Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: A systematic review and meta-analysis

Table 1 Characteristics of the included studies

Study	Comparators	Sample size	Age (yr)	Interventional type	Interval	Treatment period	Outcomes
Sambandam et al[31], 2011	Mulligan	20	61.0 ± 5.81	Unspecific; CT: 10 min hot pack and quad isometrics, 10 rep; HE: 10 rep isometric quadriceps	Once per day	2 wk	1, 2, 3
	Maitland	20	60.0 ± 5.11
Kiran et al[14], 2018	Mulligan	31	47.5 ± 0.61	Depending on pain; CT: 10 min hot pack and quad isometrics	3 times per week	2 wk	1, 2, 3
	Maitland	31		Grade 1, 2 for pain; Grade 3 for ROM; CT: 10 min hot pack and quad isometrics
Jeyakumar et al[30], 2017	Mulligan	20	51.0 ± 1.51	Medial, lateral, and rotational Mulligan without a belt; one glide per sec for 30 sec; 3 sets per treatment session; CT: hot pack, quad isometrics and SLR	Once per day	3 wk	1, 2
	Maitland	20	50.0 ± 2.71	Medial, lateral, posterior glide; one glide per seconds for 30 seconds; 3 sets per treatment session; CT: hot pack, quad isometric and SLR
Multu et al[33], 2018	Mulligan	21	54.2 ± 7.31	A sustained manual glide of the tibia (medial, lateral, or rotation) during active; knee flexion and extension, 3 sets of 10 rep; EP: aerobic, active ROM, strength, stretching exercises	3 times per week	4 wk	1, 2, 3
	Maitland	21	56.3 ± 6.61	Knee distraction and dorsal glides, ventral glides and patellar glides in all direction; 2-3 oscillations per seconds for 1-2 min; 3-6 rep; EP: aerobic, active ROM, strength, stretching exercises
Lalnunpuii et al[35], 2016	Mulligan	15	49.5 ± 5.51	Medial, lateral, rotation and dorsal mobilization with active knee flexion; 3 sets of 10 rep; EP: isometric strengthening (quad, hamstring, VMO), Stretch (quad, hamstring), ROM	3 sessions per week	4 wk	2, 3
	Maitland	15	48.5 ± 6.91	Tibia-femoral anterior-posterior glide, Tibia-femoral posterior-anterior glide, Patella-femoral caudal-cephaloid glide, 2-3 oscillations per sec for 1-2 min. EP: isometric strengthening (quad, hamstring, VMO), Stretch (quad, hamstring), ROM
Giri [32], 2019	Mulligan	30	61-702	A sustained manual glide of the tibia (either medial, lateral, anterior, posterior or rotation) during active knee flexion and extension; 3 sets of 10 rep. Mulligan taping: tape with brown rigid tape	3 times per week	2 wk	1, 3
	Maitland	30		Tibia-femoral anterior and posterior glided. Kinesio taping: superior "Y" technique
Rao et al[34], 2017	Mulligan	30	51.2 ± 9.21	According to individual condition	-	-	1
	Maitland			AP, PA, medial, lateral, compression and distraction glides; rotation
Lalit et al[15], 2012	Mulligan	30	51.72	internal rotation the tibia, 3 reps for 3 sets; EP: multiple angle isometrics, terminal arc knee extension, mini-squats, partial lunges one-leg balances, cross-body leg swings, 10 rep per session, 3 sessions per day	3 sessions per day	5 d	1, 3
	Maitland	30	54.73	Anterior and posterior glide for tibial-femoral joint, superior-inferior and medio-lateral glides for patellar femoral joint, 10 rep per session, 3 sessions per day; EP: multiple angle isometrics, terminal arc knee extension, mini squats, partial lunges one-leg balances, cross-body leg swings (10 rep per session, 3 sessions per day)

¹mean ± SD.

²Range.

³mean. 1: Pain; 2: ROM: Range of motion; 3: WOMAC function score: Western Ontario and McMaster Universities function score. Rep: Repetition; CT: Conventional treatment; HE: Home exercise; SLR: Straight leg raise; EP: Exercise program; VMO: Vastus medialis oblique; AP: Anterior to posterior; PA: Posterior to anterior.

Table 2 Quality of included studies by PEDro Scale

Author	C1	C2	C3	C4	C5	C6	C7	C8	C9	C10	C11	TS	Level of evidence
Lalnunpuii et al[31], 2016	1	1	0	1	1	1	1	1	1	1	1	10	A2
Rao et al[34], 2017	1	1	0	1	1	0	1	1	0	1	1	8	B
Kiran et al[14], 2018	1	1	0	1	0	0	0	1	1	1	1	7	B
Mutlu et al[33], 2018	1	1	1	1	1	0	1	1	0	1	1	9	B
Giri et al[32], 2019	1	1	0	1	0	0	0	1	1	1	1	7	B
Jeyakumar et al[30], 2017	1	1	1	1	0	0	0	1	1	1	1	8	B
Sambandam et al[31], 2011	0	1	0	1	0	0	1	1	1	1	1	7	B
Lalit et al[15], 2012	1	0	0	0	0	0	0	1	1	1	1	5	B

C1: Eligibility criteria were specified; C2: Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received); C3: Allocation was concealed; C4: The groups were similar at baseline regarding the most important prognogstic indicators; C5: There was blinding of all subjects; C6: There was blinding of all therapists who administered the therapy; C7: There was blinding of all assessors who measured at least one key outcome; C8: Measurements of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups; C9: All subjects for whom outcome measurements were available received the treatment or control condition as allocated, or where this was not the case, data for at least one key outcome were analyzed by "Intention to treat"; C10: The result of between-group statistical comparisons were reported for at least one key outcome; C11: The study provided both point measurements and measurements of variability for at least one key outcome; 0: Does not meet the included criteria; 1: Meets the included criteria. TS: Total score.