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Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a
Nikolaos Stathopoulos1, Zacharias Dimitriadis1, George A Koumantakis2
1Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK.
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 I2 index 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.