Journal of Oral Rehabilitation

Journal of Oral Rehabilitation 2016

Review
Self-management in temporomandibular disorders:
a systematic review of behavioural components
W. P. STORY*, J. DURHAM*†, M. AL-BAGHDADI‡, J. STEELE*† &
V . A R A U J O - S O A R E S † *Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, †
Institute of Health
‡
& Society, Newcastle University, Newcastle-upon-Tyne, UK and Oral Surgery Unit, Al-Noor Specialized Dental Care Centre, Ministry of
Health, Baghdad, Iraq

SUMMARY The aim of this qualitative systematic employed in SM programmes. Other behaviour
review was to identify the behaviour change change techniques should be examined to see
techniques most frequently employed in whether there is a theoretical underpinning that
published temporomandibular disorder (TMD) might support their inclusion in self-management
self-management (SM) programmes. The reviewers programmes in TMD. Further trials are required to
matched the components of SM programmes into conclude that SM programmes are more effective
the relevant behaviour change technique domains than no treatment at all and or placebo. With more
according to the definitions of the behaviour change structured SM programmes, greater therapeutic
taxonomy (version 1). Electronic databases were benefits might be achieved, and certainly if SM
searched for randomised controlled trials assessing programmes published in the literature define their
an SM programme for TMD. Manual searches were components through use of the behaviour change
also conducted for potentially important journals. taxonomy, it would be easier for clinicians to
Eligibility criteria for the review included: the type replicate efficacious programmes.
of study, the participants, the intervention utilised KEYWORDS: systematic review, temporomandibular
and the comparators/control. Fifteen randomised joint disorder, behaviour change, self-management
controlled trials with 554 patients were included in
this review. The review concludes a minority of the Accepted for publication 12 July 2016
available behaviour change techniques are currently

which is also termed ‘self-care’ in the literature. There

Introduction
is an emerging interest in tailored and multimodel
Temporomandibular disorders (TMD) are a group of complex therapies in the management of TMD which
commonly occurring oro-facial pain conditions, which are based on SM (13–15). It is, however, still unclear
affect the temporomandibular joint, the muscles which core intervention components of SM interven-
around the jaws or both (1). One of the most com- tion programmes are the most effective, and there-
mon complaints caused by TMD is pain, and TMD are fore, no gold standard SM programme has been
known to have a substantial impact on quality of life identified and tested as yet. Perhaps unsurprisingly,
(2–5), but the majority of cases respond well to simple therefore, no singular agreed definition of SM exists
reversible therapies (6). in the literature, but it is possible to derive one
A known, core intervention that provides simple through using multiple sources (16–19) (see supple-
reversible therapy is self-management (SM) (7–12) mentary e-appendix S1) and common components of

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W . P . S T O R Y et al.

an SM intervention programme as described in the lit- 1 Participants: patients over 18 years old with any
erature include (16–19): subtype of TMD.
1 Basic elements of cognitive behavioural therapy 2 Interventions: interventions comprising, or grouped
including education. by, the term SM.
2 Relaxation techniques. 3 Comparators/Control: any alternative intervention,
3 Reinforcement of desired behaviours and with- placebo or no treatment.
drawal from unwanted behaviours. 4 Outcomes: to identify and explain the most common
4 Home physiotherapy. BCTs utilised in SM programmes. No time limita-
5 Non-prescription pharmacological therapy, but this tion for outcome measurement.
may vary depending on local prescribing regula- 5 Studies: Peer-reviewed English language randomised
tions. and quasi-randomised clinical trials (RCTs & q-
RCTs) and comparative studies.
SM programmes for TMD detailed in the literature
invariably involve and strive to achieve behaviour Further details on PICOS inclusion/exclusion crite-
change by the patient in order to be considered suc- ria are available in the supplementary e-appendix S1.
cessful (20–23). Behaviour change interventions are,
however, complex. Currently, the way SM interven-
Search methods
tions have been described in the literature makes
replication difficult if not impossible, both in further Four electronic databases were searched up to the
research as well as in everyday clinical practice, given 15th April 2016: Cochrane Central Register of Con-
the lack of detail provided on each of the active ingre- trolled Trials (CENTRAL); Medline via OVID;
dients (interventions) of each SM programme. A EMBASE via OVID; CINAHL. Detailed search strate-
recent international research programme addressed gies for each of these databases were developed in
the difficulties with defining behaviour change tech- order to identify studies to be considered and/or
niques (BCTs) in studies, which are the core basic included for review (see supplemental e-appendix
active ingredients of an intervention, through the cre- S2).
ation of a behavioural change techniques taxonomy Alternative resources were also used to identify
involving 93 clearly defined BCTs grouped into 16 other studies including: citation searches of included
clusters (24, 25). The underlying hypothesis of creat- studies, reference lists of included studies and refer-
ing the behavioural change taxonomy was that if ence lists of relevant review articles and textbook
studies could clearly define and specify the active chapters. In addition, the following journals were
ingredients of a behavioural change intervention identified as being potentially important and their
used, this should lead to an improved understanding tables of contents were hand-searched by the first
of the intervention, allowing for replications and reviewer (WS) from 2004 up to 15th April 2016:
thereby enabling further testing and intervention Journal of Orofacial Pain, Journal of Oral Rehabilita-
development efforts (24). The primary aim of this tion, Journal of Craniomandibular Practice, Journal of
qualitative systematic review was therefore to identify the American Dental Association and Journal of Pain.
the behaviour change techniques (24) most fre- As per our peer-reviewed priori protocol, we did not
quently employed in published SM programmes. therefore fully cover the grey literature.

