Review Article

Effectiveness of Mobilization with Movement on the Management of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

Table 2

Summary of included randomized control trials.

Authors (year)Patient characteristics, sample size, and mean ageInterventionFrequency, follow-up timeOutcome measureResultsConclusion

Shenouda (2013) [31]Source : 45outpatients
(GA = 15, GB = 15, GC = 15) and mean age (S. D) : GA = 51.93 ± 6.51, GB = 52.2 ± 5.44, and GC = 50.07 ± 5.73
GA = MWM plus exercise
GB = SWT plus exercise
GC = only exercise
Thrice per week for 4 weeksVAS
WOMAC
ROM
Significant difference in pain and functional disability was found in GA and GC. But, no significance difference was found between GA and GC for ROMMWM was effective in relieving knee pain and functional disability

Kandada and Heggannavar (2015) [32]Source : 64 outpatients
(GA = 32, GB = 32) and mean age (S. D) : GA = 50.13 ± 6.94 and GB = 54.72 ± 6.25
GA = MWM plus CPT
GB = MIMG protocol plus CPT
2 weeksVAS
ROM
WOMAC
Significant intragroup () difference was found. But, intergroup comparison is not significant in all variablesBoth MWM and MIMG protocol are effective in treating OA knee

Gupta and Heggannavar (2015) [33]Source : 60 outpatients
(GA = 20, GB = 20, GC = 20) and mean age (S. D) : GA = 54.10 ± 6.69, GB = 50.95 ± 5.97, and GC = 53.35 ± 6.34
GA = MWM plus CPT
GB = proprioceptive exercise plus CPT
GC = proprioceptive exercise plus MWM plus CPT
3 sets of 10 repetitions, 1 session per day for 2 weeksVAS
WOMAC
ROM
There were statistically significant changes in all outcome measures of GA and GCStatistically significant improvement was noted in knee joint proprioception on OA knee participants with Mulligan’s MWM

Lalnunpuii et al. (2017) [5]Source : 45 outpatients
(GA = 15, GB = 15, GC = 15) and mean age (S. D) : GA = 49.46 ± 5.48, GB = 48.46 ± 6.86, and GC = 47.93 ± 5.61
GA = MWM plus exercise
GB = Maitland mobilization plus exercise
GC = exercise only
Thrice per week for 4 weeksVAS
ROM
WOMAC
All outcome parameters () are statistically improved in the experimental group compared with the control groupMWM is more effective than Maitland mobilization in relieving pain and increasing ROM and functional capacity in females with knee OA

Kulkarni and Kamat (2017) [34]Source : 30 outpatients
(GA = 15, GB = 15) and mean age: not stated
GA = MWM plus CPT
GB = CPT
One session per day for 3 daysVAS
6-minute walk test
Statistically significant () reduction in VAS and marked improvement in the distance covered in the experimental groupMWM was effective in reducing pain, and showed marked improvement in the 6-minute walk test in the experimental group

Rao et al. (2018) [35]Source : 30 outpatients
(GA = 15, GB = 15) and mean age 51.2 ± 9.2
GA = MWM followed by Maitland mobilization
GB = Maitland mobilization followed by MWM
1–3 oscillations per second, 3 repetitions, for three daysNPRS
TUG
Pain-free squat angle
Within intervention, both groups showed significant changes () in all outcome measuresBoth are equally effective in reducing pain and improving functional mobility and pain-free squat angle for knee OA

Kaya Mutlu et al. (2018) [36]Source : 72 outpatients
(GA = 24, GB = 24, G = 24) and mean age (S. D): GA = 54.19 ± 7.34, GB = 56.29 ± 6.64, and GC = 57.77 ± 6.24
GA = MWM plus exercise
GB = PJM plus exercise
GC = electrotherapy plus exercise
Thrice per week at 1-year follow-upWOMAC
VAS
ROM
ALF
WOMAC, VAS, and knee ROM are significantly improved in the experimental group compared to the control groupMWM and PJM were superior to the control group in pain, knee ROM, quadriceps muscle strength, and functional level

