Patient Education, Self-management and Physiotherapy for Chronic Temporomandibular Disorders

Patient Education, Self-management and Physiotherapy in the Management of Chronic Painful Temporomandibular Disorders : a Two-arm Randomized Controlled Trial

The goal of this clinical trial is to understand whether a simple education and self-management program with home exercises can reduce pain and improve daily function in adults with long-lasting jaw pain caused by temporomandibular disorders (TMD) as much as a more intensive hands-on physiotherapy approach.

The main questions it aims to answer are:

1. Does an education and self-management exercise program reduce jaw pain, improve jaw function and reduce how much pain interferes with daily activities?
2. Does this program improve outcomes similarly to the usual treatment for TMDs, which includes also manual therapy and supervised exercise sessions?

Researchers will compare an education and self-management program with home exercises to usual physiotherapy care to see which approach leads to better pain relief and daily functioning over time.

Participants will:

Attend three evaluation visits (at the start of the study, after 6 weeks, and after 16 weeks);

Be assigned to one of two treatment groups:

1. A group receiving two physiotherapy-supervised education and self-management sessions with personalized home exercises; or
2. A group receiving six physiotherapy usual treatment sessions, which may include education, exercises, and hands-on therapy;

Participants will complete questionnaires about:

Jaw pain, Jaw function, Body pain, Neck disability, Oral behaviors, Pain catastrophizing, Fear of movement, Confidence in managing pain.

Measures of mouth opening will be taken (non-painful, maximal and maximal with assistance) with a ruler at all time points.

This study includes adults aged 18 to 65 years who have jaw pain for at least 3 months.

Inclusion Criteria:

• Diagnostic of painful TMD according to axis 1 of DC/TMD
• Experiencing rest pain for at least 3 months
• With a minimum pain intensity of 3 on a 10-point Numeric Pain Rating Scale (NPRS)

Exclusion Criteria:

• History of jaw surgery
• Recent trauma to head or jaw
• Ongoing dental treatment
• History of rheumatologic condition
• Severe psychiatric condition (e.g severe anxiety or severe depression)