Patient Education, Self-management and Physiotherapy for Chronic Temporomandibular Disorders
What You Need to Know Before You Apply
What is the purpose of this 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.
Are You a Good Fit for This Trial?
Inclusion Criteria
What Are the Treatments Tested in This Trial?
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
Active Control
Each of the two sessions will be conducted individually with one of two physiotherapists and will last 45 minutes each. The first session will be used at baseline to deliver proper insights to the patient regarding normal physiology and their TMD, pain pathophysiology using references and visual aids (i.e. video, biomechanical demonstration on human skeleton model) to facilitate understanding. Depending on clinical presentation and scores to self-administered questionnaires, counseling and recommendations will be tailored. Lastly, an exercise program, including self-relief manual techniques and rehabilitation exercises for posture, mobility and strength of the neck and jaw will be demonstrated, practiced and prescribed to the participants (up to 5 exercises). At home, each patient will have access to an informational binder featuring the recommendations and prescribed exercise program to ensure patient's capacity to follow the intended program.
This group will be offered six (30 min, 1x/week) in-clinic PT-supervised sessions from one of two experienced physiotherapists over a 5-week period. The usual intervention group will receive personalized care tailored to each participant's presentation with the intention of reducing pain, increasing mobility and strength, and optimizing daily function. Care provided will not be standardized and will include a combination of manual therapy techniques, at-home exercises (up to 5 jointly chosen by PTs and participants) and education regarding potential contributing factors to the presenting TMD. Treatments will not only focus on the TMJ, but may also involve treatment for the neck, head and shoulder griddle based on the physiotherapist's expert clinical reasoning. All therapies will be documented for analysis.
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Who Is Running the Clinical Trial?
Ciusss de L'Est de l'Île de Montréal
Lead Sponsor
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