Joint mobilization of the hands in rheumatoid arthritis: an assessor-blinded, randomized crossover study

Kaltenborn 'within-the-slack' Grade I-II manual mobilization is carried out in this study at the Rheumatology Clinic of the Karolinska University Hospital in Solna, Stockholm, Sweden, by five licensed Swedish manual therapists (1 physiotherapist, 4 naprapaths: minimum 1 year of experience) on the metacarpophalangeal (MCP) joints II-V of the hands of participants with rheumatoid arthritis (primary group) or hand osteoarthritis (clinical comparator group). Treatments are carried out individually per participant with two different therapists per hand. Kaltenborn Grade I-II manual mobilization is a method in manual therapy whereby the treated joint is gently mobilized with a traction force to reduce pain and help the joint regain functionality and flexibility. The method is utilized by manual therapists worldwide -- including physiotherapists, chiropractors, and naprapaths -- for treating joint- and muscle-related pain. In the context of this study, the session would begin with the participant sitting comfortably in front of a treatment table. One hand, relaxed from the support of a mobilization wedge or pillow, would face palm up. The therapist would then grip the proximal and intermediate phalanges of the finger with one hand whilst the other would grip the metacarpus for support; and then the joint (i.e. MCP II) would be mobilized with a gentle traction force. The process would be repeated for MCPs III-V. There is one treatment session per week with two sessions over two weeks per hand. First, the randomized hand of each participant is treated with 28-minute mobilization (per joint: 3min + 1min rest + 3min, MCP II-V) at baseline (week 1) and week 2. Upon crossover at week 3, the control hand is instead treated at week 3 and 4. An untreated 1-month follow-up after the final treatment (week 4) is carried out to assess outcome measures after a longer period without mobilization treatment.