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.
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
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)
Parallel
Standard Physiotherapy Program
BehavioralCervical 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.
Dual-Task Training
BehavioralBackward 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.
Pain Intensity
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
(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.
Temporomandibular Disorder Classification
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
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
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)
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.
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