“Nothing about us without us”: Co-production of and ‘How To’ implement a biopsychosocial supported self-management intervention for TMD
Vishal R. Aggarwal, Agata Witkowska, Karina LovellBackground:
Temporomandibular disorders (TMDs) affect up to 1 in 15 people, significantly impairing daily function and quality of life. Despite clinical guidance recommending a biopsychosocial approach, treatment remains largely biomedical, often relying on occlusal splints or invasive procedures with limited evidence. This study describes a patient-centred, supported, self-management intervention for TMDs co-developed with patients, and its implementation into clinical practice.
Methods:
The intervention was co-developed with patients through syntheses of systematic reviews, qualitative research, and adaptation from a chronic widespread pain intervention. It incorporates a biopsychosocial framework including pain science education, jaw posture control, behavioural activation, cognitive restructuring, and habit reversal. The intervention guide is designed for remote delivery by a trained facilitator. It was evaluated in a proof-of-concept trial and service evaluation.
Results:
The evaluation study (N=104) demonstrates the intervention’s feasibility and efficacy for TMD, reducing pain, interference, and healthcare use. Patients favoured the personalised, remote, guided delivery. Key mechanisms included breaking physical/psychosocial vicious cycles using goal-setting, thus enabling patients to regain control and reverse unhelpful patterns.
Conclusion:
The intervention aligns with biopsychosocial models of care, empowering patients with self-management skills to manage their TMDs. Its flexible, remote format enhances accessibility and environmental sustainability. By addressing key gaps in current pathways, this work also underscores the importance of patient co-design in producing acceptable, scalable, and effective health interventions.