{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T15:18:42Z","timestamp":1772205522175,"version":"3.50.1"},"reference-count":48,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Faculty of Medical Sciences, Santa Casa de S\u00e3o Paulo, Brazil","award":["Not applicable (ou \"N\/A\u201d)"],"award-info":[{"award-number":["Not applicable (ou \"N\/A\u201d)"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,13]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the prognosis and prognostic factors associated with pain intensity and function in individuals with temporomandibular disorders (TMDs). Secondary objectives included identifying prognostic factors related to symptom progression, subsequent treatment needs and psychosocial outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review with meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Dentistry and Oral Sciences Source, SportDiscus and CINAHL (EBSCOhost) were searched up to September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Prospective longitudinal studies examining prognostic factors for pain intensity or functional outcomes in adults with TMD, with a minimum follow-up of 3\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>\n                      Two independent reviewers screened titles and abstracts and assessed full texts for eligibility. Data were extracted in duplicate using a standardised protocol that included study characteristics, prognostic factors and outcomes. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool, and the certainty of evidence was graded using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Meta-analyses were performed with random-effects models, reporting ORs and 95% CIs. Heterogeneity was evaluated using\n                      <jats:italic>I\u00b2<\/jats:italic>\n                      (I-squared) and Tau\u00b2 (Tau-squared) statistics. Where pooling was not feasible, findings were synthesised narratively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine prospective studies met the inclusion criteria; eight were included in quantitative analyses (n=4282) and one large cohort was synthesised narratively (n=94\u2009769), for a total of 99\u2009051 participants. After standardising definitions, 56 candidate factors were analysed. In adjusted models for pain, pain provoked by movement or palpation was associated with a worse course (eg, joint pain with sound: OR=2.10, 95%\u2009CI 1.39 to 3.18; muscle pain during movement: OR=2.10, 95%\u2009CI 1.33 to 3.31), while shorter pain duration (OR=0.25, 95%\u2009CI 0.09 to 0.70) and greater pain-free mouth opening (OR=0.60, 95%\u2009CI 0.40 to 0.90) were protective. For the function outcome, pain intensity was associated with poorer outcomes (OR=1.39, 95%\u2009CI 1.14 to 1.69), whereas age, sex, depression, somatisation, disability days and self-efficacy showed no consistent associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adults with TMD, pain provoked by movement or palpation and higher pain intensity were consistently associated with less favourable prognoses. Conversely, shorter pain duration and greater pain-free opening were associated with better outcomes. These associations are non-causal and based on low to very low certainty evidence amid methodological heterogeneity. While they may inform risk stratification, they should not guide treatment decisions without confirmatory longitudinal studies using standardised outcomes and improved control of confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024557159.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103638","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:40:42Z","timestamp":1772203242000},"page":"e103638","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic factors for pain intensity and function in individuals with temporomandibular disorders (TMDs): a systematic review and meta-analysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1866-5732","authenticated-orcid":false,"given":"Mait\u00ea","family":"Amaral","sequence":"first","affiliation":[{"name":"Master and Doctoral Program of Health Science, Faculdade de Ci\u00eancias M\u00e9dicas da Santa Casa de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Pain Cognition and Sports Science, Research Group, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9943-0163","authenticated-orcid":false,"given":"Leandro","family":"Fukusawa","sequence":"additional","affiliation":[{"name":"Master and Doctoral Program of Health Science, Faculdade de Ci\u00eancias M\u00e9dicas da Santa Casa de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Pain Cognition and Sports Science, Research Group, S\u00e3o Paulo, Brazil"},{"name":"Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Martins","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana Gabrich Moraes","family":"Campos","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasmin","family":"El-Hage","sequence":"additional","affiliation":[{"name":"No current affiliation, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinicius C","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil"},{"name":"Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Galace de Freitas","sequence":"additional","affiliation":[{"name":"Master and Doctoral Program of Health Science, Faculdade de Ci\u00eancias M\u00e9dicas da Santa Casa de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Pain Cognition and Sports Science, Research Group, S\u00e3o Paulo, Brazil"},{"name":"Department of