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

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.