A systematic review on the effectiveness of manipulation and mobilisation in the treatment of osteoarthritis

Abstract

Osteoarthritis (OA) is an increasing condition globally as the population ages and the number of elderly increases. However, there is a lack of relevant evidence-based guidelines for manual therapy in the treatment of OA especially involving OA of the spine, wrist, temporomandibular joint (TMJ), and the glenohumeral joint (GHJ). A systematic review organises and critiques literature in a more concise form for practitioners. This study aimed to briefly provide practitioners the evidence available on the effectiveness of manipulation and mobilisation on OA. Methods: A systematic review of available literature was performed using keywords including “manipulation”; “mobilization”; “manual therapy” and “osteoarthritis”; “spondylosis”; “degenerative joint disease”; “degenerative disc disease”. The database searches were through CINAHL, DUT summons, Google scholar, Pubmed and Scopus. Following a screening using inclusion criteria, 20 articles were chosen for review. Each of the studies were than reviewed by three reviewers using the Newcastle-Ottawa scale, the PEDRO scale, the Joanna Briggs Institute (JBI) scale for case series and the JBI scale for case reports. These scales evaluated the methodological rigour (internal validity) of the chosen articles. In addition, the external validity was determined through a critique of each article. The internal and external validity formed the basis for decisions on the level of evidence provided in support of manual therapy. Results: Of those chosen articles, 13 provided evidence of treatment programmes and could not contribute to evidence specific to mobilisation and manipulation. In contrast, four articles assessed the efficacy of mobilisation, one study assessed the efficacy of manipulation, and two studies assessed the efficacy of neural mobilisation. There was moderate evidence in support of mobilisation on thumb carpometacarpal (CMC) OA, but only limited evidence in support of its use on cervical spine OA and no evidence in support of its use on lumbar spine OA, GHJ OA and TMJ OA. Manipulation was suggested to have moderate to limited evidence in support of its use on lumbar spine OA, but no evidence for cervical spine OA. Neural mobilisation was suggested to have limited evidence in support of its use for treating thumb CMC OA. Conclusion: It was evident in this systematic review that there is limited evidence for mobilisation, manipulation and neural mobilisation. Further research is required to expand on the limited areas, as well as strengthen the current evidence for clinical use.