PLOS ONE

STUDY PROTOCOL

Effectiveness of neural mobilization on pain

intensity, disability, and physical performance
in adults with musculoskeletal pain—A
protocol for a systematic review of
randomized and quasi-randomized controlled
trials and planned meta-analysis
Frederico Mesquita Baptista ID1☯*, Eduardo Brazete Cruz2‡, Vera Afreixo3‡, Anabela
G. Silva4☯

1 Department of Medical Sciences, University of Aveiro, Aveiro, Portugal, 2 Department of Physiotherapy,

Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal, 3 CIDMA–Center for Research
a1111111111
and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro (UA),
a1111111111 Aveiro, Portugal, 4 Center for Health Technology and Services Research (CINTESIS.UA), School of Health
a1111111111 Sciences, University of Aveiro, Aveiro, Portugal
a1111111111
a1111111111 ☯ These authors contributed equally to this work.
‡ These authors also contributed equally to this work.
* [email protected]

OPEN ACCESS Abstract

Citation: Baptista FM, Cruz EB, Afreixo V, Silva AG
(2022) Effectiveness of neural mobilization on pain Recent studies show that musculoskeletal conditions contribute significantly to years lived
intensity, disability, and physical performance in with disability considering the entire global population. Pain and functional disability are the
adults with musculoskeletal pain—A protocol for a main problems that people with these conditions suffer. Neural mobilization has been
systematic review of randomized and quasi-
shown to be an effective intervention in the treatment of musculoskeletal pain within individ-
randomized controlled trials and planned meta-
analysis. PLoS ONE 17(3): e0264230. https://doi. ual trials, also contributing to improved functionality. Some systematic reviews have been
org/10.1371/journal.pone.0264230 carried out during the last years with the aim of synthesizing the scientific evidence on the
Editor: Dylan A. Mordaunt, Illawarra Shoalhaven use of neural mobilization techniques in the treatment of musculoskeletal disorders. How-
Local Health District, AUSTRALIA ever, they varied a lot in the methodological approaches and, consequently, in the findings
Received: October 23, 2021 and conclusions. Thus, this document is a planned protocol of a comprehensive systematic
review with meta-analysis that we intend to carry out to review the scientific literature regard-
Accepted: February 5, 2022
ing up-to-date evidence on the use of neural mobilization in the management of people suf-
Published: March 10, 2022
fering from musculoskeletal pain disorders. The study designs that we will consider as
Copyright: © 2022 Baptista et al. This is an open inclusion criteria will be randomized and quasi-randomized clinical trials. The target popula-
access article distributed under the terms of the
tion will be adults and older adults with musculoskeletal pain. Any controlled trial using any
Creative Commons Attribution License, which
permits unrestricted use, distribution, and neural mobilization technique as an intervention in one of the trial groups will be included.
reproduction in any medium, provided the original The main outcomes of interest will be pain, functional status, and physical performance
author and source are credited. tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up
Funding: The author(s) received no specific time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2
funding for this work. tool and the certainty of the evidence will be evaluated using the comprehensive Assess-
Competing interests: The authors have declared ment, Development and Assessment of Assessment Recommendation (GRADE)
that no competing interests exist.

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

approach. We intend to present the findings through narrative descriptions and, if possible,
through meta-analytic statistics.
Trial registration: PROSPERO registration number. CRD42021288387.

