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Immediate effects of Mulligan's techniques on pain and functional mobility in individuals with knee osteoarthritis: a randomized control trial
Bhagat M, Neelapala YVR, Gangavelli R
Physiotherapy Research International 2019 Sep 10:Epub ahead of print
clinical trial
9/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND AND PURPOSE: Mulligan'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. METHODS: Thirty 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. RESULTS: Statistically significant differences were identified between the groups in post-intervention median (interquartile range) NPRS (I group 4.00 (2.00 to 5.00); S group 6.00 (4.00 to 7.00)) and TUG scores (I group 10.9 (9.43 to 10.45); S group 13.18 (10.38 to 16.00)) with the intervention group demonstrating better outcomes (p < 0.05). Within-group, the post-intervention scores of NPRS and TUG were significantly lower (p < 0.05) 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. CONCLUSION: Mulligan'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.

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