Effectiveness of Mulligan mobilization versus proprioceptive exercises in knee osteoarthritis: a randomized controlled trial

Background. Knee osteoarthritis (KOA) is a common orthopedic disorder that causes chronic pain, limits the mobility, and reduces the overall quality of life. As much as efficacy of exercise therapy is supported by empirical evidence, relative effectiveness of Mulligan Mobilization with Movement (MMT) by comparison with proprioceptive training is yet to be established. Objective. The purpose of the proposed study was to compare the impacts of MMT with proprioceptive exercises (PEG) and standard physiotherapy in people with KOA on pain and functional status. Methods. A randomized controlled trial including 60 participants (aged ≥40 years) was conducted over 10 weeks. Participants were allocated to MMT, PEG, or control physiotherapy groups. Pain intensity (NPRS) and knee function (KOOS Total Score) were assessed at baseline, 4th, 8th, and 10th weeks. Repeated-measures ANOVA with Bonferroni-adjusted pairwise comparisons was used. Results. The statistically significant improvements were observed in all the intervention groups (p < 0.001). The most significant pain reduction and the maximum functional improvement was found in MMT. PEG had an intermediate degree of improvement, and conventional physiotherapy had the lowest degree of effect size. Effect sizes were highest for MMT (NPRS η² = 0.624; KOOS η² = 0.387). Conclusion. Among patients with KOA, Mulligan Mobilization with Movement was found to be better than proprioceptive exercises and traditional physiotherapy in reducing pain and improving the knee function. These results support the use of MMT as a conservative modality of first instance, which offers clinicians a powerful and effective alternative to achieve better patient outcomes.