Immediate effects of Mulligan's techniques on pain and functional mobility in individuals with knee osteoarthritis: A randomized control trial

Abstract

Background and PurposeMulligan's mobilization with movement was shown to be effective when implemented in multimodal therapy for knee osteoarthritis. However, no study has evaluated the Mulligan's technique in isolation and compared the relative effectiveness with sham‐controlled interventions. Hence, the present study examined the immediate effects of Mulligan's techniques with sham mobilization on the numerical pain rating scale (NPRS) and timed up and go (TUG) test in individuals with knee osteoarthritis.MethodsThirty participants (mean age: 55.3 ± 8.3 years) with symptoms at the knee and radiographic diagnosis of knee osteoarthritis were randomized into sham (n = 15) and intervention (n = 15) groups. The intervention (I) group received Mulligan's mobilization glides that resulted in relative pain relief for three sets of 10 repetitions. For the sham (S) group, the therapist's hand was placed over the joint surfaces mimicking the pain‐relieving glides, without providing the gliding force. The outcome measures NPRS and TUG were recorded by a blinded assessor pre‐ and post‐intervention.ResultsStatistically significant differences were identified between the groups in post‐intervention median (interquartile range) NPRS (I group: 4.00 [2.00–5.00]; S group: 6.00 [4.00–7.00]) and TUG scores (I group: 10.9 [9.43–10.45]; S group: 13.18 [10.38–16.00]) with the intervention group demonstrating better outcomes (p < .05). Within‐group, the post‐intervention scores of NPRS and TUG were significantly lower (p < .05) compared to the pre‐intervention scores in the intervention group. In the sham group, a statistically significant pre–post change was noticed only in the NPRS scores but not in the TUG scores.ConclusionMulligan's techniques were effective in improving pain and functional mobility in individuals with knee osteoarthritis. The underlying mechanisms for observed effects must be examined further, as participants reported pain relief following sham mobilization.

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial

“…These results are consistent with previous studies investigating the efficacy of mobilisation with movement for the management of symptomatic knee osteoarthritis. 12–14,25,26…”

“…As well, we did not include a placebo group which could have helped to understand the true effects of mobilisation with movement as there is contrasting evidence on its efficacy over a placebo response in the management of knee osteoarthritis. 12,13 A further limitation is that we trusted the verbal feedback for ensuring the subjects adherence to the home exercise protocol. We did not evaluate adherence.…”

“…These results are consistent with previous studies investigating the efficacy of mobilisation with movement for the management of symptomatic knee osteoarthritis. [12][13][14]25,26 The improvement seen in both groups is likely partly explained by the positive effects of exercise. A Cochrane systematic review conducted by Fransen et al 9 provides high to moderate quality evidence for the beneficial effects of exercise in knee osteoarthritis.…”

“…11 Differing to traditional passive manual therapy techniques, Mulligan manual therapy includes mobilisation with movement. This active form of treatment has demonstrated successful outcomes in the short-term 12,13 as well as preliminary evidence in the long-term in patients with knee osteoarthritis pain. 14…”

“…11 Differing to traditional passive manual therapy techniques, Mulligan manual therapy includes mobilisation with movement. This active form of treatment has demonstrated successful outcomes in the short-term 12,13 as well as preliminary evidence in the long-term in patients with knee osteoarthritis pain. 14 The purpose of this study was to examine the long-term efficacy of mobilisation with movement in addition to usual care comprising exercise and heat in patients with symptomatic knee osteoarthritis.…”