Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial

Adrian Levitsky, Yogan Kisten, Sara Lind, Patric Nordström, Helene Hultholm, Jessica Lyander, Viveka Hammelin, Cidem Gentline, Ioanna Giannakou, Francesca Faustini, Eva Skillgate, Ronald van Vollenhoven, Tobias Sundberg

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA). Methods: A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound. Results: In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group. Conclusion: In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.
Original languageEnglish
Pages (from-to)34-46
JournalJournal of Manipulative and Physiological Therapeutics
Volume42
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Cite this

Levitsky, Adrian ; Kisten, Yogan ; Lind, Sara ; Nordström, Patric ; Hultholm, Helene ; Lyander, Jessica ; Hammelin, Viveka ; Gentline, Cidem ; Giannakou, Ioanna ; Faustini, Francesca ; Skillgate, Eva ; van Vollenhoven, Ronald ; Sundberg, Tobias. / Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial. In: Journal of Manipulative and Physiological Therapeutics. 2019 ; Vol. 42, No. 1. pp. 34-46.
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title = "Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial",
abstract = "Objective: The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA). Methods: A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound. Results: In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group. Conclusion: In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.",
author = "Adrian Levitsky and Yogan Kisten and Sara Lind and Patric Nordstr{\"o}m and Helene Hultholm and Jessica Lyander and Viveka Hammelin and Cidem Gentline and Ioanna Giannakou and Francesca Faustini and Eva Skillgate and {van Vollenhoven}, Ronald and Tobias Sundberg",
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Levitsky, A, Kisten, Y, Lind, S, Nordström, P, Hultholm, H, Lyander, J, Hammelin, V, Gentline, C, Giannakou, I, Faustini, F, Skillgate, E, van Vollenhoven, R & Sundberg, T 2019, 'Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial' Journal of Manipulative and Physiological Therapeutics, vol. 42, no. 1, pp. 34-46. https://doi.org/10.1016/j.jmpt.2018.04.007

Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial. / Levitsky, Adrian; Kisten, Yogan; Lind, Sara; Nordström, Patric; Hultholm, Helene; Lyander, Jessica; Hammelin, Viveka; Gentline, Cidem; Giannakou, Ioanna; Faustini, Francesca; Skillgate, Eva; van Vollenhoven, Ronald; Sundberg, Tobias.

In: Journal of Manipulative and Physiological Therapeutics, Vol. 42, No. 1, 01.01.2019, p. 34-46.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial

AU - Levitsky, Adrian

AU - Kisten, Yogan

AU - Lind, Sara

AU - Nordström, Patric

AU - Hultholm, Helene

AU - Lyander, Jessica

AU - Hammelin, Viveka

AU - Gentline, Cidem

AU - Giannakou, Ioanna

AU - Faustini, Francesca

AU - Skillgate, Eva

AU - van Vollenhoven, Ronald

AU - Sundberg, Tobias

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA). Methods: A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound. Results: In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group. Conclusion: In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.

AB - Objective: The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA). Methods: A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound. Results: In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group. Conclusion: In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.

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