Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.954
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
Processing time: 190 Days and 9.2 Hours
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.
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.
To determine the efficacy of Maitland and Mulligan mobilization methods in adults with KOA.
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.
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).
The Mulligan mobilization has been recommended to be applied in alleviating pain and improving Western Ontario and McMaster Universities function score.
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.