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|Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008 to 2017 [with consumer summary]|
|Stathopoulos N, Dimitriadis Z, Koumantakis GA|
|Physiotherapy 2019 Mar;105(1):1-9|
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 to 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 techniquesfor pain (mean difference (95%CI) -16.12 (-19.77 to -12.48) and I2 = 72%) and disability (mean difference (95%CI) -17.51 (-22.84 to -12.19) and I2 = 88%) or against another manual therapy treatment (pain mean difference (95%CI) -10.43 (-11.38 to -9.48) and I2 = 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.