This study is a randomized controlled experimental trial designed, which investigates the effectiveness of Clinical Pilates when added to lifestyle counseling, aims to contribute to the literature by evaluating its potential role in the treatment planning of women with TMD. Within the scope of this research, the therapeutic effects of Clinical Pilates will be examined.
The study will include agree to participate voluntarily, and meet the study criteria.
Inclusion criteria:
* Female participants aged between 18 and 45 years
* Diagnosed with temporomandibular disorder (according to DC/TMD diagnostic criteria)
* Experiencing TMD-related complaints for at least the past 3 months
* No prior experience with Pilates or lifestyle counseling
* No contraindications to exercise
* Diagnosed with muscle-related TMD
Exclusion Criteria:
* Presence of rheumatologic diseases
* Neurological disorders
* Pregnancy
* History of head or neck trauma
* Diagnosis of joint-related TMD (with or without reduction)
Participants will be randomly assigned into two groups:
* Group 1 (Control Group): Participants will receive lifestyle counseling only.
* Group 2 (Intervention Group): In addition to lifestyle counseling, participants will take part in a Clinical Pilates exercise program twice a week for a total duration of 8 weeks.
To evaluate the effects of the interventions, pre and post-treatment assessments will be conducted using the following outcome measures:
* Visual Analog Scale (VAS) and Graded Chronic Pain Scale Version 2.0 (GCPS v2.0) for pain assessment,
* Jaw Functional Limitation Scale-20 (JFLS-20) and Maximum Mouth Opening (MMO) for assessing jaw function,
* Craniovertebral Angle Measurement for evaluating head posture,
* Oral Behavior Checklist (OBC) for assessing oral parafunctions and bruxism,
* Generalized Anxiety Disorder-7 (GAD-7) for psychological status,
* Patient Health Questionnaire-15 (PHQ-15) for quality of life,
* Pittsburgh Sleep Quality Index (PSQI) for sleep quality.
Treatment Program Lifestyle counseling will be delivered as a structured program focusing on stress management, sleep hygiene, oral habits, and nutritional behaviors. Clinical Pilates exercises will be tailored to each participant's symptoms and supervised by an experienced physiotherapist. It will be elaborated during the reporting phase of the study and written into the article.
Sample size The sample size is a critical component in the study, and its consideration is essential for the interpretation of the results.
The sample size of the study will be determined using the GPower 3.1.9 software (GPower, Universität Düsseldorf, Germany) with a statistical power of 85% and a type I error rate of 5%. As there is no existing study with an effect size that precisely matches the current research design, the effect size obtained from a pilot study will be used, and a post-hoc power analysis will be conducted to finalize the sample size.
Statistical Analysis Descriptive statistics are reported as mean and standard deviation or median and mode. Categorical variables are defined with numbers and percentages. The normality assumption is tested using the Shapiro-Wilks test and graphs (hygtogram, QQ plot, etc.). When comparing two groups, the independent groups t-test is used if the assumptions are met, and the Mann-Whitney U test is used if the assumptions are not met. Two-way analysis of variance for repeated measures is used when the assumptions are met, and Friedman's test is used when the assumptions are not met. Chi-squared tests will be used to determine whether there is a significant difference between categorical variables. Analyses will be performed using IBM SPSS v.21 and the significance level will be set at p\<0.05.