Physiotherapy, Irmandade da Santa Casa de Misericordia de Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"2026022706403777000_16.2.e103638.1","article-title":"Revision of the American Association of Dental Research\u2019s Science Information Statement about Temporomandibular Disorders","volume":"76","author":"Greene","year":"2010","journal-title":"J Can Dent Assoc"},{"key":"2026022706403777000_16.2.e103638.2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102419893823"},{"key":"2026022706403777000_16.2.e103638.3","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.joms.2005.05.318","article-title":"The Role of Facial Trauma as a Possible Etiologic Factor in Temporomandibular Joint Disorder","volume":"63","author":"Yun","year":"2005","journal-title":"J Oral Maxillofac Surg"},{"key":"2026022706403777000_16.2.e103638.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12903-023-02737-1","article-title":"Temporomandibular disorder severity and its association with psychosocial and sociodemographic factors in Turkish adults","volume":"23","author":"Omezli","year":"2023","journal-title":"BMC Oral Health"},{"key":"2026022706403777000_16.2.e103638.5","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.oooo.2024.06.007","article-title":"Risk factors for temporomandibular disorders: a systematic review of cohort studies","volume":"138","author":"Da-Cas","year":"2024","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"2026022706403777000_16.2.e103638.6","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1111\/joor.13786","article-title":"Association of night-time sleep and daytime napping with painful temporomandibular disorder","volume":"51","author":"Jiang","year":"2024","journal-title":"J Oral Rehabil"},{"key":"2026022706403777000_16.2.e103638.7","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1080\/08869634.2021.1982496","article-title":"Somatic and temporomandibular disorder symptoms - Idioms of psychological distress in Southeast Asian youths","volume":"42","author":"Yap","year":"2024","journal-title":"CRANIO\u00ae"},{"key":"2026022706403777000_16.2.e103638.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(97)00194-2"},{"key":"2026022706403777000_16.2.e103638.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2013.11.493"},{"key":"2026022706403777000_16.2.e103638.10","unstructured":"Sociedade brasileira de disfun\u00e7\u00e3o temporomandibular e dor orofacial. 2017. Available: http:\/\/sbdof.com\/"},{"key":"2026022706403777000_16.2.e103638.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.02.005"},{"key":"2026022706403777000_16.2.e103638.12","doi-asserted-by":"publisher","DOI":"10.2174\/1573397112666151231110947"},{"key":"2026022706403777000_16.2.e103638.13","first-page":"9","article-title":"Longitudinal outcome of temporomandibular disorders: A 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders","volume":"17","author":"Rammelsberg","year":"2003","journal-title":"J Orofac Pain"},{"key":"2026022706403777000_16.2.e103638.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2019.03.023"},{"key":"2026022706403777000_16.2.e103638.15","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001348"},{"key":"2026022706403777000_16.2.e103638.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026022706403777000_16.2.e103638.17","unstructured":"Higgins JP , Green S . Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Book Series,"},{"key":"2026022706403777000_16.2.e103638.18","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001390"},{"key":"2026022706403777000_16.2.e103638.19","doi-asserted-by":"crossref","DOI":"10.1186\/s41512-019-0050-0","article-title":"Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS-aspects of interrater agreement","volume":"3","author":"Grooten","year":"2019","journal-title":"Diagn Progn Res"},{"key":"2026022706403777000_16.2.e103638.20","doi-asserted-by":"crossref","DOI":"10.1186\/2046-4053-2-71","article-title":"Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework","volume":"2","author":"Huguet","year":"2013","journal-title":"Syst Rev"},{"key":"2026022706403777000_16.2.e103638.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.006"},{"key":"2026022706403777000_16.2.e103638.22","unstructured":"Chapter 10: Analysing Data and Undertaking Meta-Analyses.2025. Available: https:\/\/training.cochrane.org\/handbook\/current\/chapter-10"},{"key":"2026022706403777000_16.2.e103638.23","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.916"},{"key":"2026022706403777000_16.2.e103638.24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/joor.12009","article-title":"Improvement in patients with a TMD-pain report. A 6-month follow-up study","volume":"40","author":"Rollman","year":"2013","journal-title":"J Oral Rehabil"},{"key":"2026022706403777000_16.2.e103638.25","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-86502-0","article-title":"Women are worse off in developing and recovering from temporomandibular disorder symptoms","volume":"15","author":"L\u00f6vgren","year":"2025","journal-title":"Sci Rep"},{"key":"2026022706403777000_16.2.e103638.26","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.jds.2020.02.007","article-title":"Influence of psychological factors on the prognosis of temporomandibular disorders pain","volume":"16","author":"Jung","year":"2021","journal-title":"J Dent Sci"},{"key":"2026022706403777000_16.2.e103638.27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/00016357.2019.1650955","article-title":"Factors associated with signs of temporomandibular pain: an 11-year-follow-up study on Finnish adults","volume":"78","author":"Banafa","year":"2020","journal-title":"Acta Odontol Scand"},{"key":"2026022706403777000_16.2.e103638.28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/00016357.2022.2085323","article-title":"Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults","volume":"81","author":"Banafa","year":"2023","journal-title":"Acta Odontol Scand"},{"key":"2026022706403777000_16.2.e103638.