---
title: "Behavioral Modification as a Mediator of Digital Therapeutic Response in Temporomandibular Disorde"
id: "pubmed-42691400"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42691400"
content_type: "clinical_feed_article"
specialty: "Dentistry"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42691400/"
doi: "10.2196/104264"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Behavioral Modification as a Mediator of Digital Therapeutic Response in Temporomandibular Disorde
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42691400
- **Specialty:** [Dentistry](https://medichelpline.com/clinical-feed/dentistry.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42691400/)
- **DOI:** [10.2196/104264](https://doi.org/10.2196%2F104264)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This secondary analysis evaluated whether **behavioral modification** or engagement intensity mediates clinical response to a **digital therapeutic (DTx)** for **temporomandibular disorders (TMDs)** using data from a multicenter, double-blind, sham-controlled randomized superiority trial in South Korea. - The per-protocol sample included 93 participants (DTx, n=44; sham, n=49) drawn from two tertiary care centers. - Investigators integrated multiple data streams: self-reported measures, server-derived engagement metrics, and clinician-rated outcomes to probe mechanisms of treatment response. - The analysis applied five complementary analytic approaches; the abstract lists “responder logistic regressio” before truncation, indicating a range of regression and responder-profile methods were planned. - The study aimed to identify behavioral mechanisms, responder profiles, and moderators that explain why some patients benefit from DTx while others do not. - The report does not provide full methodological details, statistical results, effect sizes, or specific findings in the available abstract text; those details were not reported in the provided source. - Key reported trial features: multicenter, double-blind, sham-controlled randomized superiority design, per-protocol cohort size, and integration of multiple outcome sources. - Because the source abstract is truncated, interpretation must be limited to reported aims, design, and available cohort information; specific conclusions about mediation by behavioral modification or engagement intensity are not available in the provided text. - The analysis addresses an important clinical question: whether a DTx exerts benefit via changing patient behavior versus simply reflecting higher engagement, with implications for tailoring and optimizing DTx for **TMD** management.
## Clinical Analysis & Structured Key Points
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](https://pubmed.ncbi.nlm.nih.gov/42691400/#abstract) * [ Publication types ](https://pubmed.ncbi.nlm.nih.gov/42691400/#publication-types) * [ MeSH terms ](https://pubmed.ncbi.nlm.nih.gov/42691400/#mesh-terms) Title & authors Abstract Publication types MeSH terms Randomized Controlled Trial JMIR Mhealth Uhealth Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22JMIR+Mhealth+Uhealth%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22JMIR+Mhealth+Uhealth%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42691400/) . 2026 Sep 3:14:e104264. doi: 10.2196/104264. # Behavioral Modification as a Putative Mediator of Digital Therapeutic Response in Temporomandibular Disorders: Secondary Analysis of a Multicenter Sham-Controlled Randomized Trial [Soo-Hwan Byun](https://pubmed.ncbi.nlm.nih.gov/?term=Byun+SH&cauthor_id=42691400)[#](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Sung-Woon On](https://pubmed.ncbi.nlm.nih.gov/?term=On+SW&cauthor_id=42691400)[#](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-4 "Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea."), [Byong-Eun Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+BE&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Sung-Ah Che](https://pubmed.ncbi.nlm.nih.gov/?term=Che+SA&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-4 "Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea."), [Sang-Min Yi](https://pubmed.ncbi.nlm.nih.gov/?term=Yi+SM&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Yongjin Park](https://pubmed.ncbi.nlm.nih.gov/?term=Park+Y&cauthor_id=42691400)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-5 "Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China \(Hong Kong\)."), [Yeolib Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+Y&cauthor_id=42691400)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-6 "School of Business Administration, Ulsan National Institute of Science and Technology, Ulsan, Ulsan, Republic of Korea."), [Sang-Yoon Park](https://pubmed.ncbi.nlm.nih.gov/?term=Park+SY&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#full-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978.") Affiliations Expand ### Affiliations * 1 Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea. * 2 Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea. * 3 Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978. * 4 Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea. * 5 Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China (Hong Kong). * 6 School of Business Administration, Ulsan National Institute of Science and Technology, Ulsan, Ulsan, Republic of Korea. # Contributed equally. * PMID: **42691400** * DOI: [ 10.2196/104264 ](https://doi.org/10.2196/104264) Item in Clipboard Randomized Controlled Trial # Behavioral Modification as a Putative Mediator of Digital Therapeutic Response in Temporomandibular Disorders: Secondary Analysis of a Multicenter Sham-Controlled Randomized Trial Soo-Hwan Byun et al. JMIR Mhealth Uhealth. 2026. Show details Display options Display options Format Abstract PubMed PMID JMIR Mhealth Uhealth Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22JMIR+Mhealth+Uhealth%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22JMIR+Mhealth+Uhealth%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42691400/) . 2026 Sep 3:14:e104264. doi: 10.2196/104264. ### Authors [Soo-Hwan Byun](https://pubmed.ncbi.nlm.nih.gov/?term=Byun+SH&cauthor_id=42691400)[#](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Sung-Woon On](https://pubmed.ncbi.nlm.nih.gov/?term=On+SW&cauthor_id=42691400)[#](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-4 "Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea."), [Byong-Eun Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+BE&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Sung-Ah Che](https://pubmed.ncbi.nlm.nih.gov/?term=Che+SA&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-4 "Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea."), [Sang-Min Yi](https://pubmed.ncbi.nlm.nih.gov/?term=Yi+SM&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978."), [Yongjin Park](https://pubmed.ncbi.nlm.nih.gov/?term=Park+Y&cauthor_id=42691400)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-5 "Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China \(Hong Kong\)."), [Yeolib Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+Y&cauthor_id=42691400)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-6 "School of Business Administration, Ulsan National Institute of Science and Technology, Ulsan, Ulsan, Republic of Korea."), [Sang-Yoon Park](https://pubmed.ncbi.nlm.nih.gov/?term=Park+SY&cauthor_id=42691400)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-1 "Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-2 "Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691400/#short-view-affiliation-3 "Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978.") ### Affiliations * 1 Institute of Clinical Dentistry, Hallym University, Hallym University, Chuncheon, Gangwon-do, Republic of Korea. * 2 Dental Artificial Intelligence and Robotics R&D Center, Hallym University Medical Center, Anyang, Gyeonggi-do, Republic of Korea. * 3 Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea, 82 313805978. * 4 Department of Oral and Maxillofacial Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea. * 5 Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China (Hong Kong). * 6 School of Business Administration, Ulsan National Institute of Science and Technology, Ulsan, Ulsan, Republic of Korea. # Contributed equally. * PMID: **42691400** * DOI: [ 10.2196/104264 ](https://doi.org/10.2196/104264) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Temporomandibular disorders (TMDs) are common chronic conditions involving orofacial pain and functional limitations. Digital therapeutics (DTx) have demonstrated efficacy in TMD management; yet, the behavioral and clinical mechanisms underlying treatment response remain poorly characterized, particularly whether behavioral modification or DTx engagement intensity drives therapeutic benefit. **Objective:** This study aimed to investigate the behavioral mechanisms, responder profiles, and moderators of clinical response to a DTx intervention for TMD through a post hoc analysis integrating self-reported, server-derived, and clinician-rated outcome measures. **Methods:** We performed a post hoc secondary analysis of a multicenter, double-blind, sham-controlled randomized superiority trial conducted at 2 tertiary care centers in South Korea. The per-protocol cohort comprised 93 participants (DTx: n=44; sham: n=49). Five complementary analyses were applied: responder logistic regressio
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