Mobilization with movement on reducing pain and disability for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

IntroductionKnee osteoarthritis (OA), affecting both tibiofemoral and patellofemoral compartments, causes pain and reduced quality of life. The Mulligan Concept of mobilization with movement (MWM) may relieve symptoms by modifying sensory input, enhancing central inhibition, and improving motor activation. This study conducted a systematic review and meta-analysis with subgroup analysis to evaluate MWM's efficacy in improving pain and disability in knee OA.MethodsElectronic databases were searched from inception to January 2025 for randomized controlled trials (RCTs) on the effects of MWM on knee OA. Pain intensity and disability improvement, standardized using Hedges' g, were the primary and secondary outcomes. Two reviewers independently assessed study quality, extracted data, and performed a meta-analysis using a random-effects model. Subgroup analyses considered intervention regimens, technique including weight-bearing or not, Kellgren-Lawrence (K-L) classification grades, and control group comparisons.ResultsFrom 23 RCTs (996 participants; mean age 37-61 years), MWM significantly reduced pain (Hedges' g = -0.984, 95% CI = -1.375 to -0.593) and improved disability (Hedges' g = -1.041, 95% CI = -1.477 to - 0.606).. Greater effect sizes were observed when MWM was combined with other therapies, including weight-bearing positions, and among participants without advanced K-L grades. MWM also demonstrated significant effects in comparison with active controls.ConclusionThis meta-analysis showed that MWM reduces pain and disability in individuals with knee osteoarthritis, especially when incorporated into treatment protocols featuring weight-bearing positions and combined physical therapies. Clinically, MWM could be incorporated into rehabilitation programs to enhance pain relief and functional recovery. Future studies should extend follow-ups and address bias.