Mulligan Mobilization in Rheumatoid Hand

NCT05660629 | Completed

• 1 other identifier: Ahi Evran University
• Study Type: interventional
• Target: 21
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Rheumatoid Arthritis

Keywords

Mulligan Mobilization; Hand Rheumatoid Arthritis

Outcome Measures

Primary Outcomes (4)

• 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 Outcomes (5)

• Determining the state of pain after treatment

  6 weeks

• Grip force

  6 weeks

• Range of Motion

  6 weeks

• Post-treatment status of disease-related quality of life

  6 weeks

• Physical, social, and emotional well-being in RA

  6 weeks

Study Arms (3)

Mulligan Mobilization

EXPERIMENTAL

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

Sham Mobilization

SHAM COMPARATOR

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

Control

NO INTERVENTION

Participants will receive therapeutic patient training consisting of home exercise recommendations, basic disease information, physical activity advice, and joint protection methods.

Interventions

Mulligan Mobilization OTHER

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.

Mulligan Mobilization; Sham Mobilization

Eligibility Criteria

• Age: 30 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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,

You may not qualify if:

• 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,

Sponsors & Collaborators

• Kirsehir Ahi Evran Universitesi: lead

Study Sites (1)

Ahi Evran University

Kırşehir, Turkey (Türkiye)

Location

Related Publications (4)

• 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.

  PMID: 30879707 RESULT

• 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.

  PMID: 23719518 RESULT

• 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.

  PMID: 35949976 RESULT

• Ozcelep OF, Tunali N, Turhan A, Polat E, Demir C, Gumusay D, Tuncay F. The effect of mobilization with movement on pain, joint distance, effusion area, and inflammation in rheumatoid arthritis: a double-blind randomized controlled clinical trial. J Orthop Surg Res. 2025 Oct 28;20(1):929. doi: 10.1186/s13018-025-06121-3.

  PMID: 41152887 DERIVED

MeSH Terms

Conditions

Arthritis, Rheumatoid

Condition Hierarchy (Ancestors)

Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases

Study Officials

• Figen TUNCAY, Professor

  Kirsehir Ahi Evran Universitesi

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Study Record Dates

• First Submitted: November 30, 2022
• First Posted: December 21, 2022
• Study Start: October 30, 2023
• Primary Completion: December 11, 2024
• Study Completion: December 12, 2024
• Last Updated: December 17, 2024

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: It will be shared for 2 years.

Locations

TU (1)