Using the brief DC/TMD in a multidisciplinary orofacial pain care setting: a validation study

Abstract

Abstract: Background: The DC/TMD is the comprehensive reference standard for TMD diagnoses. Its utilization in clinical settings remains infrequent due to the time and training required for full administration. A shorter diagnostic instrument designed for non-specialist clinicians could help facilitate proper initial management. To address this need, the brief DC/TMD was developed to diagnose the most common TMDs. Objectives: To perform a validation assessment the brief DC/TMD Axis I against a clinical reference diagnosis and identify areas for further research. Methods: Data was collected retrospectively from an open label clinical cohort trial at the University of Minnesota. Participants were ages 18-66, diagnosed with TMD by a board certified orofacial pain specialist, and referred for physical therapy care. Data from subjective and objective examination results were abstracted from clinical notes by a third party evaluator and used in the brief DC/TMD algorithm to determine diagnoses for comparison with the clinical diagnoses initially derived by the orofacial pain specialist. Diagnoses formulated using the different methods were analyzed for raw percent agreement, Cohen’s kappa, bias and prevalence adjusted kappa (PABAK), specificity, sensitivity, predictive value, and likelihood ratios. Results: 181 participants were assessed. Diagnostic agreement between methods was high with PABAK values ranging from 77-98%. Validity measures were generally high with specificity between 88-98% for all six diagnoses and sensitivity ranging from 80-99% for five of the six diagnoses. Conclusion: The brief DC/TMD is sufficiently reliable and valid for use with patients with common TMDs. Additional studies are important to examine its robustness across diverse populations and with diverse groups of clinicians in non-specialist settings.