 |
Total Sleep Time (TST)†† | 391.86 (362.96, 463.44) | 424.74 (388.32, 458.64) | 0.191 |
Total Sleep Time (TST) < 420‡ | 60.26% (47/78) | 50.00% (11/22) | 0.466 |
Wake After Sleep Onset (WASO)†† | 52.46 (42.32, 66.48) | 48.67 (41.13, 59.33) | 0.621 |
Sleep efficiency†† | 88.41 (85.57, 90.86) | 90.22 (87.85, 91.11) | 0.190 |
Sleep fragmentation index† | 25.13 (7.20) | 23.00 (4.81) | 0.198 |
Movement index† | 13.04 (3.21) | 11.96 (2.66) | 0.156 |
Fragmentation index† | 12.09 (4.88) | 11.03 (3.56) | 0.352 |
Comorbidity levels
Low (n = 78) | High (n = 22) | P-value | |
---|---|---|---|
ESS† | 6.77 (4.49) | 6.23 (3.38) | 0.544 |
ESS > 10‡‡ | 18.18% (14/77) | 13.64% (3/22) | 0.756 |
PSQI† | 7.90 (3.41) | 7.91 (2.73) | 0.987 |
PSQI ≥ 5‡ | 85.71% (66/77) | 90.91% (20/22) | 0.727 |
FAI† | 4.14 (1.01) | 4.43 (0.71) | 0.207 |
FIQ† | 29.39 (19.54) | 31.78 (16.26) | 0.605 |
FM diagnosis‡‡ | 1.30% (1/77) | 13.64% (3/22) | 0.033* |
WPI†† | 3.00 (2.00, 6.00) | 4.00 (2.00, 5.00) | 0.809 |
SS† | 4.71 (2.24) | 5.05 (2.25) | 0.546 |
COMPASS 31 | |||
Orthostatic intolerance†† | 20.00 (8.00, 28.00) | 22.00 (8.00, 28.00) | 0.920 |
Vasomotor†† | 1.67 (1.67, 1.67) | 1.67 (1.67, 1.67) | 0.871 |
Secretomotor† | 18.34 (3.19) | 19.29 (2.69) | 0.208 |
Gastrointestinal†† | 15.18 (10.71, 16.96) | 12.95 (9.15, 16.74) | 0.247 |
Bladder†† | 3.33 (3.33, 4.44) | 3.33 (3.33, 3.33) | 0.296 |
Pupillomotor†† | 2.67 (1.00, 3.33) | 1.00 (1.00, 3.25) | 0.210 |
Total† | 60.85 (15.26) | 59.58 (12.11) | 0.723 |
CSI† | 30.38 (17.59) | 31.68 (15.43) | 0.756 |
CSI ≥ 30‡ | 41.56% (38/77) | 50% (11/22) | 1.000 |
BDI† | 8.45 (8.14) | 9.41 (7.01) | 0.622 |
BDI ≥ 30‡ | 1.30% (1/77) | 0.00% (0/22) | 1.000 |
BAI†† | 4.00 (2.00, 11.00) | 5.00 (2.00, 10.25) | 0.847 |
BAI ≥ 26‡‡ | 3.90% (3/77) | 4.55% (1/22) | 1.000 |
GAD-7† | 4.03 (4.89) | 4.09 (3.30) | 0.982 |
PILL† | 52.71 (31.98) | 57.36 (31.87) | 0.553 |
PILL > 84‡‡ | 18.18% (14/77) | 13.64% (3/22) | 0.756 |
PSS† | 16.10 (7.37) | 14.68 (7.05) | 0.427 |
PSS > 13‡ | 62.34% (48/77) | 50% (11/22) | 0.332 |
TSK-TMD† | 26.76 (6.71) | 29.59 (5.01) | 0.082 |
TSK-TMD ≥ 23‡‡ | 78.21% (61/78) | 86.36% (19/22) | 0.551 |
SF-36 | |||
Physical functioning†† | 95.00 (80.00, 100.00) | 95.00 (76.25, 100.00) | 0.973 |
Role physical†† | 100.00 (50.00, 100.00) | 75 (31.25, 100.00) | 0.080 |
Role emotional†† | 100.00 (66.67, 100.00) | 66.67 (41.67, 100.00) | 0.073 |
Energy/fatigue† | 49.68 (20.39) | 46.82 (19.75) | 0.565 |
Emotional well-being† | 67.90 (20.02) | 66.55 (14.46) | 0.924 |
Social functioning†† | 87.50 (67.50, 100.00) | 87.50 (69.38, 90.00) | 0.646 |
Pain† | 64.51 (21.98) | 56.59 (19.81) | 0.196 |
General health† | 53.44 (22.71) | 54.09 (16.56) | 0.804 |
PHQ-9† | 4.41 (4.95) | 5.50 (4.24) | 0.354 |
PHQ-9 ≥ 20‡‡ | 1.28% (1/78) | 0.00% (0/22) | 1.000 |
PHQ-15† | 5.76 (4.61) | 6.45 (3.96) | 0.524 |
PHQ-15 ≥ 15‡‡ | 6.41% (5/78) | 4.55% (1/22) | 1.000 |
Headache‡ | 41.56% (32/77) | 63.64% (14/22) | 0.408 |