Introduction
Musculoskeletal disorders are the most prevalent conditions that require rehabilitation care
worldwide [1]. More than 150 clinical conditions that affect the locomotor system of individu-
als constitute the set of pathologies related to the musculoskeletal system (e.g., back and neck
pain, osteoarthritis, regional and widespread pain disorders) [2]. They range from acute condi-
tions with a sudden onset and short duration (e.g., fractures, sprains, and strains), to chronic
disorders associated with ongoing functional limitations and disabilities [2,3]. Some studies
have shown that individuals with musculoskeletal disorders have more pain, functional dis-
ability, mobility impairments and a greater risk of injuries related to falls than those without
these conditions [2,4,5]. Moreover, it is estimated that 1.71 billion people have some disorder
related to the musculoskeletal system in the world, contributing with 149 million years lived
with disability (YLDs) [1].
A therapeutic intervention that has been applied to treat patients with musculoskeletal con-
ditions is neural mobilization (NM), which has shown positive effects in reducing pain and
improving functioning [6–9]. NM consists of combinations of joint movements that promote
the gliding or the tensioning of the neural tissue and that can be performed both passively by
the health professional or actively by the individual [10–13]. It is believed to facilitate the nerve
gliding in relation to adjacent tissues, to facilitate neural vascularity, and to improve the axo-
plasmic flow, which in turn results in improved neural functioning and, consequently, in
improved motor and sensory function [14] and, particularly decreased pain [15].
Previous systematic reviews varied in their aim and in their conclusions. The earliest sys-
tematic review concluded that there was only weak evidence to support the use of NM for ner-
vous system-related pathologies [14]. More recently, Su & Lim (2016) found that NM was
superior only to the minimal intervention for pain relief and disability reduction on people
with chronic musculoskeletal pain, but when compared to other forms of intervention, there
was no evidence that NM has a superior effectiveness in reducing pain and disability [16].
Neto et al. (2017) concluded that NM had large positive effects on pain and disability in people
with low back pain and moderate effects on flexibility in healthy participants [17]. A more
recent systematic review suggest that NM is effective for back and neck pain but remains
unclear for other conditions [18].Our planned systematic review adds to previous reviews by
updating the synthesis with recent studies, using a meta-analysis, exploring the effects of dose
and type of neural mobilization on treatment response, and by broadening the outcomes of
interest.
Therefore, the primary objective of our upcoming systematic review will be to synthetize
the findings of studies that address the effectiveness of NM techniques on pain intensity, per-
ceived functioning, and physical performance (e.g., flexibility, balance, and muscular strength)
in adults and older adults with musculoskeletal pain. The secondary objectives will be to com-
pare the effectiveness of different types and doses of NM and to assess the effectiveness of NM
in immune responses, sensory acuity, intraneural edema and morphological and functional
changes in peripheral nerves (e.g., nerve stiffness, nerve elasticity).
Based on the results of this systematic review, we intend to provide consumers and other
stakeholders (e.g., patients and clinicians) with up-to-date, relevant, and high-quality

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

information on the use of NM techniques in individuals aged 18 years and older with musculo-
skeletal pain providing a more precise estimate of effect of this intervention. In addition, we
plan to identify specific limitations and gaps in existing scientific knowledge that merit further
research.

Materials and methods

This protocol is a document of planned methods, results and analyzes for an upcoming sys-
tematic review. It was developed considering the set of standards established by the Preferred
Reporting Items for Systematic Reviews and Meta-Analysis for protocols (PRISMA-P) guide-
lines (S1 Checklist) [19,20]. We guarantee that any changes to the original protocol version
will be documented and justified in a table summarizing protocol amendments, as well as in a
specific section in the next systematic review ("Differences between the protocol and the
review") with a description of the changes and its respective dates by the corresponding author
(FB). The completed systematic review will be in line with PRISMA 2020 guidelines [21,22].

