Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008–2017

Abstract

Background

The Mulligan method of manual therapy advocates the use of ‘mobilization with movement (MWM)’ techniques to effectively manage peripheral joint ‘positional fault’ dysfunctions.

Objectives

To provide an updated evidence-based systematic review and meta-analysis regarding the effectiveness of MWM techniques.

Data sources

PubMed, EBSCOhost, PEDro, Cochrane Library and Google Scholar between 1st August 2008–31st August 2017.

Study selection

Two reviewers applied the population intervention comparison outcome (PICO) question to screen the studies for this review. Only RCTs/CCTs were included.

Data extraction

Information on study design, subjects, intervention, outcome measures and efficacy results were extracted. Methodological quality was independently assessed by two reviewers using the PEDro Scale.

Data synthesis

Sixteen studies with 576 participants were included in four separate meta-analyses for pain and disability. The I2index assessed the heterogeneity between studies.

Results

MWMs have demonstrated statistically significant improvements against sham treatment, passive and control intervention techniques for pain [mean difference (95%CI):−16.12 (−19.77, −12.48) & I = 72%] and disability [mean difference (95%CI):−17.51 (−22.84, −12.19) 2 2 2 2 & I = 88%] or against another manual therapy treatment [pain mean difference (95%CI): −10.43 (−11.38, −9.48) & I = 0%], however not against another manual therapy treatment for disability. The clinical significance of the pooled differences was compared against Minimal Clinically Important Difference values.

Limitations

No long-term effectiveness data were identified in any of the included studies.

Conclusions and implications of key findings

The overall post-intervention short-term statistical and clinical significance of MWM techniques has been verified, although the high heterogeneity identified may require further validation of those methods.

Systematic review registration number: PROSPERO 2016:CRD42017071595.

Citation


Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008–2017