Materials and methods Data collection and analysis

This systematic review was conducted in accordance Selection of studies. The first reviewer (WS) selected eli-
with the Centre for Reviews and Dissemination gible studies resulting from the various search
(CRD) recommendations (26), and it had an a priori methodologies according to the inclusion/exclusion
protocol that was peer-reviewed by two international criteria. The full texts of all potentially eligible studies
experts in the field. were examined independently. All papers eligible for
Criteria for considering studies for the systematic inclusion were subject to a blinded second review
review are as follows (PICOS): (the second reviewer ‘JD’ was blinded to authors,

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 A REVIEW OF BEHAVIOURAL COMPONENTS IN TMD

institutions and journal name). Any disagreement blinding, incomplete data, selective reporting and
regarding inclusion/exclusion was resolved through other potential sources of bias. Bias assessment was
discussion with a third reviewer (MA). Reason(s) for subject to a dual review (WS & JD). Any lack of con-
any exclusion were recorded. sensus was discussed and subject to third review as
necessary.
Data extraction and management. A pre-piloted stan-
dardised form was used to extract data from included
Results
studies. All data extracted were cross-checked by a
second reviewer. Any lack of consensus was dealt The search strategy identified 180 articles (155 from
with as previously documented. electronic sources and 25 from other sources – see
Fig. 1). After screening, 116 articles were rejected as
Matching the SM components to relevant BCTs. The first they did not meet the inclusion criteria for a variety of
reviewer matched the components of reviewed SM reasons leaving 64 papers whose full text was obtained
programmes into the relevant BCTs using an excel and read. After examining the full text of these 64
spreadsheet according to the BCTs taxonomy version papers, sixteen papers (15 original studies and one fol-
1 (24). To ensure reliability and avoid data misrepre- low-up report) were identified as eligible for inclusion
sentation, two reviewers (JD & VA) independently in this systematic review (Komiyama et al., 1999 (28);
cross-checked the allocation of each SM component Wright et al., 2000 (12); Carlson et al., 2001 (8);
to each BCT. Dworkin et al., 2002 (1); Michelotti et al., 2004 (9);
Truelove et al., 2006 (11); Turner et al., 2006 (29);
Risk of bias assessment. The Cochrane risk of bias tool Mulet et al., 2007 (30); Turner et al., 2011 (31); Nie-
was used to assess the methodological quality of the mela et al., 2012 (32); Michelotti et al., 2012 (10);
studies included (high, low or an unclear risk of bias Craane et al., 2012 (33); De Vocht et al., 2013 (34);
(27)) according to the following domains: random Conti et al., 2015 (35); Costa et al., 2015 (36); Qvintus
sequence generation, allocation concealment, et al., 2015 (37)). A list of the 48 excluded, with
Identification

Records idenfied through database Addional records idenfied through

searching other sources
(n = 155) (n = 25)

Records aer duplicates removed

(n = 180)
Screening

Records screened Records excluded

(n = 180) (n = 116)

Full-text arcles assessed for Full-text arcles excluded,

eligibility with reasons
Eligibility

(n = 64) (n = 48)

Studies included in
qualitave synthesis
(n = 16 ’15 studies & 1 follow
up report’)
Included

Fig. 1. Study flow diagram.

