Distal Radial FractureNCT07288060
The Effect of Mulligan and GMI on Distal Radius Proprioception
A study testing Conventional Physiotherapy, Mulligan Mobilisation and Graded Motor Imagery (GMI) in people with Distal Radial Fracture and Rehabilitation, run by Istanbul Aydın University at 1 site in Turkey (Türkiye).
Trial summary
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. Read more about this study
- Who is it for?
- Ages 25 to 65 years
- Conditions the study is for
- Distal Radial Fracture, Rehabilitation, Mulligan Mobilization
- What is being tested?
- Conventional Physiotherapy, Mulligan Mobilisation and Graded Motor Imagery (GMI)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 39 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Nov 2025to 15 Aug 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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
Who cannot join
- 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 locations and contacts
1 site in 1 country.
About this study
Official title: The Effect of Mulligan Mobilisation and Graded Motor Imagery Therapy on Proprioception in Distal Radius Fractures
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.
Read more
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.
- Conditions
- Distal Radial Fracture, Rehabilitation, Mulligan Mobilization, Motor Imagery Training, Physical Therapy
- Being tested
- Conventional Physiotherapy, Mulligan Mobilisation, Graded Motor Imagery (GMI)
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Conventional PhysiotherapyOther
Patients receive the standard physical therapy program only.
Mulligan MobilisationOther
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.
Graded Motor Imagery (GMI)Other
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
| Study group | Role | What they receive |
|---|---|---|
| Conventional physiotherapy | Active comparator | 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. Receives: Other: Conventional Physiotherapy |
| Mulligan Mobilisation Group | Experimental | 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. Receives: Other: Conventional Physiotherapy; Other: Mulligan Mobilisation |
| Graded motor imagery(GMI) Group | Experimental | 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 Receives: Other: Conventional Physiotherapy; Other: Graded Motor Imagery (GMI) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Tampa Scale of Kinesiophobia (TSK)
The Tampa Scale of Kinesiophobia (TSK) is a self-report measure developed to assess the fear of pain related to movement in patients with musculoskeletal pain. It consists of 17 questions designed to measure the fear of movement and re-injury. The scale utilizes a 4-point Likert scoring system (1 = strongly disagree, 4 = strongly agree). The items are grouped into two distinct factors: activity avoidance and somatic focus. The TSK is commonly used in distal radius fracture cases to assess general fear of movement.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Proprioception Assessment (Joint Position Sense)
Application in Your Study: In your project, this assessment will be performed using both a universal goniometer and an electrogoniometer (K Force Sens).The patient is asked to memorize a target angle (20 extension) and then actively reproduce it, with the difference between the target angle and the measured angle recorded as the degree of error.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Secondary outcomes (5)
Pain Assessment
Visual Analog Scale (VAS) Used to rate the severity of the patient's pain. It typically consists of a 100 mm line with two descriptors representing extreme pain intensity (e.g., no pain and worst possible pain) at either end. Patients mark their intensity on the line, and the score is measured as the distance from the "no pain" end.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Pressure Pain Threshold (PPT)
Algometer (Baseline dolorimeter 66 pound) Used as an objective method to measure the pressure pain threshold on the patient's wrist. Measurements are recorded in kilograms (kg). The test is 10 seconds long with gradually increasing pressure. Assessment points include the lateral epicondyle, medial epicondyle, ulnar styloid, and radial head.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Functionality & Disability
Patient-Rated Wrist/Hand Evaluation (PRWHE) Used to assess the patient's functionality. It is a subjective outcome measure consisting of 15 questions that determine the level of pain and disability in hand/wrist problems. It includes pain and function subscales, and sections for specific and daily activities. Total score is calculated out of 100, with a higher score indicating greater disability.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Grip Strength (Gross)
Jamar Hand Dynamometer considered the gold standard for measuring hand grip strength, highly reliable, and recommended by the American Society of Hand Therapists (ASHT). The measurement is taken in a standard position (seated, shoulder adducted/neutral rotation, elbow 90^\circ$ flexion, forearm mid-rotation/supported, wrist neutral). The average of 3 measurements, with 1-minute rests between each, is recorded.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Specific Muscle Strength
Digital Handheld Dynamometer Used to evaluate the strength of the wrist flexor, extensor, ulnar, and radial deviation muscles. The device provides objective data and records measurements in kilograms (kg) over a 10-second resistance test.
Measured: From the start of physiotherapy (approximately 6 weeks post-surgery) to the end of the 6-week treatment period.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Dec 2025
- Study start1 Nov 2025
- Primary completion15 Aug 2026
- Study completion15 Aug 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Distal Radial FractureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 39 participants (actual)
Sponsor and investigators
- Lead sponsor
- Istanbul Aydın University
- Sponsor type
- University, hospital or other
- Collaborators
- Biruni University, Istanbul University, The Scientific and Technological Research Council of Turkey
- Responsible party
- Principal investigator, Barış CELBEK, Istanbul Aydın University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07288060
- Sponsor's protocol ID
- 04.04.2025/07
- Other IDs
- 424S042
- Status last verified
- Sep 2026
- First submitted
- 4 Dec 2025
- Last updated
- 4 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Mulligan Mobilisation and Graded Motor Imagery Therapy on Proprioception in Distal Radius Fractures
- ClinicalTrials.gov ID
- NCT07288060
- Acronym / sponsor ID
- 04.04.2025/07
- Conditions
- Distal Radial Fracture, Rehabilitation, Mulligan Mobilization, Motor Imagery Training, Physical Therapy
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 39 participants (actual)
- Lead sponsor
- Istanbul Aydın UniversityUniversity, hospital or other
- Collaborators
- Biruni University, Istanbul University, The Scientific and Technological Research Council of Turkey
- Study start
- 1 Nov 2025 (actual)
- Primary completion
- 15 Aug 2026 (actual)
- Study completion
- 15 Aug 2026 (actual)
- First posted
- 17 Dec 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Conventional physiotherapy | Active comparator | Other: Conventional PhysiotherapyThis 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. |
| Mulligan Mobilisation Group | Experimental | Other: Conventional Physiotherapy, Other: Mulligan MobilisationThe 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. |
| Graded motor imagery(GMI) Group | Experimental | Other: Conventional Physiotherapy, Other: Graded Motor Imagery (GMI)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 |
Who may qualify
- Ages
- 25 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- 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
Key exclusion criteria (4 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Conventional PhysiotherapyPatients receive the standard physical therapy program only. | Other | Conventional physiotherapy, Graded motor imagery(GMI) Group, Mulligan Mobilisation Group |
| Mulligan MobilisationIn 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 | Mulligan Mobilisation Group |
| 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 | Other | Graded motor imagery(GMI) Group |
Primary outcome
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.
The Tampa Scale of Kinesiophobia (TSK) is a self-report measure developed to assess the fear of pain related to movement in patients with musculoskeletal pain. It consists of 17 questions designed to measure the fear of movement and re-injury. The scale utilizes a 4-point Likert scoring system (1 = strongly disagree, 4 = strongly agree). The items are grouped into two distinct factors: activity avoidance and somatic focus. The TSK is commonly used in distal radius fracture cases to assess general fear of movement.
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.
Application in Your Study: In your project, this assessment will be performed using both a universal goniometer and an electrogoniometer (K Force Sens).The patient is asked to memorize a target angle (20 extension) and then actively reproduce it, with the difference between the target angle and the measured angle recorded as the degree of error.
5 secondary outcomes
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.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Conventional Physiotherapy, Mulligan Mobilisation and Graded Motor Imagery (GMI) in people with Distal Radial Fracture and Rehabilitation, run by Istanbul Aydın University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
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.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.