A systematic review and Meta-Analysis: Exploring the efficacy of self-managed treatments for Temporomandibular Disorders (TMD): The role of home exercise and digital therapies

Abstract

Temporomandibular disorders (TMD) are highly prevalent and frequently associated with chronic pain and functional impairment, forming part of the diagnostic spectrum in cranio-maxillofacial surgery. Scalable, self-managed interventions - including home-exercise programs, psychoeducational strategies, and digitally supported approaches - are increasingly used, yet their pooled effectiveness has not been systematically quantified. A systematic search of PubMed, Scopus, and Cochrane CENTRAL identified randomized controlled trials evaluating predominantly self-managed or remotely delivered interventions for TMD. Eligible studies were qualitatively synthesized, and trials providing sufficient numerical data were meta-analyzed. Standardized mean differences (Hedges’ g) were calculated using random-effects models; heterogeneity, prediction intervals, robustness, and publication bias were assessed. Self-managed interventions produced a statistically significant and clinically meaningful reduction in pain (SMD = −0.78; 95% CI −1.33 to −0.24; p = 0.005; I 2 = 84%), with robust findings in sensitivity analyses. For maximal mouth opening, the pooled estimate showed a nonsignificant trend toward improved mandibular mobility (SMD = 0.63; 95% CI −0.11 to 1.37; I 2 = 91%). These findings support structured self-management strategies as effective components of contemporary TMD care pathways, with direct relevance for evidence-based indication setting and patient counseling in cranio-maxillofacial practice.