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W . P . S T O R Y et al.

reasons for exclusion, is available in the supplementary number of BCTs employed in a single SM programme
e-appendix S3. None of the studies selected for was 11 (Turner et al (31)), and the minimum was
inclusion had a low risk of bias across all domains, and two (Niemela et al (32)) (Table 2).
eleven studies were found to have an unclear risk of
bias due to insufficient information available (see
Discussion
e-appendix S4).
SM is widely considered to be a core part of manage-
ment of TMD (20) irrespective of whether additional
Description of studies included in the review:
interventions are added; such as the adjunctive use of
All of the studies within this systematic review con- an occlusal splint. There were no reported adverse
tained a treatment group of a SM programme compat- effects of SM in this systematic review suggesting a
ible with our initial definition. All fifteen studies potential favourable risk:benefit ratio for SM. SM prob-
included used the RDC/TMD to diagnose patients. The ably therefore merits further investigation as the
follow-up period varied between trials from 1 month methodological quality of the trials included in this
to 12 months (Table 1). review was generally low and no study examined SM
In terms of primary outcome, thirteen studies used against no treatment, for example a waiting list con-
pain intensity as one of their outcome measures and trol. Further research is required to trial other BCTs in
it was measured using: the visual analogue scale differing combinations within SM programmes to
(VAS) in seven studies (8–10, 28, 32, 33, 35); the ascertain their efficacy over a ‘standard’ generic SM
characteristic pain intensity (CPI) in three studies (1, programme for TMD as a ‘catch-all’ group. Following
29, 31); the numerical rating scale (NRS) in two this, research could examine different SM programmes
studies (30, 34); and the symptom severity index for the differing subtypes of TMD in both Axis 1 and
(SSI) in one study (12). In the remaining studies, Axis 2 of the DC/TMD to see whether efficacy can be
pain as an outcome was monitored by change in the improved by a more tailored approach (13–15) to the
number of painful sites in one study (11) and patient’s biopsychosocial profile. Future trials should
another assessed anxiety, depression and catastrophi- also seek to adopt the IMMPACT recommendations
sation (36). The supplemental e-appendix S5 demon- (38–40) for trial design in pain studies and follow the
strates the intra-group effect size of SM on pain Template for Intervention Description and Replication
intensity in the varying studies for information pur- (TIDieR) checklist in describing the SM intervention
poses only. (41) to help improve methodological quality and thus
the robustness of the evidence available.
Although our definition of SM was drawn from
Narrative review of behavioural change techniques
multiple sources (16–19) and the inclusion criteria for
employed in the included studies:
this review involved a wide range of potential fea-
Sixteen from a total 93 of BCTs defined in the beha- tures for an SM programme, the evidence base for
viour change taxonomy v1 (24) were employed in SM seems, at best, limited. The results suggest there is
SM programmes for TMD (Table 1). The sixteen BCTs likely to be wide interinstitutional variation in SM
used came from six of the 16 group clusters of the programmes, which use only a small proportion of
behaviour change taxonomy: Goals and planning the range of BCTs available. Common psychosocial
(n = 4 BCTs); Feedback and monitoring (n = 3 BCTs); comorbidities in TMD include low self-efficacy and
Repetition and substitution (n = 3 BCTs); Regulation high pain catastrophising, and these are known to
(n = 2 BCTs); Shaping knowledge (n = 1 BCT); Ante- predict treatment response (22). Catastrophisation
cedents (n = 1 BCT). The most commonly used BCTs and low self-efficacy may therefore represent thera-
were: persuasive argument (n = 12 studies); instruc- peutic targets for future SM programmes through an
tions on how to perform a behaviour (n = 11 studies); expansion in the number of BCTs employed within
behaviour substitution (n = 10 studies) (Table 2). SM programmes. Further use of BCTs such as setting
Some studies employed more BCTs in their SM pro- graded tasks, prompt practice, feedback and reinforce-
gramme than others, but the reasons for this seemed ment for self-efficacy, self-talk, biofeedback and relax-
empirical rather than evidence based. The maximum ation training could be incorporated into an SM

