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Patient Adherence to Splint Therapy and Counselling Programmes in Temporomandibular Disorders: Development and

Soaad Tolba Badawy¹, Amal T Badawi^2,3, Mai Ahmed Haggag¹

¹Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.

Journal of Oral Rehabilitation

|January 24, 2026

Abstract

Background:

Adherence to conservative treatments is essential for optimal outcomes in temporomandibular disorder (TMD) patients, yet validated tools for measuring adherence are lacking.

Purpose:

This study aimed to develop and validate a bilingual (Arabic-English) questionnaire to comprehensively assess adherence among TMD patients.

Study Design, Setting, Sample:

A cross-sectional, observational, five-phase design was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University (Egypt). The study included a pilot sample of 60 TMD patients and a psychometric evaluation sample of 300 patients.

Exposure:

The exposure was adherence behaviour, measured by a newly developed 50-item, 11-domain adherence questionnaire.

Main Outcome Variable(S):

The primary outcomes were psychometric properties of the questionnaire, including content validity, internal consistency, test-retest reliability and construct validity.

Covariates:

Patient language version (Arabic or English) was considered to examine potential influences on questionnaire performance.

Analyses:

Content validity was assessed using Item-Content Validity Index (I-CVI) and Content Validity Ratio (CVR). Reliability was evaluated with Cronbach's α and intra-class correlation coefficient (ICC). Construct validity was examined with exploratory factor analysis (EFA).

Results:

The final 50-item, 11-domain questionnaire demonstrated strong content validity. Internal consistency was acceptable for both Arabic (Cronbach's α = 0.70) and English (α = 0.68) versions. Test-retest reliability was good (ICC = 0.762-0.898; p < 0.001). EFA confirmed 11 domains, accounting for 61.5% of variance in Arabic and 64.73% in English.

Conclusions And Relevance:

The Badawy and Haggag Adherence Questionnaire for TMD demonstrated strong validity and reliability across Arabic and English versions. It provides a robust clinical and research tool for assessing adherence to conservative TMD management, enabling clinicians to identify non-adherence and design tailored interventions to improve outcomes.

Trial Registration:

ClinicalTrials.gov ID NCT07045441. The trial was first posted on 22 June 2025, and the most recent update was posted on 30 June 2025. Retrospectively registered.

Keywords:

bilingual validation counselling factor analysis patient adherence psychometrics questionnaire validation splint therapy temporomandibular disorders

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