Added: Nakima Ybanez - Date: 28.08.2021 19:32 - Views: 45904 - Clicks: 8967
Osteoarthritis is becoming a global major cause of pain and functional disability worldwide, especially in the elderly population. Nowadays, evidence shows that mobilization with movement MWM has a beneficial effect on knee osteoarthritis subjects. However, its adequacy remains unclear. To review the best available evidence for the effectiveness of MWMs on pain reduction and functional improvement in patients with knee osteoarthritis. Only randomized controlled trials RCTs were included, and the methodological quality of the studies was appraised using the PEDro scale.
A total of 15 RCTs having participants were included. This systematic review demonstrated that MWM was effective to improve pain, range of motion, and functional activities in subjects with knee osteoarthritis. Osteoarthritis OA is a chronic degenerative disease characterized by the deterioration of the cartilage in the ts, creating stiffness, pain, and impaired movement [ 12 ]. Osteoarthritis a leading cause of pain and functional disability in both developed and developing countries, especially in the elderly population [ 34 ].
The knee t is the most commonly affected t by OA due to its weight-bearing requirement, high mobility, and lack of intrinsic stability [ 5 ]. It le to limitations in activities of daily life and impairment in the quality of life because of the accompanying pain and morning stiffness in the t [ 6 ].
Generally, The management of knee OA needs a multidisciplinary approach. The conservative treatment forms for knee OA comprise pharmacological and nonpharmacological modalities. Mobilization with movement MWM is a manual therapy technique that is used most frequently for the management of musculoskeletal conditions [ 22 ]. It was initially advocated by Brian Mulligan and has been proposed as a novel manual therapy technique to treat a variety of upper and lower limb t-related soft tissue conditions [ 2324 ].
In this technique, the physiological movement is performed in a pain-free manner [ 24 ] with accessory glides being applied in the direction towards the opposite of the ly painful movement to have the greatest improvement [ 25 ]. The rationale for the use of MWM techniques is directed towards correcting positional faults at the t [ 27 ]. evidence has furnished the beneficial effects of MWM on different peripheral ts [ 232528 ]. Nevertheless, its adequacy remains unclear. Therefore, the aim of this review was to analyze the effectiveness of MWM on pain reduction and functional improvement in patients with knee OA.
An extensive literature search Mwm 4 sub female performed to identify all eligible randomized controlled trials from inception to September The search was made using the following keywords: mobilization with movement, knee osteoarthritis, and randomized controlled trial.
The study selection process was performed by four reviewers G. T, Mwm 4 sub female H. Only randomized control trials and studies intervening knee OA with MWM were included in this review. Any disagreement between the reviewers should be consulted by two reviewers G. S and A. A to reach a consensus. Four reviewers independently assessed all sources of the papers, and the level of each study was determined according to the hierarchical system of Lloyd-Smith. The level of evidence reveals the degree to which bias has been considered within study de, with a lower rating on the hierarchy indicating less bias.
Merely studies that scored between 1b and 2a on the Lloyd-Smith scale were included in this systematic review. In this approach, we could ensure that MWM for knee OA supported by this review was based on of high-level evidence. Based on a predetermined extraction tool, three authors G. A, and G. S independently extracted relevant data from each article. A total of articles were identified by the searching strategy. After adjusting for duplicates, remained.
After the title and abstract screening of studies, studies were expelled. Subsequently, by full content screening out of 38 articles, 15 randomized controlled trials were included in this review 1. The characteristics of the included studies are illustrated in Table 2. The included studies were published between and September Overall, participants with knee OA aged from 40 to 70 years were included.
The average age of the participants ranged from The follow-up duration of the experimental and control group ranged from two days to twelve months [ 3640 ], with the majority of the studies having a follow-up duration of around two to three weeks. The mean PEDro score of the studies was 6. Two trials [ 3644 ] scored 8, and four trials [ 5353940 ] scored 9 on the PEDro scale, which was the highest possible score given the intervention, as it would not be feasible to blind clinicians.
The methodological qualities of the included studies are summarized and reported in Table 3.
