Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review

Abstract

BACKGROUND AND OBJECTIVES: Joint mobilization is a non-pharmacological technique used to treat chronic musculoskeletal pain. However, it is controversial due to a lack of studies comparing its effects on this painful condition. The objective of this study was to assess the risk of bias in clinical trials investigating the effect of joint mobilization on chronic musculoskeletal pain. CONTENTS: A systematic search on Pubmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science, and Scopus was performed on September 2019 from the combination of three keywords: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Randomized controlled clinical trials that evaluated the use of joint mobilization associated or not to other therapies in chronic musculoskeletal pain treatment were included. Five thousand five hundred eighty-seven articles were screened, and 14 studies were analyzed, including 812 participants, with a mean age of 54 years, and female being the most affected. According to these articles, joint mobilization promoted the reduction of pain intensity in short and long terms, increase in range of motion, strength and function when used alone or in association with conventional physiotherapy. Regarding methodological quality, most of the studies were classified with low risk for selection, performance, detection and reporting bias. In the "other bias" item, which considered therapists experience Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review Mobilização articular associada ou não a outras terapias reduz dor musculoesquelética crônica: uma revisão sistemática

Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients With Chronic Musculoskeletal Pain

“…Mechanical hyperalgesia, evaluated with PPT, was improved after any of the OMT included techniques 27,46–72 . However, these improvements were limited to immediately after intervention or in the short-term (hours to days).…”

“…A list of excluded articles ( n = 26) with reasons can be found in the supplementary material (Appendix S2, Supplemental Digital Content 3, http://links.lww.com/PHM/C14). Overall, 29 SRs (with or without MA) were included in the qualitative synthesis, 26,27,46–72 whereas four MAs were included in the quantitative synthesis 26,70–72 . A flowchart of the selection process was created according to PRISMA guidelines (supplementary material, Fig.…”

“…According to the type of intervention, joint mobilization (passive mobilization or mobilization with movement) was the most commonly used technique in the intervention group, 27,46,47,52,53,57–60,63,69,71 followed by joint manipulation 49,51,54–56,61,67,68,70 and neurodynamic mobilization 48,62 . Finally, six reviews included studies with a combination of previous approaches 26,50,64–66,72 …”

“…In terms of the control group, sham techniques were the most commonly used control, 26,27,47–49,51,61,62,65,69,70 followed by manual contact, 46,50,52,57–60,63,66,71 other forms of OMT, 54–56 detuned ultrasound, 64,67,72 usual care, 53 or no control group 68 …”

“…The most pain sensitivity measured outcome was PPT, assessed in all SRs but one, 27,46–72 followed by TS 26,48,62 and CPM 26 …”