Mobilization with movement on reducing pain and disability for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials (2025)

Introduction

Knee 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.

Methods

Electronic 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.

Results

From 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.

Conclusion

This 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.

Notes on contributors

Long-Huei Lin

Long-Huei Lin is a physical therapist and PhD student at Chang Gung University. His research focuses on manual therapy, exercise intervention, and musculoskeletal rehabilitation.

Min Lin

Min Lin is an occupational therapist at Kaohsiung Veterans General Hospital with 15 years of clinical experience in physical rehabilitation. She works with individuals of all ages with disabilities, employing various techniques and equipment to help them maintain, regain, or improve their independence in daily activities.

Guo-Jia Hsieh

Guo-Jia Hsieh is a physical therapist and master’s student at Chang Gung University. His interests include manual therapy, exercise-based interventions, and musculoskeletal rehabilitation.

Hsin-I Chen

Hsin-I Chen is a physical therapist with 14 years of clinical experience, specializing in chronic musculoskeletal pain. She earned her Master’s degree from National Yang Ming Chiao Tung University and currently practices at Chen-Yi Physical Therapy Clinic.

Shu-Fen Sun

Shu-Fen Sun is the chief of Department of Physical Medicine and Rehabilitation at Kaohsiung Veterans General Hospital, specializing in neurological and musculoskeletal disorders.

Ren Jei Tsai

Ren Jei Tsai is a physical therapist and PhD candidate in Physical Therapy at National Taiwan University. He is a lecturer at Cardinal Tien Junior College of Healthcare and Management, focusing on teaching and clinical education. His expertise lies in managing musculoskeletal disorders and chronic diseases, with interests in evidence-based rehabilitation and integrated care for long-term conditions.