Mobilization with movement enhances early rehabilitation outcomes in knee osteoarthritis: a six-week randomized controlled trial

Abstract Background Exercise is a first-line approach for knee osteoarthritis (KOA), yet pain during movement may limit adherence. Mulligan’s mobilization with movement (MWM) is proposed to facilitate pain-free exercise and hasten early clinical gains. Objective To determine whether adding MWM to isometric training (IT) improves pain, quadriceps strength, and disability over six weeks compared with IT alone. Methods Two-arm, double-masked RCT in adults with radiographic KOA (Kellgren–Lawrence grade 2–3). Participants were randomized to MWM + IT or IT-only (n = 25/group), 5 supervised sessions/week for 6 weeks. Outcomes: pain (VAS), quadriceps strength (strain-gauge dynamometry), disability (WOMAC) measured at baseline, weeks 1, 3, and 6. Primary analyses used linear mixed-effects models with fixed effects for Group, Time, and Group × Time and a random intercept for Subject; joint Wald tests evaluated factor significance. Results Significant Time effects indicated improvement across outcomes (VAS χ2(3) = 456.338, p < 0.0001; STN χ2(3) = 186.876, p < 0.0001; WOMAC χ2(3) = 1515.459, p < 0.0001). Group×Time interactions were significant for VAS (χ2(3) = 170.550, p < 0.0001), STN (χ2(3) = 204.327, p < 0.0001), and WOMAC (χ2(3) = 71.041, p < 0.0001), demonstrating faster and larger six-week gains with MWM + IT. The Group main effect was significant for VAS (χ2(1) = 42.599, p < 0.0001) and non-significant for STN (χ2(1) = 0.613, p = 0.4336) and WOMAC (χ2(1) = 0.019, p = 0.8901). Conclusion Adding MWM to IT accelerated and amplified six-week improvements in pain, strength, and function compared with IT alone. Early integration of MWM may enhance pain-free exercise and short-term rehabilitation outcomes in KOA. Larger multicentre trials with extended follow-up and economic evaluation are warranted. Trial registration ClinicalTrials.gov Identifier: NCT05577403; prospectively registered on 12 /07/2021 (last updated on 14/09/2025).; available at https://clinicaltrials.gov/study/NCT05577403 .