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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mulligan Mobilization | Experimental | Rehabilitation Program (Active wrist ROM exercises):
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:
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| 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. |
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| Control | No Intervention | Participants will receive therapeutic patient training consisting of home exercise recommendations, basic disease information, physical activity advice, and joint protection methods. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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. |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Figen TUNCAY, Professor | Kirsehir Ahi Evran Universitesi | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ahi Evran University | Kırşehir | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30879707 | Result | 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. | |
| 23719518 |
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Sharing of data will be done using the Google Drive link.
It will be shared for 2 years.
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| ID | Term |
|---|---|
| D001172 | Arthritis, Rheumatoid |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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|
| 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 |
| 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. |
| 35949976 | 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. |
| 41152887 | Derived | 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. |
| D003240 |
| Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |