The Effect of Mulligan and GMI on Distal Radius Proprioception

Istanbul Aydın University

Status: Invitation-only

Conditions: Mulligan Mobilization; Rehabilitation; Distal Radial Fracture; Motor Imagery Training; Physical Therapy

Treatments: Other: Graded Motor Imagery (GMI); Other: Mulligan Mobilisation; Other: Conventional Physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07288060

424S042 (Other Grant/Funding Number)

04.04.2025/07

Details and patient eligibility

About

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.

Enrollment: 33 estimated patients

Sex: All

Ages: 25 to 65 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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33 participants in 3 patient groups

Conventional physiotherapy

Active Comparator group

Description:

This group of participants will receive only standard care, defined as conventional physiotherapy, during their rehabilitation process following distal radius fracture surgery. The treatment program will commence at the 6th week post-surgery and will be applied twice a week for 6 weeks (totaling 12 sessions), with each session lasting an average of 30-35 minutes. Conventional physiotherapy includes joint range of motion exercises (flexion, extension, ulnar/radial deviation for the wrist; supination/pronation for the elbow) for 10 repetitions. Strengthening exercises, utilizing Theraband for wrist movements (10 repetitions) and Powerweb/Theraputty for grip strength (10 repetitions), will be applied, with resistance levels set at approximately 60-70% of the 1 Repetition Maximum method. Additionally, Closed Kinetic Chain exercises (wall press, plyometric wall push-ups, crawling, and push-ups after week 5) will be incorporated starting from the 3rd week of conventional treatment.

Treatment:

Other: Conventional Physiotherapy

Mulligan Mobilisation Group

Experimental group

Description:

The Mulligan Group will receive Mobilization With Movement (Mulligan MWM) techniques in addition to conventional physiotherapy, aiming to achieve pain-free movement by correcting the "positional fault" in the joint. The treatment will be administered for 6 weeks starting from the 6th week post-surgery, with 2 sessions per week (totaling 12 sessions) , and the MWM component will last approximately 15-20 minutes. MWM techniques, which must be performed pain-free, are initiated with the lateral glide of the carpal row and include continuous lateral glide to improve wrist flexion and extension. Furthermore, MWM of the distal and proximal radioulnar joint to improve supination will be added to the program starting from the 3rd week. Each mobilization is applied as 3 sets of 10 repetitions , with a rest period of 15-20 seconds between sets. To ensure continuous pain-free movement, patients will also be taught self-mobilization (10 repetitions) to be performed at home.

Treatment:

Other: Conventional Physiotherapy

Other: Mulligan Mobilisation

Graded motor imagery(GMI) Group

Experimental group

Description:

The Graded Motor Imagery (GMI) Group will implement a three-phase protocol aimed at supporting functional recovery by increasing neuroplasticity, in addition to conventional physiotherapy. The treatment will begin at the 6th week post-surgery and will be administered for 6 weeks at 2 sessions per week (12 sessions total), with the GMI component lasting approximately 15-20 minutes. The protocol is designed so that each of the three phases lasts one to two weeks due to immobilization constraints. Phase 1 (Lateralization Training) (the first 2 weeks) involves the patient correctly and quickly identifying whether presented images are of the right or left hand. Phase 2 (Explicit Motor Imagery) (the remaining 4 weeks) requires the patient to visualize movements of the affected wrist in various positions mentally, a process that is tracked via a dedicated website.Finally, during Phase 3 (Mirror Therapy), the patient moves the unaffected hand while observing its reflection, creating the illus

Treatment:

Other: Conventional Physiotherapy

Other: Graded Motor Imagery (GMI)