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b3829","article-title":"Prognosis for patients with chronic low back pain: inception cohort study","volume":"339","author":"Costa","year":"2009","journal-title":"BMJ"},{"key":"2026022706403777000_16.2.e103638.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h444","article-title":"Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis","volume":"350","author":"Kamper","year":"2015","journal-title":"BMJ"},{"key":"2026022706403777000_16.2.e103638.31","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph20042777","article-title":"Effects of an Interdisciplinary Approach in the Management of Temporomandibular Disorders: A Scoping Review","volume":"20","author":"Brighenti","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"2026022706403777000_16.2.e103638.32","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwj100"},{"key":"2026022706403777000_16.2.e103638.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2005.06.017"},{"key":"2026022706403777000_16.2.e103638.34","doi-asserted-by":"crossref","unstructured":"Henschke N , Maher CG , Refshauge KM , et al . Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008;337. doi:10.1136\/bmj.a171","DOI":"10.1136\/bmj.a171"},{"key":"2026022706403777000_16.2.e103638.35","doi-asserted-by":"crossref","unstructured":"Kent P , Cancelliere C , Boyle E , et al . A conceptual framework for prognostic research. BMC Med Res Methodol 2020;20. doi:10.1186\/s12874-020-01050-7","DOI":"10.1186\/s12874-020-01050-7"},{"key":"2026022706403777000_16.2.e103638.36","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jpain.2013.03.013","article-title":"Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study","volume":"14","author":"Campbell","year":"2013","journal-title":"J Pain Agosto De"},{"key":"2026022706403777000_16.2.e103638.37","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001097"},{"key":"2026022706403777000_16.2.e103638.38","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1002\/ejp.1782","article-title":"Self\u2010reported prognostic factors in adults reporting neck or low back pain: An umbrella review","volume":"25","author":"Mansell","year":"2021","journal-title":"Eur J Pain"},{"key":"2026022706403777000_16.2.e103638.39","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph20021545","article-title":"Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles","volume":"20","author":"Vi\u00f1als Narv\u00e1ez","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"2026022706403777000_16.2.e103638.40","doi-asserted-by":"crossref","unstructured":"Alrizqi AH , Aleissa BM . n.d. Prevalence of Temporomandibular Disorders Between 2015-2021: A Literature Review. Cureus 15:e37028. doi:10.7759\/cureus.37028","DOI":"10.7759\/cureus.37028"},{"key":"2026022706403777000_16.2.e103638.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12903-024-04736-2","article-title":"Clinical profile in relation to age and gender of patients with temporomandibular disorders: a retrospective study","volume":"24","author":"Qin","year":"2024","journal-title":"BMC Oral Health"},{"key":"2026022706403777000_16.2.e103638.42","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3390\/clockssleep5040047","article-title":"Diagnostic Accuracy of a Portable Electromyography and Electrocardiography Device to Measure Sleep Bruxism in a Sleep Apnea Population: A Comparative Study","volume":"5","author":"Cid-Verdejo","year":"2023","journal-title":"Clocks Sleep"},{"key":"2026022706403777000_16.2.e103638.43","doi-asserted-by":"publisher","DOI":"10.1177\/0022034516648264"},{"key":"2026022706403777000_16.2.e103638.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2015.03.022"},{"key":"2026022706403777000_16.2.e103638.45","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11216396","article-title":"Relationship between Oral Parafunctional and Postural Habits and the Symptoms of Temporomandibular Disorders: A Survey-Based Cross-Sectional Cohort Study Using Propensity Score Matching Analysis","volume":"11","author":"Abe","year":"2022","journal-title":"J Clin Med"},{"key":"2026022706403777000_16.2.e103638.46","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare12050575","article-title":"Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC\/TMD) from 2018 to 2022","volume":"12","author":"Warzocha","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"2026022706403777000_16.2.e103638.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2014.08.007"},{"key":"2026022706403777000_16.2.e103638.48","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-4-201302190-00009"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-103638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:40:46Z","timestamp":1772203246000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-103638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,27]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-103638"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-103638","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}