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Meta-Analysis
. 2022 Feb;30(1):13-32.
doi: 10.1080/10669817.2021.1955181. Epub 2021 Aug 1.

Efficacy of mobilization with movement (MWM) for shoulder conditions: a systematic review and meta-analysis

Kiran Satpute  1 , Sue Reid  2 , Thomas Mitchell  3 , Grant Mackay  4 , Toby Hall  5
Affiliations
Meta-Analysis

Efficacy of mobilization with movement (MWM) for shoulder conditions: a systematic review and meta-analysis

Kiran Satpute et al. J Man Manip Ther. 2022 Feb.

Abstract

Objective: To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders.

Methods: Six databases and Scopus, were searched for randomized control trials. The ROB 2.0 tool was used to determine risk-of-bias and GRADE used for quality of evidence. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and/or electrotherapy when compared with other conservative interventions.

Results: Out of 25 studies, 21 were included in eight separate meta-analyses for pain, ROM, and disability in the two sub-categories. For frozen shoulder, the addition of MWM significantly improved pain (SMD -1.23, 95% CI -1.96, -0.51)), flexion ROM (MD -11.73, 95% CI -17.83, -5.64), abduction ROM (mean difference -13.14, 95% CI -19.42, -6.87), and disability (SMD -1.50, 95% CI (-2.30, -0.7). For shoulder pain with movement dysfunction, the addition of MWM significantly improved pain (SMD -1.07, 95% CI -1.87, -0.26), flexion ROM (mean difference -18.48, 95% CI- 32.43, -4.54), abduction ROM (MD -32.46, 95% CI - 69.76, 4.84), and disability (SMD -0.88, 95% CI -2.18, 0.43). The majority of studies were found to have a high risk of bias.

Discussion: MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders and the effects clinically meaningful. However, these findings need to be interpreted with caution due to the high levels of heterogeneity and risk of bias.

Level of evidence: Treatment, level 1a.

Keywords: Mulligan’s mobilization with movement; manual therapy; shoulder dysfunction; systematic review.

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Conflict of interest statement

Kiran Satpute, Grant Mackay, Thomas Mitchell, and Toby Hall teach the Mulligan Concept on postgraduate physiotherapy courses, for which they receive a teaching fee.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.
Figure 2.
Figure 2.
ROB 2.0  judgements according to domain and overall risk of bias for each study
Figure 3.
Figure 3.
Forest plots for frozen shoulder sub category (a) Standardized Mean Difference Scores for pain. (b) Mean Difference Scores for flexion range of motion. (c) Mean Difference Scores for abduction range of motion. (d) Standardized Mean Difference Scores for disability.
Figure 4.
Figure 4.
Forest plots for shoulder pain with movement dysfunction sub-category. (a) Standardized Mean Difference Scores for pain. (b) Mean Difference Scores for flexion range of motion. (c) Mean Difference Scores for abduction range of motion. (d) Standardized Mean Difference Scores for disability.
See this image and copyright information in PMC

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