EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

Alsiri, Najla, Alshatti, Sharifa A., Al-Saffar, Maryam, Bhatia, Rashida S., Fairouz, Fatemah and Palmer, Shea ORCID: https://orcid.org/0000-0002-5190-3264 2025. EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial. Journal of Orthopaedic Surgery and Research 20 , 181. 10.1186/s13018-025-05568-8

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Abstract

Background: Mobilization with Movement (MWM) is an examination and management approach for correcting the intra-articular translational and rotational movements to facilitate the active physiological movement. The study aimed to determine the effects of MWM on Total Knee Arthroplasty (TKA) using a randomized controlled trial (RCT) design. Methods: The trial is registered (ISRCTN ref: 13,028,992). A blinded examiner assessed patients at pre-surgical (before TKA), post-surgical (at 3-weeks post-TKA), 6-weeks and 6-months post-TKA. Participants were randomly assigned to receive MWM (six sessions, between 3 and 6 weeks post-TKA) plus standard rehabilitation (intervention group) or standard rehabilitation alone (control group) of outpatient rehabilitation including range of motion and strengthening exercises, cycling, gait and stair training. Outcome measures were range of motion (goniometer), pain (visual analogue scales), physical function (Timed Up and Go (TUG)), a 15-m walk test, and health status (Western Ontario and McMaster (WOMAC) Osteoarthritis Index). Change in outcome measures from post-surgical to 6 weeks and 6 months post-TKA were compared between groups. The primary outcome was change in knee flexion range of motion at 6 weeks. Results: 84 women scheduled for TKA were randomly allocated to intervention (n = 42) or control (n = 42); mean ± (SD) age 65.1 ± 7.4 and 66.8 ± 8.9 years, respectively. The intervention group demonstrated significantly greater increase in knee flexion at both 6 weeks (median (IQR) + 10.000 (20.000) compared with + 2.500 (6.250) in the control group) and 6 months (+ 12.500 (15.000) and + 5.000 (10.000) respectively) (both p < 0.05). There were no differences between groups in secondary outcomes. Conclusion: Introducing MWM for TKA rehabilitation has greater benefits for women post-TKA in increasing knee joint flexion range of motion than the standard rehabilitation programs in the short and medium-term. This evidence-based approach offers a promising adjunctive intervention for optimizing recovery and rehabilitation process following TKA in women. Clinicians should consider including MWM approach in post-TKA rehabilitation programs.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Healthcare Sciences
Subjects:	R Medicine > R Medicine (General)
Uncontrolled Keywords:	Rehabilitation; knee arthroplasty; surgery; manual therapy; range of motion; Mulligan approach
Publisher:	BioMed Central
ISSN:	1749-799X
Funders:	Kuwait Foundation for the Advancement of Sciences (KFAS) (Ref:PR19-13MM-05)
Date of First Compliant Deposit:	20 February 2025
Date of Acceptance:	4 February 2025
Last Modified:	20 Feb 2025 15:00
URI:	https://orca.cardiff.ac.uk/id/eprint/176042

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