Hematologic indices
Low (n = 77) | High (n = 22) | P-value | |
---|---|---|---|
WBC† | 5.83 (1.42) | 6.02 (1.39) | 0.584 |
WBC group (≥ 10)‡‡ | 1.30% (1/77) | 0.00% (0/22) | 1.000 |
RBC† | 4.51 (0.37) | 4.43 (0.34) | 0.355 |
RBC group (≥ 5.40)‡‡ | 6.49% (5/77) | 9.09% (2/22) | 0.650 |
Hgb†† | 13.70 (12.80, 14.30) | 13.60 (12.65, 14.05) | 0.426 |
Hgb group (< 12)‡‡ | 2.60% (2/77) | 4.55% (1/22) | 0.534 |
Hct† | 40.71 (3.11) | 39.96 (2.74) | 0.315 |
Hct group (≤ 36)‡‡ | 3.90% (3/77) | 9.09% (2/22) | 0.307 |
Platelet† | 262.90 (47.60) | 269.32 (51.68) | 0.589 |
PLR†† | 82.87 (30.38) | 86.88 (32.68) | 0.749 |
PLR group (≥ 142.76 (F), ≥ 122.73 (M))‡‡ | 3.90% (3/77) | 4.55% (1/22) | 1.000 |
NLR†† | 1.13 (0.76) | 1.25 (0.83) | 0.614 |
NLR group (≥ 1.662 (F), ≥ 1.634 (M))‡‡ | 15.58% (12/77) | 27.27% (6/22) | 0.222 |
dNLR† | 1.40 (0.53) | 1.47 (0.62) | 0.601 |
LMR†† | 5.10 (3.93, 6.26) | 4.83 (3.84, 5.68) | 0.711 |
LMR group (≤ 5.598 (F), ≤ 5.048 (M))‡ | 33.77% (26/77) | 31.82% (7/22) | 1.000 |
SII†† | 249.58 (171.78, 356.45) | 255.39 (181.97, 399.05) | 0.668 |
ESR (mm/h)†† | 5.00 (2.00, 10.00) | 9.00 (4.25, 14.75) | 0.440 |
CRP (mg/L)†† | 0.04 (0.02, 0.08) | 0.05 (0.04, 0.08) | 0.354 |
RF‡‡ | 1.30% (1/76) | 4.50% (1/22) | 0.400 |
FANA‡ | 29.90% (23/77) | 18.20% (4/22) | 0.416 |
Anti-CCP‡‡ | 3.90% (3/77) | 0.00% (0/22) | 1.000 |
Total protein (g/dL)†† | 7.40 (7.1, 7.7) | 7.30 (7.0, 7.58) | 0.660 |
Physical activity indices indicating high disability TMD
Variable | Standardized β | Standard error | 95% CI | P-value |
---|---|---|---|---|
Time of light physical activity | −0.001 | 0.000 | 0.999-1.000 | 0.026* |
Age | −0.035 | 0.021 | 0.926–1.007 | 0.100 |
Mucosal ridging | −1.608 | 0.664 | 0.055–0.735 | 0.015* |
GAD-7 | −0.197 | 0.103 | 0.671–1.005 | 0.056 |
PHQ-9 | 0.196 | 0.094 | 1.011–1.463 | 0.038* |
Pain on mouth opening | 1.248 | 0.603 | 1.069–11.357 | 0.038* |
Constant | 2.227 | 1.543 | - | 0.149 |
Amount of physical activity predictive of high disability TMD
AUC (95% CI) | Cut off value | Sensitivity | Specificity | PPV | NPV | LR+ | LR- | Error rate (%) | P value | |
---|---|---|---|---|---|---|---|---|---|---|
Average kcals per day | 0.467 (0.318–0.617) | 1511.446 | 0.364 | 0.782 | 0.320 | 0.813 | 1.670 | 0.813 | 31.00 | 0.641 |
METs | 0.453 (0.315–0.592) | 2.441 | 0.136 | 0.718 | 0.120 | 0.747 | 0.482 | 1.203 | 41.00 | 0.506 |
Step counts | 0.508 (0.370–0.646) | 6.900 | 0.727 | 0.397 | 0.640 | 0.920 | 1.206 | 0.688 | 15.00 | 0.907 |
Light PA | 0.636 (0.442–0.708) | 3770.000 | 0.636 | 0.551 | 0.560 | 0.893 | 1.416 | 0.661 | 31.00 | 0.281 |
Moderate PA | 0.516 (0.375–0.656) | 1409.000 | 0.409 | 0.744 | 0.360 | 0.827 | 1.598 | 0.794 | 29.00 | 0.822 |
Vigorous PA | 0.643 (0.526–0.761) | 2.500 | 0.864 | 0.487 | 0.760 | 0.960 | 1.684 | 0.279 | 9.00 | 0.041* |
MVPA | 0.520 (0.379–0.661) | 1447.500 | 0.409 | 0.756 | 0.360 | 0.827 | 1.676 | 0.782 | 29.00 | 0.774 |