Mulligan Mobilization in Rheumatoid Hand

Comparison of the Effects of Exercise and Protective Approach in the Rheumatoid Hand and Joint Mobilization Applications on Pain, Functional Status and Quality of Life

The goal of this randomized-controlled study is to learn about the effectiveness of the Mulligan mobilization in rheumatoid hands. The main question it aims to answer are:

-Does mulligan mobilization reduce effusion in wrist joints with rheumatoid arthritis? Participants will take Mulligan mobilization application and active ROM exercises for their hands. Researcher will compare treatments group ith sham mobilization.

Study Overview

• Status: Completed
• Conditions: Rheumatoid Arthritis
• Intervention / Treatment: Other: Mulligan Mobilization

Detailed Description

Rheumatoid arthritis (RA) is a systemic disease that can lead to chronic pain, bone and soft tissue damage, and disability retirement. Alleviating pain and maintaining joint range of motion in RA are important for reducing disability. Joint mobilizations are manual therapy techniques used to increase range of motion and reduce pain. The aim of this study is to investigate the effects of rheumatoid hand exercise and protective approach and joint mobilization applications on pain, functional status and quality of life.

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Kırşehir, Turkey
    • Ahi Evran University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Having been diagnosed with RAS according to ACR and EULAR criteria,
• Being under the control of a physiatrist for at least 1 year,
• Have not had any upper extremity surgery in the last 6 months
• Have the cognitive capacity to understand commands,
• Not to be involved in any other rehabilitation program or study,

Exclusion Criteria:

• Presence of soft tissue injury and chronic bone damage in the hand,
• Presence of acute inflammation in any joint in the previous week,
• Presence of a degenerative or non-degenerative neurological condition that causes a change in pain perception,

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan Mobilization; Rehabilitation Program (Active wrist ROM exercises): Forearm pronation and supination; Wrist flexion and extension; Wrist flexion and extension (in the form of a fist); MCP Joint Flexion and Extension; Thumb IC joint Flexion and Extension; Abduction and Adduction of Fingers These exercises will be performed by the physiotherapist in the form of 5 seconds of movement / 15 seconds of rest, 10 repetitions a day, 5 days a week for 6 weeks. Mulligan Mobilization: Carpal Medio-lateral Glide (open kinetics, wrist flexion and extension movement); Carpal Rotation (open kinetics, wrist flexion and extension); Scaphoid Antero-posterior Glide (open kinetics); Metacarpal Antero-posterior Glide (When Clenching); Medio-lateral Glide to PIP-DIP joints (open kinetics, fingers flexed)	Other: Mulligan Mobilization; Mobilization with movement (MWM) is the concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end range applied by the patient. Passive end-of-range overpressure, or stretching, is then delivered without pain as a barrier.
Sham Comparator: Sham Mobilization; Participants will receive sham mobilization in addition to the ROM exercises given in the Mulligan group. Sham mobilization will be done in the same position as Mulligan but without any glide force.	Other: Mulligan Mobilization; Mobilization with movement (MWM) is the concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end range applied by the patient. Passive end-of-range overpressure, or stretching, is then delivered without pain as a barrier.
No Intervention: Control; Participants will receive therapeutic patient training consisting of home exercise recommendations, basic disease information, physical activity advice, and joint protection methods.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Joint activity	Primary outcomes included the automated quantification (Q) of joint activity using color Doppler pixel count calculations (% hyperemia/blood flow activity score within an inflamed joint: color Q-Doppler MCP/region)	6 weeks
Amount of hypertrophia and effusion in wrist joints	Synovial fluid (area of hypertrophy and effusion, mm2: synovial fluid MCP/region)	6 weeks
Distance in wrist joints	the radiographic distance (mm) between the MCP or interphalangeal bone space (joint space MCP/region)	6 weeks
DAS-28	High disease activ ity >5.1, low disease activity ≤ 3.2, remission ≤ 2.6	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determining the state of pain after treatment	Pain will be assessed using the Mcgill-Melzack Pain Questionnaire	6 weeks
Grip force	Hand grip strength will be measured with a pinch meter and a dynamometer	6 weeks
Range of Motion	Range of Motion will be measured with goniometer	6 weeks
Post-treatment status of disease-related quality of life	Quality of life was assessed using the Rheumatoid Arthritis Quality of Life (RAQoL).	6 weeks
Physical, social, and emotional well-being in RA	Arthritis Impact Measurement Scales (AIMS)	6 weeks

Collaborators and Investigators

• Sponsor: Kirsehir Ahi Evran Universitesi
• Investigators: Study Director: Figen TUNCAY, Professor, Kirsehir Ahi Evran Universitesi

Publications and helpful links

General Publications

• Levitsky A, Kisten Y, Lind S, Nordstrom P, Hultholm H, Lyander J, Hammelin V, Gentline C, Giannakou I, Faustini F, Skillgate E, van Vollenhoven R, Sundberg T. Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial. J Manipulative Physiol Ther. 2019 Jan;42(1):34-46. doi: 10.1016/j.jmpt.2018.04.007. Epub 2019 Mar 14.
• Villafane JH, Cleland JA, Fernandez-de-Las-Penas C. Bilateral sensory effects of unilateral passive accessory mobilization in patients with thumb carpometacarpal osteoarthritis. J Manipulative Physiol Ther. 2013 May;36(4):232-7. doi: 10.1016/j.jmpt.2013.05.008. Epub 2013 May 27.
• Ozcelep OF, Ustun I, Algun ZC. Effect of task-oriented training on pain, functionality, and quality of life in rheumatoid arthritis. Turk J Phys Med Rehabil. 2022 Mar 1;68(1):76-83. doi: 10.5606/tftrd.2022.6666. eCollection 2022 Mar.

Study record dates

Study Major Dates

• Study Start (Actual): October 30, 2023
• Primary Completion (Actual): December 11, 2024
• Study Completion (Actual): December 12, 2024

Study Registration Dates

• First Submitted: November 30, 2022
• First Submitted That Met QC Criteria: December 13, 2022
• First Posted (Actual): December 21, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 13, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: Mulligan Mobilization; Hand Rheumatoid Arthritis
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Rheumatic Diseases; Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases; Arthritis; Arthritis, Rheumatoid
• Other Study ID Numbers: Ahi Evran University

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Sharing of data will be done using the Google Drive link.
• IPD Sharing Time Frame: It will be shared for 2 years.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No