Effectiveness of Articular and Neural Mobilization for Managing Cervical Radicular Pain: A Systematic Review With Network Meta-Analysis

Abstract

OBJECTIVE: To evaluate the impact of articular and neural mobilization on pain intensity and disability in patients with cervical radicular pain. DESIGN: Intervention systematic review with network meta-analysis. LITERATURE RESEARCH: The MEDLINE, SciELO, PubMed, PEDro, Scopus, Web of Science, and Cochrane databases were searched up to February 2024.STUDY SELECTION CRITERIA: Randomized controlled trials studying the effects of articular or neural mobilization in adults with cervical radicular pain were included. DATA SYNTHESIS: A frequentist network meta-analysis was used to assess pain intensity and disability. The risk of bias and the certainty of the evidence were evaluated using Version 2 of the Cochrane Risk of Bias (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Out of 777 reports, 50 were analyzed quantitatively. The combination of articular and neural mobilization with usual care was most effective in reducing short-term pain intensity compared to wait and see, sham, or placebo interventions (mean difference [MD], −3.23; 95% confidence interval [CI]: −4.33, −2.12) and to standard care alone (MD, −1.52; 95% CI: −2.31, −0.73). There were significant improvements in pain-related disability with neural mobilization plus usual care, surpassing wait and see, sham, placebo interventions (standardized mean difference [SMD], −1.57; 95% CI: −2.53, −0.61), and usual care alone (SMD, −1.31; 95% CI: −1.88, −0.73). Risk of bias and heterogeneity of included trials downgraded the certainty of evidence. CONCLUSION: Combining mobilization techniques with standard care may be considered in clinical practice, although with care due to the moderate to very low certainty of the evidence.