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 A REVIEW OF BEHAVIOURAL COMPONENTS IN TMD

Table 1. Included studies’ characteristics and components of self-management (SM) group classified by behaviour change technique
(BCT)

Study group
identified as Patients
meeting review’s in SM
Subtype of TMD definition of group Duration/
Study (year)† studied‡ Self-Management (n) months Details of SM group and BCTs§

Komiyama Myofascial pain IT-2 20 12 • Jaw muscle relaxation/posture training (BS)

et al. (1999) with limited • Posture instructions and CBT reinforced
(28) opening during 12 sessions over 12 months (HR)
• Self-monitoring instructions given to assess
signs and symptoms of TMD (SB)
• Clinician led instructions given to patients
(PA)
• Patients had the opportunity to perform
relaxation exercises for the jaw on clinic
(IPB)
• Stress coping strategies (RNE)
Wright et al. Masticatory TMD Treatment Group 30 1 • Patients told to rest masticatory muscles as
(2000) (12) much as possible (BS)
• Observation of patient exercise performance
at a review appointment. Patients encouraged
to modify techniques where necessary (FB)
• Dentist and physiotherapy led instructions
during the trial (PA)
• Instructions for exercises given to patients in a
schedule in order to follow correct posture
routine (IPB)
• Use of over the counter medications advised
(frequency not mentioned) (PhS)
Carlson et al. Myofascial Pain Physical 23 6 • Advised monitoring and reduction of
(2001) (8) (Type 1a and 1b) Self-Regulation parafunction in the head and neck region
(BS)
• Self-monitoring throughout process (SB)
• Dentist led instructions given over two
sessions (PA)
• Performance of diaphragmatic exercises
during session (IPB)
Dworkin et al. TMD Self-care 61 12 • Taught specific methods of relaxation for the
(2002) (1) head, neck and masticatory muscles (BS)
• Observed patient performance of prescribed
exercises and provided feedback and positive
support (FB)
• Self-monitoring of signs and symptoms with
attention to parafunctional habits (SB)
• Personal TMD self-care plan with tailored
schedule of timings for exercises (AP)
• Recognition of the obstacles to maintaining
self-care discussed and corrective behaviours
to overcome barriers taught (PrS)
• Telephone contact made to ensure
instructions were being followed and
modifications made as necessary to achieve
goals (DB)

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W . P . S T O R Y et al.

Table 1. (continued)

Study group
identified as Patients
meeting review’s in SM
Subtype of TMD definition of group Duration/
Study (year)† studied‡ Self-Management (n) months Details of SM group and BCTs§

• Personalised plan to achieve performance

(GS)
• Therapist and dentist led instructions (PA)
• Supervised practice of exercises (IPB)
• Stress management strategies (RNE)
Michelotti et al. Myogenous TMD Education + Home 36 3 • Monitoring and reducing parafunction (BS)
(2004) (9) Physical Therapy • Stickers used to monitor exercises (BF)
• Self-monitoring of behaviour (advised to pay
close attention to jaw muscle activity and
maintain soft diet) (SB)
• Patients asked to note in diaries if they had
completed exercises (compliance ranked) (DB)
• Instructions set for behaviour and monitored
via diaries (GS)
• Dentist led clinical trial (PA)
• Instructions on diaphragmatic breathing and
timings for several instructions given (IPB)
Truelove et al. TMD with myofascial UT 64 12 • Dentist led instructions given (PA)
(2006) (11) pain with or without • Instructions given (Note: No frequency/
concurrent diagnosis duration information) (IPB)
of arthralgia or • Stress reduction suggestions (RNE)
disc displacement • Use of NSAIDs (PhS)
with reduction
Turner et al. Axis 1 TMD Self-Care 79 12 • Observation and review weekly with
(2006) (29) Diagnosis Management educator (FB)
• Patients given manuals on TMD and
education (MB)
• Clinician led instructions and education (PA)
• Pain medication as required (PhS)
Mulet et al. Myofascial pain SC+ 20 1 • Control of maladaptive behaviours such as
(2007) (30) of the avoiding clenching teeth (BS)
masticatory • Diary completed by patient assessing the
muscles completion of activities (compliance) (SB)
• Patients given specific exercises to be
completed with frequency/duration and
number of days required (AP)
• Instructions given to patient with goals of
carrying out exercise and monitoring
compliance (GS)
• Physical therapist demonstrating exercises
(PA)
• Self-care instructions given and muscle
exercises demonstrated (IPB)
• NSAID use to be kept in diary (PhS)
Turner et al. Axis 1 TMD Self-Management 60 12 • Jaw posture monitoring (BS)
(2011) (31) Diagnosis Training • Reduction in parafunctional behaviours.
Alternative jaw posture discussed. Reinforced
(HR)

