Mobilization with movement on reducing pain and disability for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.
Long-Huei Lin, Min Lin, Guo-Jia Hsieh, Hsin-I Chen, Shu-Fen Sun, Ren Jei Tsai
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Abstract
Introduction: Knee osteoarthritis (OA), affecting both tibiofemoral and patellofemoral compartments, causes pain and reduced quality of life. The Mulligan Concept of mobilization with movement (MWM) may relieve symptoms by modifying sensory input, enhancing central inhibition, and improving motor activation. This study conducted a systematic review and meta-analysis with subgroup analysis to evaluate MWM's efficacy in improving pain and disability in knee OA.
Methods: Electronic databases were searched from inception to January 2025 for randomized controlled trials (RCTs) on the effects of MWM on knee OA. Pain intensity and disability improvement, standardized using Hedges' g, were the primary and secondary outcomes. Two reviewers independently assessed study quality, extracted data, and performed a meta-analysis using a random-effects model. Subgroup analyses considered intervention regimens, technique including weight-bearing or not, Kellgren-Lawrence (K-L) classification grades, and control group comparisons.
Results: From 23 RCTs (996 participants; mean age 37-61 years), MWM significantly reduced pain (Hedges' g = -0.984, 95% CI = -1.375 to -0.593) and improved disability (Hedges' g = -1.041, 95% CI = -1.477 to - 0.606).. Greater effect sizes were observed when MWM was combined with other therapies, including weight-bearing positions, and among participants without advanced K-L grades. MWM also demonstrated significant effects in comparison with active controls.
Conclusion: This meta-analysis showed that MWM reduces pain and disability in individuals with knee osteoarthritis, especially when incorporated into treatment protocols featuring weight-bearing positions and combined physical therapies. Clinically, MWM could be incorporated into rehabilitation programs to enhance pain relief and functional recovery. Future studies should extend follow-ups and address bias.
膝关节骨性关节炎（OA），影响胫骨股腔和髌骨股腔，引起疼痛并降低生活质量。Mulligan的运动动员概念（MWM）可以通过改变感觉输入、增强中枢抑制和改善运动激活来缓解症状。本研究通过系统回顾和亚组分析来评估MWM在改善膝关节OA患者疼痛和残疾方面的疗效。方法：检索电子数据库，从成立到2025年1月，检索MWM对膝关节OA影响的随机对照试验（rct）。疼痛强度和残疾改善，使用Hedges' g标准化，是主要和次要结局。两位审稿人独立评估研究质量，提取数据，并使用随机效应模型进行meta分析。亚组分析考虑了干预方案、包括是否负重在内的技术、Kellgren-Lawrence （K-L）分级和对照组比较。结果：23项随机对照试验(996名受试者；平均年龄37-61岁)，MWM显著减轻了疼痛（Hedges' g = -0.984, 95% CI = -1.375至-0.593），改善了残疾（Hedges' g = -1.041, 95% CI = -1.477至- 0.606）。当MWM联合其他疗法（包括负重体位）时，以及在没有高级K-L等级的参与者中，观察到更大的效应值。与主动对照相比，MWM也显示出显著的效果。结论：本荟萃分析显示，MWM可减轻膝关节骨性关节炎患者的疼痛和残疾，特别是将其纳入以负重体位和联合物理疗法为特征的治疗方案时。临床上，MWM可以纳入康复计划，以增强疼痛缓解和功能恢复。未来的研究应扩大随访并解决偏见。
期刊介绍：
The Journal of Manual & Manipulative Therapy is an international peer-reviewed journal dedicated to the publication of original research, case reports, and reviews of the literature that contribute to the advancement of knowledge in the field of manual therapy, clinical research, therapeutic practice, and academic training. In addition, each issue features an editorial written by the editor or a guest editor, media reviews, thesis reviews, and abstracts of current literature. Areas of interest include: •Thrust and non-thrust manipulation •Neurodynamic assessment and treatment •Diagnostic accuracy and classification •Manual therapy-related interventions •Clinical decision-making processes •Understanding clinimetrics for the clinician
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