The effects of neurodynamic mobilizations on pain hypersensitivity in patients with hand osteoarthritis compared to robotic assisted mobilization: A randomized clinical trial

OBJECTIVE: To evaluate the effectiveness of the neurodynamic mobilization techniques compared with passive robotic physiological movement in patients with hand osteoarthritis(OA).

METHODS: A randomized controlled trial. Seventy-two patients, (mean age 71±11years), with dominant symptomatic hand OA were randomized in two groups and both received 12 treatment sessions over 4-weeks. The experimental group received neurodynamic mobilization of the median, radial and ulnar nerves and the control group received robotic assisted passive movement treatment. Both groups received a program of hand stability exercises also. Outcome measures included pain intensity, pressure pain thresholds (PPTs) and strength measurements. Group by time effects were compared using mixed-model ANOVAs.

RESULTS: After the intervention, the experimental group had statistically significant, higher PPTs than the control group at the thumb carpometacarpal-joint by 0.7kg/cm2 (95%CI:0.6;0.8), median nerve by 0.7kg/cm2 (95%CI:0.6;0.7) and radial nerve by 0.5kg/cm2 (95%CI:0.3;0.6); however, the difference was not statistically significant at 3-months post-intervention. Although mean values in the experimental group were higher than the control group at all PPT sites at both assessments, these differences were not statistically significant. The experimental group experienced a statistically significantly reduction in pain immediately post-intervention but this was not present at the 3-month follow-up. There were no statistically significant differences in pinch or grip strength between groups.

CONCLUSIONS: We found that neurodynamic mobilizations decreased hypersensitivity in patients with hand OA immediately after the intervention however differences were no longer present at 3-months. The results suggest these techniques may have some limited value in the short-term but don't have lasting effects.