Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Validity and reliability of the 8-item version of the jaw functional limitation scale (JFLS-8) in the Arabic language
1School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
2School of Psychology, University of South Australia, 5000 Adelaide, SA, Australia
3School of Nursing, Beirut Arab University, 1107 Beirut, Lebanon
4Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, P.O. Box 36, Jbeil, Lebanon
5The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, 2010 Manouba, Tunisia
6Faculty of Medicine of Tunis, Tunis El Manar University, 1007 Tunis, Tunisia
7Applied Science Research Center, Applied Science Private University, 11931 Amman, Jordan
DOI: 10.22514/jofph.2026.018 Vol.40,Issue 2,March 2026 pp.14-21
Submitted: 13 November 2025 Accepted: 09 December 2025
Published: 12 March 2026
*Corresponding Author(s): Sahar Obeid E-mail: Sahar.obeid@lau.edu.lb
*Corresponding Author(s): Souheil Hallit E-mail: souheilhallit@usek.edu.lb
† These authors contributed equally.
Background: The Jaw Function Limitation Scale (JFLS) is a recently developed instrument that assesses specific jaw function limitations and objective restrictions in daily activities such as chewing, jaw mobility, and verbal communication in a valid and reliable manner. The scale has been translated and validated in several languages and contexts, but no Arabic version is currently available. To address the absence of a validated tool for assessing jaw dysfunction in Arabic-speaking populations, this study aimed to evaluate the validity, reliability, and factor structure of the 8-item version of the JFLS. Methods: This cross-sectional study was conducted between August and October 2025 and included 427 Arabic-speaking adults from Lebanon. Confirmatory factor analysis (CFA) was used to validate the scale. Results: The analysis supported a three-factor structure. Internal reliability was satisfactory, with high internal consistency coefficients (ω = 0.93/α = 0.93). Measurement invariance across gender was confirmed, with no significant differences between males and females in jaw function limitation scores. Greater jaw function limitation was significantly associated with increased insomnia, psychological distress, and neck disability, supporting the scale’s convergent validity. Conclusions: This study provides a brief, valid, and reliable Arabic version of the 8-item JFLS for assessing jaw and masticatory functional limitations in Arabic-speaking populations. The scale has potential applications in clinical assessment, intervention planning, and cross-cultural research.
Jaw dysfunction; Validity; Reliability; Arabic; Psychometric properties
Ziad Azar,Christelle Haddad,Lynn Fayad,Tia Azar,Tylor Cosgrove,Mirna Fawaz,Sahar Obeid,Feten Fekih-Romdhane,Souheil Hallit. Validity and reliability of the 8-item version of the jaw functional limitation scale (JFLS-8) in the Arabic language. Journal of Oral & Facial Pain and Headache. 2026. 40(2);14-21.
[1] Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. The New England Journal of Medicine. 2008; 359: 2693–2705.
[2] Polat S, Öksüzler FY, Öksüzler M, Çoban Ö, Tunç M, Yüksel HD, et al. Temporomandibular joint and masticatory muscles morphometry and morphology in healthy subjects and individuals with temporomandibular dysfunction: an anatomical, radiological, and machine learning application study. Medicine. 2024; 103: e40846.
[3] Oghli I, List T, John MT, Häggman-Henrikson B, Larsson P. Prevalence and normative values for jaw functional limitations in the general population in Sweden. Oral Diseases. 2019; 25: 580–587.
[4] Kliangkaeo W, Tangpothitham S, Mitrirattanakul S, Wachiralarpphaithoon C. The effect of different pain characteristics on jaw functional limitations in patients with temporomandibular disorders. Journal of Oral Rehabilitation. 2024; 51: 998–1004.
[5] Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021; 25: 441–453.[y1]
[6] Diab A, Elkhashab MA, Aziz EA. Prevalence and severity of temporomandibular disorders among egyptian postgraduate students: a cross-sectional study. Advanced Dental Journal. 2023; 5: 166–173.
[7] Sfeir A, Touma G, Ghosein E, Tannoury C, Aoun G. Prevalence of temporomandibular joint-TMJ disorders in a sample of the Lebanese population. Bulletin of Stomatology and Maxillofacial Surgery. 2025; 21: 156–162.
[8] Kmeid E, Nacouzi M, Hallit S, Rohayem Z. Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress. Head & Face Medicine. 2020; 16: 19.
[9] Klasser GD. Arthritis of the temporomandibular joint (TMJ). 2025. Available at: https://www.msdmanuals.com/professional/dental-disorders/temporomandibular-disorders/arthritis-of-the-temporomandibular-joint-tmj (Accessed: 24 October 2025).
[10] Glerup M, Tagkli A, Küseler A, Christensen AE, Verna C, Bilgrau AE, et al. Incidence of orofacial manifestations of juvenile idiopathic arthritis from diagnosis to adult care transition: a population-based cohort study. Arthritis & Rheumatology. 2023; 75: 1658–1667.
