Interobserver variability in assessment of signs of TMD

Purpose: The aim of this report was to study the ability of examiners to me asure reliably the clinical signs of temporomandibular disorders (TMD). Fou r examiners participated in this study of 11 TMD patients and 25 nonpatient s. Materials and Methods: Vertical and lateral excursions of the jaw were m easured using a millimeter ruler. Joint sounds during vertical jaw movement s were assessed using digital palpation. The reliability of delivering appr opriate degrees of digital pressure to assess masticatory muscle pain was a ssessed using a manometer after training examiners to exert specified press ures. Results: Intraclass correlation coefficients for the measurement of v ertical and protrusive jaw movements were greater than or equal to 0.87, wh ich was considered excellent. The intraclass correlation coefficient for me asurements of left and right lateral jaw excursions varied between 0.73 and 0.85, which was considered acceptable. The interobserver agreement for det ecting the joint sounds showed overall agreement across examiners of 78%. K appa for every possible pair of examiners varied between .52 and .86 (media n .75, interquartile range .18). Reliability for diagnostic categories from the Helkimo index and Research Diagnostic Criteria for Temporomandibular D isorders involving joint noises showed modest reliability. Conclusion: Poin t estimates and measures of spread for reliability measures of single clini cal TMD signs as well as combinations of signs into diagnostic categories f rom the Helkimo index and Research Diagnostic Criteria for Temporomandibula r Disorders involving joint noises were sufficient in a group of four exami ners.