Temporomandibular disorders (TMD) is a disease characterized by pain and dysfunction of the masticatory muscles and temporomandibular joint. Many factors have been found to be related to the disease, however the underlying mechanism is yet to be fully elucidated. Physical activity is widely known to modulate pain intensity in various pain disorder. However, literature suggesting the association between physical activity and signs and symptoms of TMD are limited. 
The “Physical Activity in TMD (PAT)” is a prospective cohort study on TMD patients that aims to determine how daily physical activity and sleep duration affect long-term TMD prognosis with conventional treatment. To analyze such effects, objective data on daily physical activity levels will be collected along with clinical indices including mouth opening ranges and masticatory muscle palpation responses. Well-known comorbidities of TMD will be extensively evaluated based on validated structured questionnaires on sleep quality, fatigue level, widespread pain, psychological status including depression and anxiety, autonomic symptoms, and health-related quality of life. The collected data will be analyzed according to TMD pain severity and physical activity level, and correlations among physical activity indices and long-term TMD prognosis will be investigated.
This study is a longitudinal prospective study of adult Koreans diagnosed with TMD following standardized diagnostic procedures. Primary outcomes include physical activity levels and long-term clinical outcomes and secondary outcomes include disability from pain and related comorbidity levels. This study provides reliable data for future research and establishing clinical guidelines that will allow cause-related, patient-tailored personalized medicine for TMD.

Cohort/Group Label

Control group with low pain level according to DC/TMD

Cohort/Group Description

A group of patients corresponding to Grade I and II based on the Graded Chronic Pain Scale of DC/TMD Axis II

Cohort/Group Label

Control group with high pain level according to DC/TMD

Cohort/Group Description

A group of patients corresponding to Grade III and IV based on the Graded Chronic Pain Scale of DC/TMD Axis II

Not collect nor Archive

Adult patients who are 18 years old or older with Korean nationality who visited the outpatient clinic of the Department of Oral Medicine of Seoul National University Dental Hospital with the chief complaint of pain and dysfunction of the temporomandibular joint and diagnosed as TMD

We used a convenience sampling method in which only those who voluntarily wish to participate in the study were sampled among the patients who are eligible for the criteria

Gender

Age

Description

Korean adults who are 18 years old or over, diagnosed with temporomandibular joint disorder based on DC/TMD

Patients with previously diagnosed systemic musculoskeletal disorders including fibromyalgia, low back pain, rheumatoid arthritis, ankylosing spondylitis, gout, liver disease, kidney disease, uncontrolled endocrine disorder, autoimmune disease, trauma within the last 6 months, treatment history for a psychiatric disorder that may affect the study, and primary sleep disorder diagnosis

Amount of physical activity and sleep duration 

patient's first visit and at 6- and 12-month post-treatment

Amount of comfortable mouth opening

patient's first visit and at 6- and 12-month post-treatment

Amount of maximum mouth opening

patient's first visit and at 6- and 12-month post-treatment

Muscle tenderness on palpation

patient's first visit and at 6- and 12-month post-treatment

Joint capsule tenderness on palpation

patient's first visit and at 6- and 12-month post-treatment

International Physical Activity Questionnaire (IPAQ)

patient's first visit and at 6- and 12-month post-treatment

Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD)

patient's first visit and at 6- and 12-month post-treatment

Pittsburgh Sleep Quality Index (PSQI)

patient's first visit and at 6- and 12-month post-treatment

Epworth Sleepiness Scale (ESS)

patient's first visit and at 6- and 12-month post-treatment

Fatigue Assessment Instrument (FAI)

patient's first visit and at 6- and 12-month post-treatment

Insomnia Severity Index (ISI)

patient's first visit and at 6- and 12-month post-treatment

Morningness-eveningness questionnaire (MEQ)

patient's first visit and at 6- and 12-month post-treatment

Symptom severity (SS) scale

patient's first visit and at 6- and 12-month post-treatment

widespread pain index (WPI) 

patient's first visit and at 6- and 12-month post-treatment

Fibromyalgia Impact Questionnaire (FIQ)

patient's first visit and at 6- and 12-month post-treatment

Symptom Checklist-90-Revised (SCL-90-R)

patient's first visit and at 6- and 12-month post-treatment

Beck Depression Index (BDI)

patient's first visit and at 6- and 12-month post-treatment

Beck Anxiety Index (BAI)

patient's first visit and at 6- and 12-month post-treatment

Pain Catastrophizing Scale (PCS)

patient's first visit and at 6- and 12-month post-treatment

Central Sensitization Inventory (CSI)

patient's first visit and at 6- and 12-month post-treatment

Pennebaker Index of Limbic Languidness (PILL)

patient's first visit and at 6- and 12-month post-treatment

Perceived Stress Scale (PSS)

patient's first visit and at 6- and 12-month post-treatment

Short Form 36

patient's first visit and at 6- and 12-month post-treatment

Composite Autonomic Symptom Score 31 (COMPASS 31)

patient's first visit and at 6- and 12-month post-treatment

McGill Pain Questionnaire (MPQ)

patient's first visit and at 6- and 12-month post-treatment

Hematologic indices of systemic inflammation, including red blood cell (RBC), hsCRP, erythrocyte sedimentation rate (ESR), platelet-to-lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), and derived neutrophil lymphocyte ratio (dNLR) 

patient's first visit