Temporomandibular Disorder (TMD) Diagnostic Concordance Between Physiotherapist and Surgeon (TMD)

April 28, 2026 updated by: Sina Hashemi, McGill University Health Centre/Research Institute of the McGill University Health Centre

Improving Access and Care Quality for Temporomandibular Disorder Patients - a Prospective Study to Examine Diagnostic Concordance Between Advanced-practice Physical Therapist and Oral and Maxillofacial Surgeon

Jaw disorders is the leading cause in facial pain, affecting many people in the world. Despite many patients finding relief from conservative treatment, many get referred to the surgeon for an evaluation. In order to improve access to care and reduce wait times, a new advanced practice physiotherapist-led triage model is being studied.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Temporomandibular disorders (TMD), involving the temporomandibular joint and masticatory muscles, are the leading cause of orofacial pain, affecting approximately 5-12% of the global population and generating an estimated $4 billion in annual healthcare costs. While 50-90% of individuals experience symptom relief through non-surgical interventions, fewer than 10% ultimately require surgical treatment. For patients who do not respond to conservative management, referral to a medical specialist is typically necessary to guide further care. In Canada, however, high demand for specialized services results in prolonged wait times. At the McGill Oral and Maxillofacial Surgery (OMFS) Division, patients can wait more than six months for an initial consultation and over a year for a surgical procedure. When accounting for additional delays related to diagnostic imaging and prior referrals, total wait times may exceed two years. These delays can have deleterious consequences, including worsening pain, increased functional disability, and a significant decline in quality of life for patients awaiting timely interventions. Above all, in the absence of a structured triage process, many patients are prematurely referred to surgical services, often before exhausting appropriate non-surgical options. This contributes to unnecessary delays in care, increased healthcare costs, and excessive demand on already overburdened speciality clinics.

The implementation of innovative care models led by advanced practice physiotherapists (APPTs) offers a promising solution. APPTs are highly trained health professionals with advanced competencies in musculoskeletal assessment, differential diagnosis, and evidence-based management, with the ability, depending on regulated scope of practice, to independently recommend investigations, initiate treatment plans, and make referrals when necessary. Advanced practice physiotherapy (APPT) models of care have been successfully deployed in various specialized care settings-such as orthopaedics, neurosurgery and rheumatology, where they have improved patient flow, reduced wait times, and maintained or improved patients' clinical outcomes. In these contexts, APPTs function as a first-contact autonomous practitioners, managing a substantial proportion of MSKD cases that would otherwise be directed to physicians or surgeons.

By integrating APPTs into the triage pathway for TMJ referrals, patients could be more effectively directed toward appropriate non-surgical care, such as physiotherapy, education, and self-management strategies, when surgical intervention is not warranted. This approach would help preserve the Oral and Maxillofacial Surgery department resources for patients with conditions that truly require surgical expertise. While APPT models have been successfully implemented and evaluated in various musculoskeletal care settings, no studies to date have described or assessed the implementation of such a model specifically for the management and triage of TMDs. This represents a significant gap in the literature and an important opportunity to explore the potential benefits of APPT-led care in improving access and efficiency in specialized orofacial pain services.

Study Type

Interventional

Enrollment (Estimated)

70

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Canada
    • Quebec
      • Montreal, Quebec, Canada
        • Montreal General Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Referred for new consultation at the MUHC TMJ clinic for temporomandibular joint (TMJ) pain or dysfunction
  • Residents of the province of Quebec and benefiaries of provincial universal health insurance coverage (Régie de l'Assurance Maladie du Québec - RAMQ)
  • Be able to understand and communicate in either French of English
  • Be legally capable of providing informed consent

Exclusion Criteria:

  • Presenting for a follow-up visit (i.e., not a new consultation)
  • Have undergone TMJ surgery within the past six months
  • Referred directly from a recognized orofacial pain dentist or oral medicine specialist
  • Referred for acute TMJ trauma requiring urgent management (e.g., fractures, dislocations)
  • Present with complex or multi-system pathology that could confound the diagnostic process and are not related to TMD

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Physiotherapy Assessment
Diagnostic test: Physiotherapy assessment

This is a non-randomized study as each participant will undergo two independent clinical assessments: one performed by the advanced-practice physical therapist (APPT) and one by the oral and maxillofacial surgeon (OMFS) and/or resident under supervision.

For logistical and feasibility reasons, the APPT will conduct the first assessment. After a brief rest period, the participant will be seen by the OMFS. Both clinicians will be blinded to each other's findings, and participants will be explicitly instructed not to share any information from the first assessment during the second.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)
Time Frame: Day 1
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)
Day 1

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
9-item Visit-Specific Satisfaction Questionnaire (VSQ-9)
Time Frame: Day 1
9-item Visit-Specific Satisfaction Questionnaire (VSQ-9)
Day 1

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

McGill University Health Centre/Research Institute of the McGill University Health Centre

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

April 1, 2027

Study Completion (Estimated)

June 1, 2027

Study Registration Dates

First Submitted

April 10, 2026

First Submitted That Met QC Criteria

April 28, 2026

First Posted (Actual)

May 1, 2026

Study Record Updates

Last Update Posted (Actual)

May 1, 2026

Last Update Submitted That Met QC Criteria

April 28, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026-12105

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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