Influência do medo do Covid-19 sobre a efetividade da terapia manual e agulhamento seco (dry needling) em pacientes com disfunção temporomandibular

Abstract

The social isolation measures imposed during the COVID-19 pandemic exacerbated psychological and behavioral disorders. Even with the gradual return to activities, many individuals remained afraid of becoming infected and this perpetuated anxiety states that potentially influenced variables related to temporomandibular disorders (TMD). Non-drug therapies such as myofascial release and dry needling (DN) can decrease temporomandibular joint (TMJ) pain in patients with TMD. Furthermore, it is possible that these techniques beneficially influence psychological outcomes and fear of COVID-19. Thus, with the present study, we aimed to evaluate the effects of manual therapy (MT) and NP on pain, joint mobility, and fear of COVID-19 in patients with TMD. Sixty participants diagnosed with myofascial TMD by the Diagnostic Criteria Tool for Temporomandibular Disorders (DC/TMD) were randomly distributed into three groups: Manual Therapy Group (GTM) and Dry Needling Group (GDN) and Cognitive Behavioral Therapy/Control Group (GCO). Participants responded to the COVID-19 Fear Scale (FCV-19S), the Visual Analogue Scale (VAS) and jaw joint mobility was assessed. Data were collected at three different times: before the intervention (T0); immediately after the last treatment session (T1) and 30 days after the end of each treatment (T2). All participants were treated for four weeks (one 30-minute session per week). The data were submitted to ANOVA Two-way mixed linear model, considering the effect of the group (dry needling x Manual Therapy x Control) and time (baseline, immediately after and 30 days later) and the interaction time*group in the variance observed in the outcomes. A time*group interaction effect was observed for maximum opening, protrusion, and pain/VAS, where the maximum opening measure increased in the DN and MT groups (p=0.005), while the protrusion increased in the DN group (p=0.007; test power=97% and large effect size). A decrease in pain scores (VAS) over time was observed only in the NP and MT groups (p<0.001; test power >99% and large effect size). Furthermore, the total COVID-19 fear score decreased in the DN and MT groups after 30 days compared to the GCO (p=0.033). The results show that both ND and TM treatment provided significant improvements in pain, joint mobility, and fear of COVID-19. It is concluded that the treatment with the TM and DN techniques are effective for improving parameters related to TMD.