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Meta-Analysis
. 2024 Feb;38(2):145-183.
doi: 10.1177/02692155231215216. Epub 2023 Nov 21.

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis

Frederico Mesquita Baptista  1 , Ellen Nery  1 , Eduardo Brazete Cruz  2 , Vera Afreixo  3 , Anabela G Silva  4
Affiliations
Meta-Analysis

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis

Frederico Mesquita Baptista et al. Clin Rehabil. 2024 Feb.

Abstract

Objective: To investigate up-to-date evidence of the effectiveness of neural mobilisation techniques compared with any type of comparator in improving pain, function, and physical performance in people with musculoskeletal pain.

Data sources: The following sources were consulted: PubMed, Web of Science, CENTRAL, CINAHL, Scopus, and PEDro databases; scientific repositories; and clinical trial registers. The last search was performed on 01/06/2023.

Methods: Two reviewers independently assessed the studies for inclusion. We included randomised, quasi-randomised, and crossover trials on musculoskeletal pain in which at least one group received neural mobilisation (alone or as part of multimodal interventions). Meta-analyses were performed where possible. The RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation tools were used to assess risk of bias and to rate the certainty of evidence, respectively.

Results: Thirty-nine trials were identified. There was a significant effect favouring neural mobilisation for pain and function in people with low back pain, but not for flexibility. For neck pain, there was a significant effect favouring neural mobilisation as part of multimodal interventions for pain, but not for function and range of motion. Regarding other musculoskeletal conditions, it was not possible to conclude whether neural mobilisation is effective in improving pain and function. There was very low confidence for all effect estimates.

Conclusions: Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain. For the other musculoskeletal conditions, results are inconclusive.

Keywords: Physical therapy; disability; musculoskeletal disorders; neural mobilisation; pain.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Global and subgroup standardised mean differences (95% confidence interval) in the effect of neural mobilisation versus other treatments on pain intensity in participants with low back pain. A: multimodal vs. single intervention; B: sliding vs. tensioning technique.
Figure 3.
Figure 3.
Risk of bias assessment for pain intensity in low back pain studies. A: RoB 2 – randomised controlled trials; B: ROBINS-I – quasi-randomised trials.
Figure 4.
Figure 4.
Global and subgroup standardised mean differences (95% confidence interval) in the effect of neural mobilisation versus other treatments on functional status in participants with low back pain. A: multimodal vs. single intervention; B: sliding vs. tensioning technique.
Figure 5.
Figure 5.
Risk of bias assessment for functional status in low back pain studies. A: RoB 2 – randomised controlled trials; B: ROBINS-I – quasi-randomised trials.
Figure 6.
Figure 6.
Standardised mean difference (95% confidence interval) in the effect of neural mobilisation versus other treatments on flexibility in participants with low back pain.
Figure 7.
Figure 7.
Risk of bias assessment for flexibility in low back pain studies. A: RoB 2 – randomised controlled trials; B: ROBINS-I – quasi-randomised trials.
Figure 8.
Figure 8.
Global and subgroup standardised mean differences (95% confidence interval) in the effect of neural mobilisation versus other treatments on pain intensity in participants with neck pain. A: multimodal vs. single intervention; B: sliding vs. tensioning technique.
Figure 9.
Figure 9.
Risk of bias assessment for pain intensity in neck pain studies (RoB 2 – randomised controlled trials).
Figure 10.
Figure 10.
Standardised mean difference (95% confidence interval) in the effect of neural mobilisation versus other treatments on functional status in participants with neck pain.
Figure 11.
Figure 11.
Risk of bias assessment for functional status in neck pain studies (RoB 2 – randomised controlled trials).
Figure 12.
Figure 12.
Standardised mean differences (95% confidence interval) in the effect of neural mobilisation versus other treatments on range of motion in participants with neck pain. A: flexion; B: extension; C: lateral flexion; D: rotation.
Figure 13.
Figure 13.
Risk of bias assessment for range of motion in neck pain studies (RoB 2 – randomised controlled trials).
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