Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 954-965
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.954
Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: A systematic review and meta-analysis
Ling-Ling Li, Xin-Jie Hu, Yong-Hui Di, Wei Jiao
Ling-Ling Li, Xin-Jie Hu, Yong-Hui Di, Wei Jiao, Sport Medicine and Rehabilitation College, Beijing Sport University, Beijing 100084, China
Author contributions: Li LL and Hu XJ designed the research; Li LL, Hu XJ and Di YH performed the research; Li LL and Hu XJ contributed new reagents/analytic tools; Li LL and Di YH analyzed the data; Li LL and Hu XJ wrote the paper.
Supported by the National Key Research and Development Program of China, No. 2018YFF0301104.
Conflict-of-interest statement: Dr. Jiao reports grants from National Key Research and Development Program of China, during the conduct of the study.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Jiao, PhD, Academic Fellow, Sport Medicine and Rehabilitation College, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing 100084, China. jiaowei01@vip.sina.com
Received: July 9, 2021
Peer-review started: July 9, 2021
First decision: October 22, 2021
Revised: November 4, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
ARTICLE HIGHLIGHTS
Research background

Knee osteoarthritis (KOA) is the most common type of arthritis, with heavy burden on healthcare service. Manual therapy is an effective method for the treatment of KOA, but the efficacy of Maitland vs Mulligan mobilization techniques is still controversial.

Research motivation

Some reviews have found that the manual therapies might be effective and safe in ameliorating osteoarthritis symptoms, and Maitland mobilization was recommended in these studies. However, there still was no systematic review and meta-analysis to compare the efficacy of different mobilization techniques, such as Maitland vs Mulligan mobilization. Therefore, it is necessary to conduct a meta-analysis to fill this gap in our understanding.

Research objectives

To determine the efficacy of Maitland and Mulligan mobilization methods in adults with KOA.

Research methods

We searched PubMed, Embase, Web of Science, the Cochrane Library and Google Scholar from inception to September 20, 2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA. Data processing and statistical analyses were performed using Cochrane Collaboration software (Review Manager Version 5.2 for Windows). The odds ratio and 95% confidence interval (CI) were employed to analyze the dichotomous variables. Meanwhile, the standardized mean difference (SMD) with a 95%CI was used to analyze the continuous variables.

Research results

A total of 341 articles were screened from five electronic databases (PubMed, the Cochrane Library, EMbase, Web of Science and Google Scholar) after excluding duplicates. Ultimately, eight trials involving 471 subjects were included in present systematic review and meta-analysis. Mulligan mobilization is more effective in alleviating pain (SMD = 0.60; 95%CI: 0.17 to 1.03, P = 0.007; I2= 60%, P = 0.020) and improving Western Ontario and McMaster Universities function score (standardized mean difference = 7.41; 95%CI: 2.36 to 12.47, P = 0.004; I2= 92%, P = 0.000). There was no difference in the effect of the two kinds of mobilization on improving the range of motion (standardized mean difference = 9.63; 95%CI: -1.23 to 20.48, P = 0.080; I2= 97%, P = 0.000).

Research conclusions

The Mulligan mobilization has been recommended to be applied in alleviating pain and improving Western Ontario and McMaster Universities function score.

Research perspectives

Our meta-analysis revealed that Mulligan mobilization will be a promising alternative option for KOA treatment. Unfortunately, because of the poor methodological quality of included studies, more data and surveillance will be necessary to identify the efficacy. Also, further studies are needed to explore the cost of KOA in other ethnicities.