Eligibility criteria
Study design. Randomized controlled human trials, including cluster and quasi-random-
ized trials. Crossover trials, as well as case series, and case reports will be excluded.
Participants. Adults and older adults (18 years and older), with any musculoskeletal pain
condition in any time course: acute (< 6 weeks), sub-acute (< 3 months) or chronic (> 3
months) [23]. Regarding chronic musculoskeletal pain, it is defined as: (1) chronic pain emerg-
ing from musculoskeletal structures such as muscles, bones and joints related to known patho-
logical conditions, including diseases of the nervous system; (2) and chronic pain that cannot
be attributed to any underlying pathology, and therefore is considered as a condition in itself
[24]. Thus, studies involving participants with clinical signs or a diagnosis of tumor/cancer,
infection diseases, severe depression or other psychiatric disorders, and other systemic pathol-
ogies will be excluded.
Interventions. Eligible studies will have to include any form of neural mobilization (NM)
techniques (i.e., sliding or tensioning performed actively or passively) as a treatment modality
based on the principles proposed by Elvey, Butler and Shacklock [10,12,13] administered
either as a standalone intervention or in combination with other treatment modalities (e.g.,
exercise, electrotherapy, education).
Comparators. Considering the high variability of control interventions previously identi-
fied in the literature, multiple comparisons will be considered, including non-pharmacological
and pharmacological interventions as well as surgical procedures. Thus, the aim is not to con-
clude whether NM is more effective than a specific intervention, but rather its overall effective-
ness. Studies that compare NM against a control condition (no intervention or placebo) or any
intervention (including pharmacological and surgical interventions) will be considered. Also,
trials comparing one NM technique with another will be included.
Outcomes. The main outcomes of interest will be pain intensity (e.g., Visual Analogue
Scale [VAS] or Numeric Pain Rating Scale [NPRS]), physical performance (e.g., flexibility, bal-
ance, and muscular strength) measured by performance tests, and/or perceived functioning
measured by self-reported questionnaires (e.g., Roland Morris Disability Questionnaire,
Oswestry Disability Index, WHODAS 2.0, etc.). The secondary outcomes of interest will be
data related to immune responses, sensory acuity, morphological and functional changes in
peripheral nerves (e.g., nerve stiffness, nerve elasticity), and neurophysiological changes (e.g.,
intraneural edema and changes in temporal summation). Studies will be included if at least
one of the outcomes of interest is measured.

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

Timing and setting. There will be no restrictions for follow-up time or type of setting.
Language. We will include articles published in English, Portuguese, or Spanish. A list of
titles identified as possibly being relevant in other languages will be included in the supple-
mentary material.
The PICO strategy is summarized in Table 1.

Information sources and search strategy

The search for scientific articles to be included in the review will be conducted by one
researcher (FB) in the following electronic databases: Web of Science (five collections
included–Web of Science Core Collection, Korean Journal Database, MEDLINE1, Russian
Science Citation Index and SciELO Citation Index), PubMed, MEDLINE (via PubMed and
Web of Science), Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus
with Full Text), Cochrane Central Register of Controlled Trials, Scopus, and Physiotherapy
Evidence Database (PEDro). The CINAHL Plus and Cochrane Central will be accessed
through EBSCO host Web. In addition to these databases, it is also intended to search in grey
literature, namely unpublished sources of evidence (theses and dissertations) in the Open
Access Scientific Repositories of Portugal (RCAAP–acronym in Portuguese). The Interna-
tional Clinical Trials Registry Platform of the World Health Organization (https://www.who.
int/clinical-trials-registry-platform) and ClinicalTrials.gov will also be consulted for ongoing
or recently completed trials. The search will be conducted to include articles from January
1996 to October 2021, considering that the oldest article included in previous reviews is from
1996 [14,18]. This search will be complemented by manually detecting references from bibli-
ography of the included studies and previous reviews.
For PubMed and MEDLINE (via Web of Science), medical subject headings (MeSH) will
be used and for all databases text words related to the I (intervention) and O (outcomes)
dimensions of PICO strategy will be applied. All search terms have been chosen considering
the PICO strategy and are all listed in S1 Appendix for each database, with the respective
planned limits.
To avoid any loss of studies and considering the broad universe of musculoskeletal pain
conditions and the great variability regarding control interventions identified previously in the
literature, it was decided not to specify any input terms for the P (population) and C (compara-
tor) dimensions of the PICO strategy. This will allow for a comprehensive summary of the evi-
dence and the opportunity to explore the consistency of results across different intervention
implementations.

Table 1. PICO strategy.

