Mulligan Mobilization in Rheumatoid Hand

Study Overview
=================
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.

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.

Official Title
-----------------
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

Conditions
-----------------
Rheumatoid Arthritis

Intervention / Treatment
-----------------
* Other: Mulligan Mobilization


Participation Criteria
=================
Eligibility Criteria
-----------------
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,

Ages Eligible for Study
-----------------
Minimum Age: 30 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mulligan Mobilization<br>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<br>* 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.<br>|
| Sham Comparator: Sham Mobilization<br>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<br>* 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.<br>|
| No Intervention: Control<br>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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Mulligan Mobilization, Hand Rheumatoid Arthritis