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 A REVIEW OF BEHAVIOURAL COMPONENTS IN TMD

Table 1. (continued)

Study group
identified as Patients
meeting review’s in SM
Subtype of TMD definition of group Duration/
Study (year)† studied‡ Self-Management (n) months Details of SM group and BCTs§

• Instructions to practise self-monitoring and

behaviour via a pain diary (SB)
• Detailed individualised plans for patients
constructed. (Note: context/frequency/
duration and intensity not mentioned) (AP)
• Individualised plans carried out with
assessment of relapse and overcoming
barriers discussed. Analysed by participant
and practitioner (PrS)
• Individualised plans at the start of each
session to highlight any shortfall by the
patient (DB)
• Review of achievement and difficulties with
assessment and redesign of personal plan to
overcome barriers (GS)
• CD and articles provided for relaxation
exercises (MB)
• Education provided by dentist or hygienist in
a clinical setting (PA)
• Individualised plans include instructions on
jaw exercise and thermal packs (IPB)
• Stress management training (RNE)
Niemela et al. TMD Control Group 41 1M • Dentist led instructions given (PA)
(2012) (32) 16 12M • Instructions on performing muscle exercises
(follow-up given with duration/frequency highlighted
report: (IPB)
Qvintus et al.
(2015) (37))
Michelotti et al. Myogenous TMD Education 23 3 • Avoidance of habits and ideal posture
(2012) (10) discussed (BS)
• Use of visual aids at home to alert to tooth
contact (BF)
• Advised to pay close attention to jaw muscle
activity (SB)
• Dentist led instructions given (PA)
• Instructions over muscle relaxation (Note:
Duration/frequency not discussed) (IPB)
Craane et al. Disc displacement Control Group 26 12 • Keep the jaw muscles relaxed and avoid
(2012) (33) without reduction non-functional contacts and excessive mouth
opening (BS)
• Brochure provided to patients (MB)
• Dentist led instructions given (PA)
• Instruction given (Note: no
frequency/duration given) (IPB)
De Vocht et al. Chronic myofascial Self-Care Only 21 6 • Reduction in parafunctional behaviours
(2013) (34) temporomandibular (Note: not specific) (BS)
disorder

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W . P . S T O R Y et al.

Table 1. (continued)

Study group
identified as Patients
meeting review’s in SM
Subtype of TMD definition of group Duration/
Study (year)† studied‡ Self-Management (n) months Details of SM group and BCTs§

• Reduction in parafunctional behaviours and

stress reduction suggestions. (Note: no
recording of behaviour requested) (SB)
• Education provided by dentist or dental
co-ordinator in a clinical environment (PA)
• Use of thermal packs (No indication of timing)
(IPB)
• Use of over the counter medications (PhS)
Conti et al. Disc displacement Counselling alone 20 3 • Clinician led instructions given (PA)
(2015) (35) with reduction • Diet modification, avoidance of caffeine and
and arthralgia clenching (BS)
• Relaxation techniques and sleep hygiene
(MB)
Costa et al. Myofascial pain Counselling only 30 5 • Clinician led instructions and information
(2015) (36) about TMD aetiology given (PA)
• Diet modification and avoidance of hard
foods (BS)
• Use of reminders to avoid parafunctional
habits (SB)
• Relaxation techniques of the jaw, stretching
and self-massage (MB)
• Sleep hygiene and encouragement to practise
social and aerobic activities (RSE)
†
Studies are in a chronological order.
‡
Subtype of TMD included in the study as identified by the diagnostic criteria used by the study. If no subtype clearly identified,
‘TMD’ is stated as group.
§
BS (Behaviour substitution); SB (Self-monitoring of behaviour); AP (Action Planning); DB (Discrepancy between current behaviour
and goal); MB (Modelling of the behaviour); PA (Persuasive argument); IPB (Instructions on how to perform a behaviour); RNE (Reg-
ulate negative emotions); HF (Habit formation); FB (Feedback on behaviour); PhS (Pharmacological support); PrS (Problem solving);
GS (Goal setting); BF (Biofeedback); HR (Habit reversal); RSE (Restructuring of social environment).

