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

Nikolaos Stathopoulos; Zacharias Dimitriadis; George A Koumantakis

doi:10.1016/j.physio.2018.10.001

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

Physiotherapy. 2019 Mar;105(1):1-9. doi: 10.1016/j.physio.2018.10.001. Epub 2018 Oct 15.

Authors

Nikolaos Stathopoulos¹, Zacharias Dimitriadis², George A Koumantakis³

Affiliations

¹ Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK. Electronic address: nstathopoulos1@mitropolitiko.edu.gr.
² Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK. Electronic address: zdimitriadis@teiste.gr.
³ Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK; 401General Army Hospital of Athens, Pan. Kanellopoulou 1, Athens, Greece. Electronic address: gkoymantakis@mitropolitiko.edu.gr.

PMID: 30630623
DOI: 10.1016/j.physio.2018.10.001

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 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.

Keywords: Joints; Manual therapy; Mobilization with movement; Mulligan Concept; Peripheral.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Clinical Trials as Topic
Disability Evaluation
Disabled Persons / rehabilitation*
Humans
Movement
Musculoskeletal Manipulations / methods*
Pain Management / methods*