Nikolaos Stathopoulos1, Zacharias Dimitriadis2, George A Koumantakis3. 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.
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.
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.
Authors: Héctor Gutiérrez-Espinoza; Felipe Araya-Quintanilla; Cristian Olguín-Huerta; Juan Valenzuela-Fuenzalida; Rodrigo Gutiérrez-Monclus; Victoria Moncada-Ramírez Journal: J Man Manip Ther Date: 2021-10-20