programme to help address low self-efficacy and There are some limitations in this systematic review.
catastrophisation (42). One of these is the limited number and heterogeneous
Questions that remain unanswered from this sys- nature of the studies identified which makes it difficult
tematic review include whether or not increasing the to interpret the available evidence. Pooling the data
number of BCTs used would improve the relative was not attempted because it was beyond the remit of
effectiveness of an SM programme in TMD? Con- this qualitative review of BCTs in SM programmes. The
versely, there is a possibility that a greater number of search was not widened beyond RCTs as our aim was
BCTs would make an SM programme too intensive, to use the highest quality evidence available with mini-
providing the patient with too much information or mal risk of bias (45). The Cochrane handbook (46) does
too many tasks which would then potentially not mandate a grey literature search due to the diffi-
decrease adherence to the programme. It may, how- culty in reproducibly and reliably accessing the grey lit-
ever, be possible to translate findings related to this erature (47, 48), but we attempted to partially address
from other chronic illness self-management protocols the grey literature through our citation searches of
where data are more prevalent and interventions are included studies, reference lists of included studies and
more clearly defined (43, 44). reference lists of relevant review articles and textbook

© 2016 John Wiley & Sons Ltd

 Table 2. Frequency of use of BCTs in included studies

Number of times behaviour change technique used†

Study BS SB AP DB MB PA IPB RNE HF FB PhS PrS GS BF HR RSE

Komiyama et al. 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0
(1999) (28)
Wright et al. 1 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0
(2000) (12)

© 2016 John Wiley & Sons Ltd

Carlson et al. 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0
(2001) (8)
Dworkin et al. 1 1 1 1 0 1 1 1 0 1 0 1 1 0 0 0
(2002) (1)
Michelotti et al. 1 1 0 1 0 1 1 0 0 0 0 0 1 1 0 0
(2004) (9)
Truelove et al. 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0
(2006) (11)
Turner et al. 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0
(2006) (29)
Mulet et al. 1 1 1 0 0 1 1 0 0 0 1 0 1 0 0 0
(2007) (30)
Turner et al. 1 1 1 1 1 1 1 1 0 0 0 1 1 0 1 0
(2011) (31)
Niemela et al. 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0
(2012) (32)
(follow-up report:
Qvintus
et al. (2015)
(37))
Michelotti et al. 1 1 0 0 0 1 1 0 0 0 0 0 0 1 0 0
(2012) (10)
Craane et al. 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0
(2012) (33)
De Vocht et al. 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0
(2013) (34)
Conti et al. 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0
(2015) (35)
Costa et al. 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1
(2015) (36)
Total n BCT 12 (80) 9 (60) 3 (20) 3 (20) 5 (33
3) 15 (100) 12 (80) 4 (26
6) 1 (6
6) 3 (20 5 (33
3) 2 (13
3) 4 (26
6) 2 (13
3) 1 (6
6) 1 (6
6)
(% sample)
†
BS (Behaviour substitution); SB (Self-monitoring of behaviour); AP (Action Planning); DB (Discrepancy between current behaviour and goal); MB (Modelling of the beha-
viour); PA (Persuasive argument); IPB (Instructions on how to perform a behaviour); RNE (Regulate negative emotions); HF (Habit formation); FB (Feedback on behaviour);
A REVIEW OF BEHAVIOURAL COMPONENTS IN TMD

PhS (Pharmacological support); PrS (Problem solving); GS (Goal setting); BF (Biofeedback); HR (Habit reversal); RSE (Restructuring of social environment).
W . P . S T O R Y et al.

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W . P . S T O R Y et al.

Supporting Information Appendix S4. Risk of Bias.

Appendix S5. Supplementary data table on SM
Additional Supporting Information may be found in
programmes effect on pain intensity.
the online version of this article:
Appendix S1. PICOS inclusion/exclusion criteria
Appendix S2. List of databases searched.
Appendix S3. List of excluded studies and reason
for exclusion

© 2016 John Wiley & Sons Ltd