The Effect of Mulligan and GMI on Distal Radius Proprioception

Official title

The Effect of Mulligan Mobilisation and Graded Motor Imagery Therapy on Proprioception in Distal Radius Fractures

Overview

Distal radius fractures are common in the elderly population and clinical findings after treatment include limitation of joint motion, pain, and muscle weakness. Physical therapy modalities include exercises, physical agents, and manual therapy techniques. The Mulligan Concept-specific mobilization with movement (MWM) technique improves joint movement by reducing pain and is effective in musculoskeletal disorders. Graded motor imagery activates the motor system, increases neuroplasticity, and promotes functional recovery. It has been observed that proprioception is impaired after distal radius fracture, affecting muscle tone and postural reflexes. Our study will examine proprioception measurements with an electrogonometer (K Force Sens) and universal goniometer and the effectiveness of MWM and progressive motor imagery treatments. The study is designed as a one-blind randomized study and a total of 33 patients between the ages of 25-65 who were treated with volar plate screws after distal radius fracture will be included. Patients will be randomized as 11 people and one group will be treated with Mulligan Mobilisation in addition to conventional physiotherapy and the other group will be treated with Graded motor imagery techniques in addition to conventional physiotherapy. The control group will receive only conventional physiotherapy. Clinical Follow-up Form, Proprioception, Kinesiophobia, Hand Grip strength, Muscle strength, Pain, and functional evaluations will be performed 2 times in total, just before the patient starts physical therapy after surgery and at the end of the 6-week treatment. A goniometer and electrogoniometer will be used to measure proprioception. Visual Analogue Scale (VAS) and algometer will be used to determine the pain assessment. Jamar's hand grip strength meter and Digital Handheld Dynamometer will be used for muscle strength assessment. Tampa Kinesiophobia Scale will be used to measure the level of kinesiophobia. Patient Rated Wrist/Hand Evaluation (PRWHE) will be used to evaluate the functionality of the patients. Proprioception evaluation in the upper extremity is limited in the literature, and it will be an original study to examine the relationship between the two measurements after distal radius fracture surgery; in addition, it will be the first study to examine graded motor imagery and mulligan Mobilisation in terms of treatment efficacy.

Interventions

• Other Conventional Physiotherapy
  Patients receive the standard physical therapy program only.
• Other Mulligan Mobilisation
  In addition to conventional therapy, Mobilization With Movement (MWM) techniques are applied, focusing on achieving pain-free motion. These techniques include lateral glides of the carpal row and wrist flexion/extension/supination movements, performed in 3 sets of 10 repetitions, and patients are taught self-mobilization.
• Other Graded Motor Imagery (GMI)
  This arm adds a three-phase protocol designed to target neuroplasticity. The protocol includes: Lateralization (right/left hand recognition), Explicit Motor Imagery (mental visualization of movement), and Mirror Therapy. The second phase is uniquely tracked via an internet-based platform for home exercises, which records response times and accuracy

Primary outcome measures

• Tampa Scale of Kinesiophobia (TSK) [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]
• Proprioception Assessment (Joint Position Sense) [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]

Secondary outcome measures (5)

• Pain Assessment [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]
• Pressure Pain Threshold (PPT) [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]
• Functionality & Disability [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]
• Grip Strength (Gross) [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]
• Specific Muscle Strength [Time frame: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.]

Eligibility criteria

Inclusion criteria

• Age between 25 and 65 years
• Clinical diagnosis of distal radius fracture
• Indicated for surgical treatment
• Surgical fixation performed using plate and screw technique
• Willing and able to provide informed consent and participate in the study

Exclusion criteria

• Inability to read or write
• Presence of additional orthopedic, neurological, or cardiovascular disorders
• History of surgery involving the ipsilateral upper extremity within the past 6 months
• Visual or hearing impairment that would interfere with adherence to treatment or study assessments

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Istanbul Aydın University — Istanbul

Identifiers

NCT: NCT07288060 · 04.04.2025/07 · 424S042

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