[11] Zheng H, Shi L, Lu H, Liu Z, Yu M, Wang Y, et al. Influence of edentulism on the structure and function of temporomandibular joint. Heliyon. 2023; 9: e20307.
[12] Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of Oral and Maxillofacial Surgery. 2014; 72: 1938–1956.
[13] Xiong X, Xiao CQ, Yang YC, Li YJ, Cheng QY, Wang XY, et al. Temporomandibular disorder patients with excessive daytime sleepiness present greater pain intensity and reduced jaw function. Journal of Oral Rehabilitation. 2024; 51: 639–647.
[14] Yap AU, Zheng Y, Luo F, Liu T, Li Y, Liu Y, et al. Insights into oral behaviours among temporomandibular disorder patients: associations with psychological distress, sleep propensity and jaw function. Journal of Oral Rehabilitation. 2025; 52: 2228–2239.
[15] Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, De Beaumont L, et al. The contribution of sleep quality and psychological factors to the experience of within-day pain fluctuations among individuals with temporomandibular disorders. The Journal of Pain. 2024; 25: 104576.
[16] Rigon M, Obara K, Paixão L, Cardoso JR, Machado Junior AJ. Relationship between temporomandibular and sleep disorders in adults:
An overview of systematic reviews. Sleep Medicine. 2024; 124: 404–415.[y2]
[17] Marklund S, Wiesinger B, Wänman A. Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas. European Journal of Pain. 2010; 14: 366–371.
[18] Lim PF, Smith S, Bhalang K, Slade GD, Maixner W. Development of temporomandibular disorders is associated with greater bodily pain experience. The Clinical Journal of Pain. 2010; 26: 116–120.
[19] Ünlüer NÖ, Ateş Y, Baş SS. Temporomandibular dysfunction affects neck disability, headache, anxiety, and sleep quality in women: a cross-sectional study. Journal of Clinical Practice and Research. 2023; 45: 456.
[20] Saini RS, Quadri SA, Mosaddad SA, Heboyan A. The relationship between psychological factors and temporomandibular disorders: a systematic review and meta-analysis. Head & Face Medicine. 2025; 21: 46.
[21] de Araújo AN, do Nascimento MA, de Sena EP, Baptista AF. Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper. Drug, Healthcare and Patient Safety. 2014; 6: 21–27.
[22] Jegede O, Jegede O, Oyelakin T, Nisenoff C, Jolayemi A. Haloperidol induced unilateral temporomandibular joint dysfunction. MOJ Toxicology. 2018; 4: 358–359.
[23] Stegenga B, de Bont LG, de Leeuw R, Boering G. Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. Journal of Orofacial Pain. 1993; 7: 183–195.
[24] Peršić S, Palac A, Bunjevac T, Celebić A. Development of a new chewing function questionnaire for assessment of a self-perceived chewing function. Community Dentistry and Oral Epidemiology. 2013; 41: 565–573.
[25] Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dental Health. 1994; 11: 3–11.
[26] Hilasaca-Mamani M, Barbosa T de S, Feine J, Ferreira RI, Boni RC, Castelo PM. Brazilian translation and adaptation of the questionnaire d’alimentation. Revista CEFAC: Atualizacao Cientifica em Fonoaudiologia e Educacao. 2015; 17: 1929–1939. (In Brazilian)
[27] Ohrbach R, Larsson P, List T. The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions. Journal of Orofacial Pain. 2008; 22: 219–230.
[28] Fetai A, Dedic B, Lajnert V, Spalj S. To what extent are the characteristics of painful temporomandibular disorders predictors of self-reported limitations in jaw function? CRANIO®. 2023; 41: 290–297.
[29] Xu L, He Y, Fan S, Cai B, Fang Z, Dai K. Validation of a Chinese version of the Jaw Functional Limitation Scale in relation to the diagnostic subgroup of temporomandibular disorders. Journal of Oral Rehabilitation. 2020; 47: 1–8.
[30] Pattanaik S, John MT, Chung S, Keller S. Differential item functioning of the jaw functional limitation scale. Journal of Oral & Facial Pain and Headache. 2023; 37: 33–46.
[31] da Cunha TA, Chaves TC, Pereira Júnior FJ, de Godoi Gonçalves DA, Alstergren P, Biasotto-Gonzalez DA. Brazilian portuguese version of the diagnostic criteria for temporomandibular disorders axis II: translation, cross-cultural adaptation and measurement properties. Journal of Oral Rehabilitation. 2025; 52: 712–721.
[32] Yıldız NT, Kocaman H, Bingöl H. Validity and reliability of the Turkish version of the 20-item jaw functional limitation scale. Physiotherapy Theory and Practice. 2025; 41: 377–389.
[33] Yildiz N, Kocaman H, Bingöl H. Validity and reliability of the Turkish version of the 8-item jaw functional limitation scale. Journal of Oral & Facial Pain and Headache. 2025; 39: 166–174.