P (Population) Adults and older adults with musculoskeletal pain
I (Intervention) Neural mobilization techniques
C (Comparator) Inactive control intervention:
• Placebo
• No treatment
• Standard care
• Waiting list control
Active control intervention:
• Different variant of neural mobilization
• Non-pharmacologic interventions
• Pharmacologic interventions
• Surgical procedures
O (Outcomes) Primary outcomes:
• Pain intensity
• Perceived functioning
• Physical performance (muscle strength, flexibility, balance)
https://doi.org/10.1371/journal.pone.0264230.t001

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

Fig 1. Flow diagram adapted from the PRISMA statement.

https://doi.org/10.1371/journal.pone.0264230.g001

All the studies found will be uploaded by the researcher (FB) to Mendeley Reference Man-
ager Software [25], and to Covidence systematic review software (Veritas Health Innovation,
Melbourne, Australia) to facilitate collaboration between reviewers throughout the study selec-
tion process. The researcher will remove the duplicate articles through automation tools. From
Covidence platform, two reviewers (FB and another researcher that will be invited for this
task) will independently screen the title and abstract of all studies and decide which ones they
consider relevant for inclusion. After that, they will check the agreements and disagreements,
and in a consensus meeting they will give the final decision. Then, they will read the full manu-
scripts and will gave their recommendation for inclusion. Any disagreements that occur at this
stage will be also resolved by a consensus meeting or, when necessary, by a third researcher
(AGS). Reasons for excluding trials will be recorded.
The entire screening process will be specified in a PRISMA flowchart. An adaptation of this
flow diagram is shown in Fig 1, summarizing the planned study process for the systematic
review.

Risk-of-bias assessment for specific outcomes

Methodological assessment of the trials will be independently performed by two reviewers (FB
and the same researcher that will screen the articles) using the Revised Cochrane risk-of-bias
tool for randomized trials (RoB 2) [26,27].

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

RoB 2 considers, for each outcome within individual randomized trials, five domains: the
randomization process, deviation from intended interventions, missing outcome data, out-
come measurement, and selection of reported outcomes. The domain-level judgements lead to
an overall judgement about risk-of-bias, considering that the overall judgement is the worst
judgement for any domain. In the context of this study, the effect of adhering to intervention
as described in the trial protocol (the “per-protocol effect”) will be considered as the effect of
interest.
The possible risk-of-bias judgements are: (1) low risk-of-bias; (2) some concerns; and (3)
high risk-of-bias [26,27]. Disagreements between reviewer´s assessments will be discussed and
resolved in a consensus meeting between the two reviewers or, when necessary, by a third
researcher (EC). Reliability of inter-rater agreement will be determined using a non-weighted
kappa statistics [28]. A prior study will be carried out with a random sample of selected articles
to determine the inter-rater reliability (IRR). For the purposes of performing this analysis, the
answers "Yes" and "Probably yes" as well as "No" and "Probably no" of the instrument’s signal-
ing questions will be treated as the same response [26].
To visualize the risk-of-bias assessments, "traffic light" plots of the domain-level judgments
for each individual outcome and weighted bar plots of the distribution of risk-of-bias judg-
ments within each bias domain will be drawn using the robvis web app [29]. Besides that, the
risk-of-bias findings will be incorporated into the review through a forest plot stratified by
overall risk-of-bias for each outcome in the summary findings. In a supplementary document,
the answers, free text supports, and judgments of each evaluator will be presented separately
for total transparency of the process.
In case of inclusion of cluster or quasi-randomized trials, RoB 2 for cluster-randomized tri-
als (RoB 2 CRT) and ROBINS-I tool (risk of bias in non-randomized studies–Interventions)
will be used, respectively [30,31].

