EFFICACY OF A SELF-TREATMENT PROTOCOL FOR FACE AND TEMPOROMANDIBULAR JOINTS REHABILITATION IN SYSTEMIC SCLEROSIS

Background: In SSc, skin involvement of the face is frequent and extremelydisabling, resulting in limited mouth opening, an altered dentition, difficulty inteeth care, as well as having a strong impact on the emotional and psychologicalwell-being, thus impairing quality of life.Objectives: to evaluate the efficacy of a self-treatment protocol (created byAMURR A Multidisciplinary Association of Rheumatological Rehabilitation) forface and tempomandibular joints (TMJs) rehabilitation with two devices used inthe dental field.Methods: 40 SSc patients (37 female and 3 male) with a mouth opening≤ 40mm, were recruited and randomized in two groups of treatment: Group 1(20 patients: mean age 50,650 yrs ± 13,937 SD, mean disease duraton 10,45yrs ± 7,877 SD, opening mouth 32,250mm ± 5,590 SD) treated with a homeself-treatment protocol consisting of 23 exercises carried out at home in frontof a mirror, 22/23 exercises were performed once a day, one of these using adevice to obtain uniform stretching of the buccal rhyme, another one usingusedthree times a day to reduce tension of muscles of the TMJs, facilitating the mouthopening; group 2 (20 patients: mean age 58,05 yrs ± 18,103 SD, mean diseaseduration 17,4 yrs ± 15,017 SD, opening mouth 34,950mm ± 5,753) without physical rehabilitation, only drugs as treatments of SSc and its complications. Allpatients underwent a baseline (T0) and 45 days (T1) clinimetric assessment byself-assessment of quality of life with SF-36 (Short-Form 36 Health Survey), ofthe degree of disability of the mouth with MHISS (of the Mouth Handicap in Systemic Sclerosis scale), Muscle pain evaluated by numerical rating scale (NRS)of the temporomandibular joint with TMD (Temporo mandibular Disorders), evaluation of mouth opening and ROM of the cervical spine. Statistical analysis wasperformed using the t-test or the Mann-Whitney test for assessing changes in allmeasurement scales between treatment groups.Results: The protocol of home physiotherapy exercises resulted in a statisticallysignificant improvement in the treated group compared to group 2 both for mouthopening (T0: 32,250 ± 5,590, T1: 35,650 ± 6,046) vs (T0: 34,950 ± 5,753 T1:34,300 ± 6,001) (p<0.001), cervical flexion (T0: 2,950 ± 1,939 T1: 1.700 ± 1,525)vs (T0: 4,450 ± 2,282 T1:4,075 ± 2,238) (p<0.01), cervical extension (T0: 17,025± 1,895 T1: 17,625 ± 1,605) vs (T0: 17,050 ± 2,089 T1: 16,525 ± 3,110) (p<0.05),cervical right lateral flexion (T0: 14,075 ± 2,386 T1:13,400 ± 2,431) vs (T0: 14,200± 1,765 T1: 14,425 ± 1,742) (p<0.01), cervical right rotation (T0: 14,200 ± 3,416T1:13,750 ± 3,206) vs (T0: 14,900 ± 1,683 T1: 15,550 ± 2,188) (p<0.01), cervicalleft rotation (T0: 14,725 ±3,640 T1:14,450 ± 3,710) vs (T0: 15,900 ± 2,614 T1:16,450 ± 2,964) (p<0.05), mouth disability at MHISS (T0: 19,100 ± 10,356 T1:16,000 ± 9,989) vs (T0: 20,950 ± 9,950, T1: 21,100 ± 10,775) (p<0.01).Conclusion: The use of the home exercises protocol associated with the twodevices has shown a significant improvement of the disability linked to skininvolvement of the face. This highlights the fundamental role that home rehabilitation self therapy has in practice. These data will need to be confirmed in alarger cohort of patients