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

Key points

1. 01MWM reduced pain significantly versus sham or no treatment (mean difference -16.12 [95% CI -19.77, -12.48], p < 0.001)
2. 02MWM reduced disability significantly versus sham or no treatment (mean difference -17.51 [95% CI -22.84, -12.19], p < 0.001)
3. 03MWM reduced pain more than other manual therapy methods (mean difference -10.43 [95% CI -11.38, -9.48], p < 0.001)
4. 04MWM did not show statistically significant superiority over other manual therapy for disability reduction (mean difference -7.95 [95% CI -17.59, 1.68], p = 0.11)
5. 05High heterogeneity across disability meta-analyses (I2 up to 94%) warrants caution in interpreting pooled results

How it was conducted

Design

Systematic review and meta-analysis of RCTs and CCTs

Search period

August 2008 to August 2017, across PubMed, EBSCOhost, PEDro, Cochrane Library, and Google Scholar

Included studies

16 RCTs/CCTs

Participants

576 total across included studies

Primary outcomes

Pain and disability, standardised to a 0-100 scale

Quality assessment

PEDro Scale; 7 studies rated high quality (7-10/10), 7 moderate (4-6/10), 2 low (0-3/10)

What they found

• MWM vs sham/no treatment for pain (13 studies, n = 223 MWM recipients): mean difference -16.12 [95% CI -19.77, -12.48], Z = 8.68, p < 0.001, I2 = 72%
• MWM vs other manual therapy for pain (4 studies): mean difference -10.43 [95% CI -11.38, -9.48], Z = 21.54, p < 0.001, I2 = 0%
• MWM vs sham/no treatment for disability (11 studies, n = 189 MWM recipients): mean difference -17.51 [95% CI -22.84, -12.19], Z = 6.45, p < 0.001, I2 = 88%
• MWM vs other manual therapy for disability (5 studies): mean difference -7.95 [95% CI -17.59, 1.68], Z = 1.62, p = 0.11 (non-significant), I2 = 94%
• Pain results exceeded MCID thresholds from comparator studies: hip osteoarthritis MCID -15.3 mm on VAS; rotator cuff shoulder pain MCID referenced from similar studies
• Disability results exceeded MCID thresholds: chronic knee disability MCID -16.0 points (KOOS); knee osteoarthritis -9.1 points and hip osteoarthritis -7.9 points (WOMAC)

Limitations

• No long-term follow-up data were identified in any of the included studies, so durability of effects is unknown
• High heterogeneity (I2 72-94%) in several meta-analyses limits confidence in the pooled estimates
• Some pooled comparisons included small numbers of studies and participants
• Only RCTs and CCTs were included, excluding other study designs; and studies in languages other than English or Greek were excluded

Why it matters

For patients

Patients with peripheral joint pain or stiffness, such as shoulder, hip, or knee problems, may experience meaningful short-term relief from MWM as part of physiotherapy treatment.

For clinicians

MWM can be recommended as a short-term intervention for peripheral joint pain and disability, with a clear advantage over passive or sham treatment, though superiority over other manual therapy techniques for disability remains unproven.

For readers

This meta-analysis provides the most comprehensive pooled evidence to date for MWM across peripheral joints, but the high heterogeneity and absence of long-term data highlight important gaps that future high-quality RCTs should address.