[34] Tedin Ng FN, Kadir K, Yusof ZYM. Reliability and validity of the malaysian english version of the diagnostic criteria for temporomandibular disorder (M-English DC/TMD). Healthcare. 2022; 10: 329.
[35] Aiyegbusi OL, Roydhouse J, Rivera SC, Kamudoni P, Schache P, Wilson R, et al. Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nature Communications. 2022; 13: 6026.
[36] Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of Oral & Facial Pain and Headache. 2014; 28: 6–27.
[37] Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000; 25: 3186–3191.
[38] Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine. 2001; 2: 297–307.
[39] Hallit S, Haddad C, Hallit R, Al Karaki G, Malaeb D, Sacre H, et al. Validation of selected sleeping disorders related scales in Arabic among the Lebanese population. Sleep and Biological Rhythms. 2019; 17: 183–189.
[40] Vernon H, Mior S. The neck disability index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 1991; 14: 409–415.
[41] Shaheen AAM, Omar MTA, Vernon H. Cross-cultural adaptation, reliability, and validity of the Arabic version of neck disability index in patients with neck pain. Spine. 2013; 38: E609–E615.
[42] Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009; 50: 613–621.
[43] Obeid S, Hemade A, Malaeb D, Sakr F, Dabbous M, Xu J, et al. Psychometric properties of the ultra-brief self-report Patient Health Questionnaire-4 (PHQ-4) to assess anxiety and depression in Arabic-speaking adults. BMC Psychiatry. 2024; 24: 537.
[44] Kline RB. Principles and practice of structural equation modeling. 4th edn. New York Guilford Press: New York, NY. 2015.
[45] Farag KA, Mohamed MA, Baker ZMA, Binsaud BM, Jaber AM. The impact of sample size on exploratory and confirmatory factor analysis: a simulation study. International Journal of Environmental Sciences. 2025; 11: 1691–1695.
[46] Byrne BM. Structural equation modeling with AMOS: basic concepts, applications, and programming. 2nd edn. Routledge: New York, NY. 2013.
[47] Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling. 2007; 14: 464–504.
[48] Swami V, Todd J, Azzi V, Malaeb D, Sarray El Dine A, Obeid S, et al. Psychometric properties of an Arabic translation of the Functionality Appreciation Scale (FAS) in Lebanese adults. Body Image. 2022; 42: 361–369.
[49] Vandenberg RJ, Lance CE. A review and synthesis of the measurement invariance literature: suggestions, practices, and recommendations for organizational research. Organizational Research Methods. 2000; 3: 4–70.
[50] Brown TA. Confirmatory factor analysis for applied research. 2nd edn. The Guilford Press: New York, NY. 2015.
[51] Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choinière M. A systematic literature review of 10 years of research on sex/gender and experimental pain perception—part 1: are there really differences between women and men? Pain. 2012; 153: 602–618.
[52] Alqarni A, Khan F, Alabasi U, Ruscheweyh R. Translation, cross-cultural adaptation, and measurement properties of the Arabic version of the pain sensitivity questionnaire. Frontiers in Pain Research. 2024; 5: 1339449.
[53] Lai K, Green SB. The problem with having two watches: assessment of fit when RMSEA and CFI disagree. Multivariate Behavioral Research. 2016; 51: 220–239.
[54] Kenny DA, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of freedom. Sociological Methods & Research. 2015; 44: 486–507.
[55] Hoa NN, Do T, Binh TT, Dong TT, Quyen TTM, Hoang VH. Evaluation of mandibular functional limitation in patients with temporomandibular joint disorders and the relationship with other psychosocial factors. PLOS ONE. 2025; 20: e0334508.
[56] Liou YJ, Bai YM, Tsai SJ, Chen TJ, Chen MH, Lo WL. Bidirectional associations of temporomandibular joint disorders with major depressive and anxiety disorders. Journal of Evidence-Based Dental Practice. 2023; 23: 101860.
[57] Olivo SA, Fuentes J, Major PW, Warren S, Thie NMR, Magee DJ. The association between neck disability and jaw disability. Journal of Oral Rehabilitation. 2010; 37: 670–679.
[58] Walczyńska-Dragon K, Baron S, Nitecka-Buchta A, Tkacz E. Correlation between TMD and cervical spine pain and mobility: is the whole body balance TMJ related? BioMed Research International. 2014; 2014: 582414.
[59] Odzimek M, Brola W. Occurrence of cervical spine pain and its intensity in young people with temporomandibular disorders. Journal of Clinical Medicine. 2024; 13: 1941.
[60] Bednarczyk V, Proulx F, Paez A. The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: a systematic review and meta-analysis. Journal of Oral Rehabilitation. 2024; 51: 1091–1107.
[61] Kim HK, Kim ME. Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders. Journal of Oral Rehabilitation. 2021; 48: 1013–1024.
Top