Rheumatic Arthritis
Conditions
Keywords
Rheumatic arthritis, Treatment, Mobilization
Brief summary
Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disease that frequently affects the hand joints. Over time, this disease leads to joint deformities, pain, decreased muscle strength and severe impairment in hand function. Functions such as independence in activities of daily living, hand skills and grip strength may be significantly limited in individuals with RA. Although hand rehabilitation is an important component of RA management, there is still a need for research on effective intervention strategies.
Detailed description
Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disease that frequently affects the hand joints. Over time, this disease leads to joint deformities, pain, decreased muscle strength and severe impairment in hand function. Functions such as independence in activities of daily living, hand skills and grip strength may be significantly limited in individuals with RA. Although hand rehabilitation is an important component of RA management, there is still a need for research on effective intervention strategies. Conventional exercises are basic applications to maintain range of motion, muscle strength and endurance. However, these approaches may have limited effects on improving hand function. In recent years, methods such as task-oriented training and Mulligan mobilisation have gained attention for their potential to improve neuromotor control, hand dexterity and pain. Task-oriented training promotes motor learning through functional tasks, while Mulligan mobilisation aims to increase mobility through pain-free passive-joint mobilisation techniques. The effects of these two methods, separately or in combination, on hand function, pain level and quality of life in individuals with RA have not been adequately investigated. The aim of this study was to investigate the effects of task-focused training and Mulligan mobilisation on hand function, grip strength, dexterity, pain, activities of daily living and quality of life in individuals with RA.
Interventions
OTHERTask-oriented trainig
In addition to MCP, PIP, DIP joint mobilisation and isometric exercises, the task-oriented training group will perform 30 repetitions of face washing, using a fork, drinking water with a glass, sitting and wearing a t-shirt exercises.
OTHERMulligan mobilization
In patients included in the Mulligan mobilisation group, the therapist will apply a dorsal shift from the distal radius to the carpal bones and the patient simultaneously extends the wrist. It is essential that the movement is painless; if any pain occurs during mobilisation, the direction or technique is re-evaluated. This application is performed in 8-10 repetitions and the frequency of the session is planned according to the patient's symptoms.
OTHERConventional treatment
Passive range of motion exercises, metacarpopalangeal, proximal interphalangeal and distal interphalangeal joint mobilisation and isometric exercises will be applied. Isometric exercises will be performed as 30 repetitions, while joint mobilisations will be performed by the therapist as moderate anteroposterior and mediolateral shifts.
Sponsors
Kirsehir Ahi Evran Universitesi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Intervention model description
Randomized controlled trials
Eligibility
Sex/Gender
ALL
Age
30 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Followed for at least one year for the diagnosis of Rheumatoid Arthritis, aged between 30 and 65, * Have the cognitive capacity to understand and follow the instructions given, * Has not undergone upper extremity surgery for orthopaedic, neurological or other reasons * Participants with functional capacity class I-II
Exclusion criteria
* Severe pain as assessed by Visual Analogue Scale (VAS) (VAS \>7), * Declaring the intention to withdraw from the study without giving any reason, * Having a major psychiatric disorder such as schizophrenia or major depression, * Having cardiovascular diseases such as coronary artery disease, history of myocardial infarction, angina, stroke, uncontrolled hypertension, chronic obstructive pulmonary disease (COPD)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of Hand Grip Strength | 5 week | Hand grip strength of the participants was measured with a hand dynamometer (Takei Scientific Instruments Co., Ltd., Japan). During the test application, the standard positioning rules determined by the American Association of Hand Therapists will be followed. Accordingly, the participant will be ensured to be in an upright sitting position and the consistency of the measurements will be maintained by not allowing the arms to be supported. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of Hand Functions | 5 week | Nine-Hole Peg Test and Duruöz Hand Index will be used for the evaluation of hand functions. The Nine-Hole Peg Test is a practical and rapidly applicable manual skill measurement method with scientifically proven validity and reliability. The Duruöz Hand Index was first developed in 1996 to assess hand function in patients with Rheumatoid Arthritis. Since then, it has been shown to be valid and reliable in a wide range of upper extremity conditions. It consists of 18 questions. |
| Evaluation of Pain Severity | 5 week | The pain intensity of the participants will be evaluated with the McGill-Melzack Pain Questionnaire. |
| Assessment of Quality of Life | 5 week | The Rheumatoid Arthritis Quality of Life Questionnaire will be used to assess patient-specific symptoms and the impact of the disease on life. The Rheumatoid Arthritis Quality of Life Scale is a unique 30-item quality of life assessment tool for RA patients developed in parallel studies in the UK and the Netherlands. |
| Disease Activity | 5 week | The Disease Activity Score-28 (DAS-28) is a widely used measure in clinical settings to assess disease activity in individuals with RA. The score is derived from the number of swollen and tender joints in the patient's 28 joints, the acute-phase reactants (erythrocyte sedimentation rate, ESR, or CRP), and a 0-100 mm visual analog scale (VAS) score that reflects the patient's overall health status. The DAS-28 score categorizes disease activity as low, moderate, or high. |
Countries
Turkey (Türkiye)
Outcome results
None listed