The 2018 update of the EULAR recommendations highlighted that exercise reduces pain and improves functionality in patients with hand OA. This study aimed to investigate the effects of neuromobilization, tendon gliding and robotic glove-assisted exercises on pain, grip strength and hand function in patients with hand osteoarthritis (OA).

Osteoarthritis (OA) is a chronic musculoskeletal disorder, and its prevalence increases with age. OA is the most common form of arthritis and is associated with reduced hand functionality and grip strength, increased pain and stiffness, and diminished quality of life. The European League Against Rheumatism (EULAR), the Osteoarthritis Research Society International (OARSI), and the American College of Rheumatology (ACR) have published guidelines for the management of hand OA. The 2018 update of the EULAR recommendations highlighted that exercise reduces pain and improves functionality in patients with hand OA. Previously, strengthening and normal range of motion exercises have been shown to improve grip strength compared to placebo. Moreover, a 2017 Cochrane review reported that interventions involving strengthening, flexibility, stretching, and ROM exercises, either individually or in combination, effectively reduce pain, improve grip strength, alleviate joint stiffness, and enhance functionality in patients with OA.

Among various exercise options, tendon gliding exercises and neuromobilization exercises have been increasingly used in recent years. Neural mobilization aims to restore the balance between neural structures and their surrounding mechanical interfaces, thereby reducing internal neural pressure and facilitating optimal physiological function. When used in combination with conventional treatments, tendon gliding exercises were found to be more effective than nerve gliding exercises in patients with carpal tunnel syndrome.

With technological advancements, the use of robotic assistive devices has become increasingly common in rehabilitation. Robotic devices are primarily used to improve upper limb functionality in neurological conditions, particularly in stroke survivors. These devices assist patients in implementing exercise programs. The use of robotic devices in patients with neurological disorders has been demonstrated to produce positive effects on the central nervous system and sensorimotor deficits. In patients with knee OA, wearable robotic assistive devices have been shown to significantly improve stair-climbing ability and reduce knee pain.

Few studies investigating the efficacy of robotic rehabilitation in hand OA are available in the literature. Research comparing the effects of robotic assistive devices with other treatment methods is still in its early stages. It has been noted by the OARSI that, due to the methodological limitations across studies, and the clinical heterogeneity between studies, it is difficult to provide any reliable practical recommendations for the choice of appropriate therapy in patients with hand OA. Considering the existing gaps in the literature and the recommended research priorities, this study aimed to investigate the effects of neuromobilization, tendon gliding exercises, and the use of a wearable robotic assistive device on pain, grip strength, and hand function in patients with hand OA.

Inclusion Criteria:

• Patients were diagnosed with primary hand OA by an orthopedics and traumatology specialist based on the ACR diagnostic criteria.
• Aged 45 to 87 years

Exclusion Criteria:

• Individuals were excluded from the study if they had a history of major psychiatric disorders, malignancies, systemic or rheumatologic diseases, severe hand trauma or surgery to the hand region within the past six months, prior intra-articular steroid or hyaluronic acid injections into the hand joints, collagen tissue disorders, peripheral vascular diseases, or a history of neuropathy.

All assessments were conducted by a single physiotherapist, who was blinded to group allocation.