Effects of Task-Oriented Training and Mulligan Mobilization on Hand Function, Pain and Quality of Life in Patients With Rheumatoid Arthritis

December 4, 2025 updated by: Mehmet CANLI, Kirsehir Ahi Evran Universitesi

Effects of Task-Oriented Training and Mulligan Mobilization on Hand Function, Pain and Quality of Life in Patients With Rheumatoid Arthritis: A Randomized Controlled Study

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disease that frequently affects the hand joints. Over time, this disease leads to joint deformities, pain, decreased muscle strength and severe impairment in hand function. Functions such as independence in activities of daily living, hand skills and grip strength may be significantly limited in individuals with RA. Although hand rehabilitation is an important component of RA management, there is still a need for research on effective intervention strategies.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disease that frequently affects the hand joints. Over time, this disease leads to joint deformities, pain, decreased muscle strength and severe impairment in hand function. Functions such as independence in activities of daily living, hand skills and grip strength may be significantly limited in individuals with RA. Although hand rehabilitation is an important component of RA management, there is still a need for research on effective intervention strategies.

Conventional exercises are basic applications to maintain range of motion, muscle strength and endurance. However, these approaches may have limited effects on improving hand function. In recent years, methods such as task-oriented training and Mulligan mobilisation have gained attention for their potential to improve neuromotor control, hand dexterity and pain. Task-oriented training promotes motor learning through functional tasks, while Mulligan mobilisation aims to increase mobility through pain-free passive-joint mobilisation techniques. The effects of these two methods, separately or in combination, on hand function, pain level and quality of life in individuals with RA have not been adequately investigated.

The aim of this study was to investigate the effects of task-focused training and Mulligan mobilisation on hand function, grip strength, dexterity, pain, activities of daily living and quality of life in individuals with RA.

Study Type

Interventional

Enrollment (Actual)

54

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Kırşehir
      • Kırşehir, Kırşehir, Turkey (Türkiye), 40100
        • Kırşehir Ahi Evran University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Followed for at least one year for the diagnosis of Rheumatoid Arthritis, aged between 30 and 65,
  • Have the cognitive capacity to understand and follow the instructions given,
  • Has not undergone upper extremity surgery for orthopaedic, neurological or other reasons
  • Participants with functional capacity class I-II

Exclusion Criteria:

  • Severe pain as assessed by Visual Analogue Scale (VAS) (VAS >7),
  • Declaring the intention to withdraw from the study without giving any reason,
  • Having a major psychiatric disorder such as schizophrenia or major depression,
  • Having cardiovascular diseases such as coronary artery disease, history of myocardial infarction, angina, stroke, uncontrolled hypertension, chronic obstructive pulmonary disease (COPD)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Conventional Group
Conventional Group, the patients performed passive range of motion (PROM) exercises, mobilization of MCP, PIP and distal interphalangeal (DIP) joints and isometric exercises. While PROM and isometric exercises were applied in 30 repetitions, joint mobilizations were performed by the therapist with moderate severity in the form of anteroposterior and mediolateral gliding.
Other: Conventional treatment
Passive range of motion exercises, metacarpopalangeal, proximal interphalangeal and distal interphalangeal joint mobilisation and isometric exercises will be applied. Isometric exercises will be performed as 30 repetitions, while joint mobilisations will be performed by the therapist as moderate anteroposterior and mediolateral shifts.
Experimental: Mulligan Mobilization Group
In the Mulligan mobilisation group, the therapist will apply a dorsal shift from the distal radius to the carpal bones and the patient will simultaneously extend the wrist. It is essential that the movement is painless; if any pain occurs during mobilisation, the direction or technique will be re-evaluated. This application will be performed in 8-10 repetitions and the frequency of the session will be planned according to the patient's symptoms.
Other: Conventional treatment
Passive range of motion exercises, metacarpopalangeal, proximal interphalangeal and distal interphalangeal joint mobilisation and isometric exercises will be applied. Isometric exercises will be performed as 30 repetitions, while joint mobilisations will be performed by the therapist as moderate anteroposterior and mediolateral shifts.
Other: Mulligan mobilization
In patients included in the Mulligan mobilisation group, the therapist will apply a dorsal shift from the distal radius to the carpal bones and the patient simultaneously extends the wrist. It is essential that the movement is painless; if any pain occurs during mobilisation, the direction or technique is re-evaluated. This application is performed in 8-10 repetitions and the frequency of the session is planned according to the patient's symptoms.
Experimental: Task-Oriented Training Group
In addition to MCP, PIP, DIP joint mobilisation and isometric exercises, the task-oriented training group will perform 30 repetitions of face washing, using a fork, drinking water with a glass, sitting and wearing a t-shirt exercises.
Other: Conventional treatment
Passive range of motion exercises, metacarpopalangeal, proximal interphalangeal and distal interphalangeal joint mobilisation and isometric exercises will be applied. Isometric exercises will be performed as 30 repetitions, while joint mobilisations will be performed by the therapist as moderate anteroposterior and mediolateral shifts.
Other: Task-oriented trainig
In addition to MCP, PIP, DIP joint mobilisation and isometric exercises, the task-oriented training group will perform 30 repetitions of face washing, using a fork, drinking water with a glass, sitting and wearing a t-shirt exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Evaluation of Hand Grip Strength
Time Frame: 5 week
Hand grip strength of the participants was measured with a hand dynamometer (Takei Scientific Instruments Co., Ltd., Japan). During the test application, the standard positioning rules determined by the American Association of Hand Therapists will be followed. Accordingly, the participant will be ensured to be in an upright sitting position and the consistency of the measurements will be maintained by not allowing the arms to be supported.
5 week

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Evaluation of Hand Functions
Time Frame: 5 week
Nine-Hole Peg Test and Duruöz Hand Index will be used for the evaluation of hand functions. The Nine-Hole Peg Test is a practical and rapidly applicable manual skill measurement method with scientifically proven validity and reliability. The Duruöz Hand Index was first developed in 1996 to assess hand function in patients with Rheumatoid Arthritis. Since then, it has been shown to be valid and reliable in a wide range of upper extremity conditions. It consists of 18 questions.
5 week
Evaluation of Pain Severity
Time Frame: 5 week
The pain intensity of the participants will be evaluated with the McGill-Melzack Pain Questionnaire.
5 week
Assessment of Quality of Life
Time Frame: 5 week
The Rheumatoid Arthritis Quality of Life Questionnaire will be used to assess patient-specific symptoms and the impact of the disease on life. The Rheumatoid Arthritis Quality of Life Scale is a unique 30-item quality of life assessment tool for RA patients developed in parallel studies in the UK and the Netherlands.
5 week
Disease Activity
Time Frame: 5 week
The Disease Activity Score-28 (DAS-28) is a widely used measure in clinical settings to assess disease activity in individuals with RA. The score is derived from the number of swollen and tender joints in the patient's 28 joints, the acute-phase reactants (erythrocyte sedimentation rate, ESR, or CRP), and a 0-100 mm visual analog scale (VAS) score that reflects the patient's overall health status. The DAS-28 score categorizes disease activity as low, moderate, or high.
5 week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Kirsehir Ahi Evran Universitesi

Investigators

  • Study Director: Mehmet CANLI, PhD., Kirsehir Ahi Evran Universitesi

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 1, 2025

Primary Completion (Actual)

November 8, 2025

Study Completion (Actual)

November 8, 2025

Study Registration Dates

First Submitted

June 8, 2025

First Submitted That Met QC Criteria

June 18, 2025

First Posted (Actual)

June 19, 2025

Study Record Updates

Last Update Posted (Actual)

December 10, 2025

Last Update Submitted That Met QC Criteria

December 4, 2025

Last Verified

June 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 43834581758"

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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