Development and Evaluation of the Effectiveness of the SMART-HAND Protocol for Hand Rehabilitation in Patients With Rheumatoid Arthritis

Rheumatoid arthritis (RA) frequently affects the hand and wrist, resulting in pain, reduced joint stability, impaired proprioception, muscle weakness, and limitations in daily activities. Although conventional rehabilitation primarily focuses on range of motion and strengthening exercises, sensorimotor impairments such as proprioceptive deficits are often underaddressed. The SMART-HAND (Sensory, Massage, Approximation, ROM, Training = Strengthening + Perturbation) protocol was developed as a structured, mechanism-based rehabilitation program to improve proprioception, joint stability, motor control, and hand function. This randomized controlled trial aims to evaluate the effectiveness of the SMART-HAND protocol in individuals with RA by comparing its effects on hand function, proprioception, pain, dexterity, muscle strength, and functional performance with conventional rehabilitation and a control group.

Inclusion Criteria: * Participants will be 18 years of age or older. * Participants will have a diagnosis of rheumatoid arthritis for at least five years. * Participants will be referred by a rheumatologist. * Participants will have been on a stable medication regimen for the past three months. * Participants will have no history of diabetes mellitus. * Participants will have no other conditions affecting sensory function. * Participants will provide informed consent to participate in the study. Exclusion Criteria: * Individuals who have undergone hand surgery within the past six months. * Individuals with a history of upper extremity fracture within the past six months. * Individuals with other musculoskeletal pain conditions involving the muscles and/or joints. * Individuals diagnosed with a neurological disease that may affect sensory or motor function. * Individuals who are unable to fully cooperate with the assessment procedures. * Individuals who have received corticosteroid treatment within the past month. * Individuals diagnosed with another rheumatic disease. * Pregnant women. * Individuals who are illiterate. Withdrawal/Discontinuation Criteria * Participants who miss more than 10% of the intervention sessions will be excluded from the study. * Participants who change their medication dosage or medication class during the study period will be excluded from the study. * Participants will have the right to withdraw from the study at any time and for any reason.