Temporomandibular Joint Dysfunction
Conditions
Keywords
temporomandibular joint dysfunction, dual-task, pain, balance
Brief summary
This randomized controlled trial will be conducted among 18-25-year-old participants who present with temporomandibular joint dysfunction symptoms, including pain, limited range of motion, and joint crepitation. Participants will be randomly allocated into control and intervention groups using block randomization. The control group will receive a standard physiotherapy program, while the intervention group will additionally perform telerehabilitation-based dual-task exercises. The intervention will last for six weeks, with progressive increases in exercise and cognitive task difficulty. Outcomes will be assessed at baseline and at the end of the 6th week. Primary and secondary outcome measures include pain intensity (Visual Analog Scale), jaw functional limitation (Jaw Functional Limitation Scale-20), oral habits, static balance (Tetrax system), and dynamic balance (Timed Up and Go Test). Within-group and between-group comparisons will be performed. The sample size was calculated using power analysis, resulting in 30 participants in total (15 per group), accounting for potential dropouts.
Interventions
BEHAVIORALStandard Physiotherapy Program
Cervical range of motion exercises, cervical lateral flexion stretching, upper trapezius stretching, pectoral stretching, breathing exercises, seated cervical postural correction exercises, supine and prone cervical postural exercises, postural training exercises, temporomandibular joint (TMJ) rotation control exercises, TMJ opening, closing, protrusion, and retrusion exercises, tongue resting position training, isometric TMJ elevation, depression, and lateral deviation exercises in sitting position, post-isometric relaxation techniques, abdominal strengthening exercises, and back extensor strengthening exercises.
BEHAVIORALDual-Task Training
Backward counting from 200 by threes during cervical range of motion exercises and pectoral stretching, naming cities starting with the letter "A" during supine cervical postural exercises, naming animals starting with the letter "A" during TMJ rotation control exercises, simple arithmetic tasks (addition and subtraction) during isometric TMJ elevation and depression exercises, and more complex arithmetic tasks during lateral deviation exercises in sitting position. Cognitive task difficulty will be progressively increased over time.
Sponsors
Ege University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Due to the nature of the interventions, participants and care providers cannot be blinded to group allocation. However, outcome assessors will be blinded to participant group assignment to minimize assessment bias. In addition, data analysts will be blinded by using coded group labels during statistical analysis to further reduce potential bias.
Intervention model description
This study is a randomized controlled parallel-group trial with two groups. Participants will be allocated by block randomization to either a control or an intervention group. The control group will receive a standard physiotherapy program including cervical range of motion, stretching, postural, temporomandibular joint mobility and control, isometric, and strengthening exercises. The intervention group will receive the same standard physiotherapy program plus telerehabilitation-based dual-task training involving concurrent physical exercises and cognitive tasks (e.g., counting, category naming, and simple arithmetic).
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of temporomandibular joint dysfunction according to the * Temporomandibular Disorders Research Diagnostic Criteria and Diagnostic * Criteria for Temporomandibular Disorders * No neurological, orthopedic, or systemic condition that may affect balance * Ability to comply with a telerehabilitation program * Willingness to provide written informed consent * No prior physiotherapy treatment for temporomandibular joint dysfunction
Exclusion criteria
* Inability to participate in regular exercise or telerehabilitation programs * Presence of severe systemic diseases (cardiac, rheumatologic, neurological) or other severe chronic conditions * Presence of psychiatric disorders or cognitive impairment * Use of medications that may affect balance (such as sedatives) * History of jaw or dental surgery within the last 6 months * Receipt of physiotherapy, splint therapy, or similar treatment for temporomandibular joint dysfunction within the last 3-6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity | Measurements will be recorded at baseline and at week 6. Change in pain intensity will be analyzed. | Pain intensity will be assessed using a 10-cm Visual Analog Scale. Participants will rate their pain at rest, during chewing, and at night. Scores range from 0 (no pain) to 10 (worst imaginable pain). |
| Jaw Functional Limitation | Assessments will be performed at baseline and week 6. | (Jaw Functional Limitation Scale - JFLS-20): Jaw function will be evaluated using the JFLS-20, a 20-item self-report scale assessing functional limitations in mastication, speech, and jaw movement. Each item is scored from 0 (no limitation) to 10 (severe limitation). Higher scores indicate greater functional impairment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Temporomandibular Disorder Classification | Assessment will be performed at baseline. | Temporomandibular joint dysfunction diagnosis and classification will be determined using the Temporomandibular Disorders Research Diagnostic Criteria and Diagnostic Criteria for Temporomandibular Disorders questionnaire, which provides a standardized multidimensional assessment of temporomandibular disorders. This assessment includes evaluation of muscle-related disorders, disc displacement conditions, and degenerative joint diseases, and enables a comprehensive clinical and psychosocial classification of temporomandibular dysfunction. |
| Oral Habits | Assessments will be performed at baseline and week 6. | Oral Habits Questionnaire: Oral parafunctional habits will be assessed using a 21-item questionnaire evaluating behaviors such as bruxism, nail biting, and gum chewing. Each item is rated on a 0-4 Likert scale, with total scores ranging from 0 to 84. Higher scores indicate more frequent parafunctional habits. |
| Dynamic Balance | Assessments will be performed at baseline and week 6. | Functional mobility and dynamic balance will be assessed using the Timed Up and Go Test. The time (in seconds) required to stand up from a chair, walk 3 meters, turn, return, and sit down will be recorded. Shorter times indicate better mobility and balance. |
| Stability Index (SI) | Baseline and after 6 weeks | Static balance will be assessed using the Tetrax system (Sunlight Medical Ltd., Israel). The Stability Index reflects overall postural sway and stability performance. Higher scores indicate poorer stability. Unit of measure: index score. |
| Weight Distribution Index (WDI) | Baseline and after 6 weeks | Measured using the Tetrax system, the WDI evaluates the distribution of body weight across four force plates. Higher values indicate asymmetry in weight distribution. Unit of measure: index score. |
| Fourier Harmonic Index (FHI) | Baseline and after 6 weeks | The FHI is derived from frequency analysis of postural sway signals obtained via the Tetrax system. It provides information about postural control mechanisms. Unit of measure: index score. |
| Fall Index | Baseline and after 6 weeks | The Fall Index estimates the risk of falling based on postural stability parameters measured by the Tetrax system. Higher scores indicate greater fall risk. Unit of measure: index score. |
Contacts
CONTACTSerkan Bakırhan, Professor
Outcome results
None listed