Varma and Purohit (2018) [37]Source : 36 outpatients
(GA = 12, GB = 12, GC = 12) and mean age (S. D) = GA = 50 ± 6.33, GB = 58 ± 5.68, and GC = 55.75 ± 4.88
GA = MWM plus CPT
GB = KT plus CPT
GC = only CPT
Thrice per week for 2 weeksVAS
WOMAC
There was a statistically significant difference in each group and between groups
Significant between-group differences were found
Both MWM and KT reduce pain and improve function, but there was a better improvement in group A

Kiran et al. (2018) [38]Source : 62 outpatients
(GA = 31, GB = 31) and mean age (S. D) : 47.47 ± 0.61
GA = MWM plus CPT
GB = Maitland mobilization plus CPT
3 sessions per week for 2 weeksVAS
ROM
WOMAC
The mean differences of both treatment interventions were significantPatients in both groups showed improvement in pain, ROM, and functions

Bhagat et al. (2020) [39]Source : 30 outpatients
(GA = 15, GB = 15) and mean age (S. D) : GA = 53.73 ± 7.06, and GB = 56.87 ± 9.35
GA = MWM
GB = Sham
3 sets with 10 repetitions, duration of follow-up not statedNPRS
TUG
NPRS and TUG are significantly improved in GA compared to GB after interventionMWM was effective in improving pain and functional mobility in individuals with knee OA

Alkhawajah and Alshami (2019) [40]Source : 40 outpatients
(GA = 20, GB = 20) and mean age (S. D) : GA = 56.5 ± 7.6 and GB = 56.6 ± 8.5
GA = MWM
GB = sham
3 sets with 10 repetitions for 2 daysVAS
ROM
WOMAC
TUG
GA showed significant improvement in pain, TUG, and knee flexion ROM ()
But, WOMAC and knee extension ROM () were not significant
MWM was superior than sham in pain, physical function (walking), knee flexion and extension muscle strength, and knee flexion ROM for at least 2 days in patients with knee OA

Saddam Hussain Shaik et al. (2019) [41]Source : 40 outpatients
(GA = 20, GB = 20), mean age not mentioned
GA = MWM plus CPT
GB = Maitland mobilization plus CPT
Three sessions per week for 6 weeksKOOS
Quadriceps peak torque
GA showed more statistical significance in improving pain and quadriceps peak torque than GBMWM was more effective than Maitland mobilization

Pawar et al. (2019) [42]Source : 20 outpatients
(GA = 10, GB = 10), mean age not stated
GA = MWM
GB = McConnell patella taping
Each session 15–20 minutes, four days a weekVASVAS is significantly improved in the experimental group () compared to the control group ()MWM is comparatively more beneficial in reducing pain than taping in OA knee patients

Mahmooda et al. (2020) [43]Source : 30 outpatients
(GA = 15, GB = 15) and mean age (S. D) = 52.80 ± 6.32
GA = MWM plus usual care
GB = Myofacial release plus usual care
Once a day, 5 days per week for two weeksNPRS
ROM
WOMAC
Pain and ROM were improved in GA (). But, reduction of stiffness and improvement of physical function were seen in group B ()MWM and myofacial release were effective for knee OA in pain, ROM, and functional abilities. However, MWM produced more quick outcomes than myofacial

Nigam et al. (2020) [44]Soure : 40 outpatients
(GA = 20, GB = 20) and mean age (S. D) : GA = 58.5 (4.36) and GB = 59.4 (6.57)
GA = MWM plus usual care
GB = usual care
Three sets of 6–10 repetitions over two weeks at 6 monthsWOMAC
VAS
ROM
TUG
Significant effect of MWM in favor of GA for WOMAC and VAS was found. But, no significant difference between GA and GB was found for knee ROM and TUGMWM provided clinically significant improvements in disability, pain, and functional activities six months later

Abbreviations: OA, osteoarthritis; MWM, Mulligan’s movement with mobilization; MIMG, Macquarie injury management group; SWT, shock wave therapy; KT, Kinesio Taping; GA, group A (experimental group), GB; group B, GC; group C, CPT; conventional physical therapy, PJM; passive joint mobilization, VAS; Visual Analog Scale; WOMAC; Western Ontario and McMaster Universities Osteoarthritis Index, ROM; range of motion, NPRS; Numeric Pain Rating Scale, TUG; Time Up and Go, ALF; Aggregated Locomotor Function, KOOS; Knee injury and Osteoarthritis Outcome Scale.