Interprofessional Collaboration in Dentistry: Role of physiotherapists to improve care and outcomes for chronic pain conditions and sleep disorders

Multidisciplinary providers' perceptions of care delivery for sleep disorders: A qualitative case study

OBJECTIVES

Sleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders.

METHODS

A qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care.

RESULTS

We interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers.

CONCLUSIONS

A range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.

Effectiveness of exercise therapy on pain relief and jaw mobility in patients with pain-related temporomandibular disorders: a systematic review

Background

Orofacial pain conditions are complex disorders that involve biological, social, and psychological factors. Temporomandibular Disorders (TMDs) are one of the most common orofacial pain conditions, and our previous literature review indicated that exercise therapy has shown promise in reducing TMD-related pain. However, more evidence is needed to firmly establish its effectiveness.

Objectives

This systematic review aims to investigate the effectiveness of exercise therapy on pain relief and jaw mobility in patients with pain-related TMDs.

Methods

To include randomized controlled trials (RCTs) written in English, a literature search was performed using PubMed, Scopus, Web of Science, Cochrane Library, Ovid, EBM reviews, and Academic Search Complete initially from 4th November 2020 until March 2022. A PICOS for this review was as follows; P: Patients with TMD myalgia or arthralgia, I: Excursion exercise, Stretch exercises, Resistance exercise, or Coordination exercise, C: No treatment or education only. O: Pain intensity and Range of Motion (ROM), S: RCTs. After title screening, a full-text assessment was done to extract data. According to Risk of Bias (RoB) 2.0, risk of bias was assessed in each included paper by 2 reviewers independently.

Results

A total of 3,388 titles were identified from the electronic database search. After the screening and full-text evaluation, only 5 studies (145 participants) were eligible to be included. Among the exercise modalities, coordination exercise showed a significant effect on pain relief and improvement of joint mobility.

Discussion

Due to the heterogeneity and small sample size of the included studies, a meta-analysis was not feasible. However, this systematic review suggested that exercise therapy, especially coordinate exercise, can be effective in managing painful TMD conditions. Further research is needed to establish optimal parameters for this patient population, as well as standardization and consistency in terminology and treatment structure.

Collaborative leadership with a focus on stakeholder identification and engagement and ethical leadership: a dental perspective

The dental profession is susceptible to change. In order to cope and adapt, individuals and organisations will need to work together, now more than ever. One approach that may be beneficial in these times, and beyond, is collaborative leadership. This is where a mutually beneficial relationship is established between two or more parties, who work towards common goals by sharing authority, responsibility and accountability for achieving results. When groups of individuals look beyond their personal interests and instead collaborate, they may channel their efforts to successfully achieve shared goals. However, for this to be fruitful, stakeholders (to include different individuals or groups that have a vested interest) will need to be identified and engaged, and ethical values based on the objectives of the organisation and those advocated by professional and regulatory bodies must be upheld. This paper explores how the traditional practices of stakeholder identification and engagement, as well as ethical leadership, may be of relevance in attaining success through the contemporary collaborative leadership approach.

In these times and beyond, embracing mutually beneficial relationships based on trust, integrity and empowerment shall be more important than ever; therefore, there is a great need for collaborative leadership within the dental profession.

An awareness of, and ability to use, the traditional practices of stakeholder identification and engagement as well as ethical leadership may allow dental organisations and professionals to better exercise collaborative leadership.

Alike with clinical knowledge and skills, dental organisations and professionals must self-reflect on their own leadership capabilities, be self-aware of their strengths and weaknesses, and aspire to improve themselves accordingly.