Out of the 15 randomized controlled trials, 9 articles reported about the procedure of proper randomization sequence and six randomized controlled trials conducted by Shenouda [ 31 ], Gupta and Heggannavar [ 33 ], Kulkarni and Kamat [ 34 ], Kiran et al. Six trials reported concealed allocation, and the majority of the articles had not clearly reported a concealed allocation method.
In study performance bias, merely 3 of the randomized controlled trials were found to be double-blinded and the other remaining articles are single-blinded. Six randomized controlled trials conducted by Lalnunpuii et al. The outcome measures for each of the fifteen trials are presented in Table 2 All the studies included outcome measures for pain and functional disability status.
Out of the 15 included trials, 14 of them reported that knee pain was ificantly improved in the MWM groups compared to the control group [ 53133 — 44 ]. Only one study reported that the MWM group had no improvement in knee pain compared to the control groups [ 32 ]. From the total included trialsnine of them had assessed knee ROM. Out of these, eight trials reported that MWM has positive effects on t range of motion for OA patients compared to the control groups [ 53133 Mwm 4 sub female, 3638404344 ]. Conversely, only one study reported that the MWM group had no improvement of knee ROM compared to the control group [ 32 ].
Out of the included trials, fourteen of them had assessed functional status. Out of these trials, thirteen of them had reported that MWM has positive effects on functional activities in OA patients compared to the control groups [ 53133 — 39414344 ]. However, two studies reported that the MWM group had no ificant effect on knee functional status in patients with knee OA [ 3240 ].
To the extent of our knowledge, this is the preliminary review to systematically evaluate the effectiveness of MWM among subjects with knee OA. In this review, 15 recent RCTs were included, which investigated the effectiveness of MWM in subjects with knee OA as compared with control interventions.
Most of the included studies published that MWMs is effective in improving pain, range of motion, and physical functioning in patients with knee OA. The in this review are consistent with the systematic reviews on peripheral ts reporting positive clinical effects of MWM [ 232528 ]. Shenouda [ 31 ] reported that MWM had positive effects for subjects with knee OA on pain reduction and functional disability. Besides, MWM has no statistically ificant difference in the improvement of knee ROM in both the interventional and control groups.
However, in within- and between-group analysis of pre- and posttreatment, there was statistical ificance in all outcome measures. In contrast, a study conducted by Kandada andHeggannavar [ 32 ] showed that the intergroup analysis shows an inificant difference in all the outcome measures.
But, the intragroup comparison shows a ificant difference in pain reduction, functional improvement, and knee ROM. Another study investigated by Gupta et al. This could mean MWM may have had beneficial Mwm 4 sub female on t nutrition because of the squeezing out of the fluid during each compression and imbibing of fluid when the compression is removed [ 45 ].
Normally, squeezing occurs when the mobilization technique is performed and imbibing of fluid occurs when the t is relaxed. This could possibly be the reason for a reduction in pain and a subsequent improvement in ROM and function that was found at the end of the treatment session. Likewise, Lalnunpuii et al. This could be beacuse MWM might provide a stretching effect on the t capsules and muscles, thus restoring normal arthrokinematics or decreasing pain by stimulation of t mechanoreceptors, which consequently inhibits nociceptive stimuli and improved motor control [ 4647 ].
Kulkarni and Kamat [ 34 ] showed that ificant reductions in pain and improvement in 6-minute walk test distance covered during posttreatment sessions in both groups. Besides, Rao et al.
Similarly, the study by Kaya Mutlu et al. This could be due to the repeated motion of MWM, which might alter the concentrations of anti-inflammatory mediators in the t, which might consequently inhibit nociceptors [ 48 ]. Another possible reason could be due to psychological effects such as a reduction in fear avoidance associated with movement [ 49 ]. Varma and Purohit [ 37 ] found that MWM combined with conventional exercise groups showed better ificant improvement in reducing pain, improving function than the conventional exercise group after 2 weeks of intervention.
In the intervention group, the improvements could be because of biomechanical and neurophysiological mechanisms of MWM that may produce pain at the spinal level pain gate mechanisms [ 50 ]. Besides, a study by Kiran et al.
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