Data extraction and management

Data collection will be performed by one author (FB) with verification by another researcher
(AGS) to reduce errors in data extraction. Qualitative and quantitative summaries will be
extracted from individual studies using data extraction forms that will be developed for this
purpose. Considering that during the data extraction process we may find more than one
report from the same study, we will verify at this stage the juxtaposition of some information
between trials (e.g., authors’ names, trial registration numbers, location and setting, specific
details of the interventions, treatment comparisons, sample sizes, outcomes) to avoid data
overlapping [32]. If there is more than one publication referring to the same trial, we will link
them together. When discrepancies between them are very large, FB and AGS will decide
which report contains the most valuable information to use as a source for the study results
[32].
Data collected will include bibliographic information (authors and year of publication),
patient subgroups (musculoskeletal condition), global and specific sociodemographic charac-
teristics of each group of participants (mean age, gender ratio and mean duration of symp-
toms), intervention details (type of neural mobilization, modes of application, number and
duration of treatment sessions, duration of follow-up, and other aspects related to dosimetry),
characteristics of the control intervention, outcomes measures and their measuring instru-
ments, time period of assessment (e.g., post-intervention, 3-months follow up) and main
results for each outcome of interest.
Regarding the outcomes of interest, for each individual trial, the following data will be col-
lected globally and from each group:

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

• For quantitative variables–pre- and post-intervention means and corresponding standard

deviations (SD) and the standard deviation of the mean differences between pre- and post-
intervention measurements. When the standard deviation of the mean difference for each
group is not available, it will be calculated from the following formula [33]:
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
SDdifference ¼ SD2 baseline þ SD2 final ð2 � corr � SDbaseline � SDfinalÞ

For quantitative variables described through order statistics, the means and standard devia-
tion values will be estimated using the method described by Hozo et al. (2005) [34].
• For qualitative variables–pre- and post-intervention counts and frequencies;
In case of missing data, authors will be contacted by email a maximum of 3 times in a
2-month period to clarify miss information.
In studies with multiple treatment groups, we will collect data from each group separately,
so that it is possible to make distinct comparisons between the treatment arms and the control
group. When there are trials with evaluations for more than one body region, data from all of
them will be collected. Furthermore, in studies with many evaluation moments, data from all
time points will be collected and pooled for analyzes (e.g., short term [<5 sessions], medium
term [5 to 10 sessions], and long term [>10 sessions]).
Qualitative and quantitative data, as information from risk-of-bias assessments, will be
summarized in Summary of Findings tables in accordance with Cochrane guidelines [35].

Data synthesis
Depending on the number of trials included, how different studies measure the variables, and
the diversity in the methods of conducting the trials, it will be possible to yield a quantitative
summary of the results pooling data with meta-analytical techniques using R software environ-
ment for statistical computing and graphics [36].
Considering the possibility of performing meta-analyses, studies will be pooled regarding
specific outcomes and musculoskeletal condition to generate estimated effect sizes for each of
the outcomes of interest within each musculoskeletal pathology.
Regarding the meta-analysis itself, the effect sizes and their 95% CI will be determined and
combined by the standardized mean differences (SMDs) for quantitative variables, considering
that in previous research many different outcome measures were identified between trials.
Based on a previous knowledge about the different characteristics between studies involving
NM techniques in previous reviews [14,16–18], we will consider a random effects model in
possible future meta-analyses.
Statistical heterogeneity will be investigated using Cochran’s Q statistic [37] for which a sig-
nificant p-value (< 0.1) will be defined [38]. The I2 statistic will also be performed, with values
of 25%, 50% and 75% reflecting low, moderate and high statistical heterogeneity, respectively
[39,40]. This type of analysis assumes evaluating the proportion of dispersion observed due to
real differences in effect sizes beyond sampling error.
Heterogeneity, subgroups and meta-regression analysis will be performed to describe and
surpass difficulties imposed by the lack of homogeneity between studies (e.g., stratify meta-
analysis by overall risk-of-bias judgement [low or moderate risk-of-bias versus high risk-of-
bias], by different types of neural mobilization [sliding versus tensioning], by different inter-
vention characteristics [single-component intervention study or a multi-component interven-
tion study], by participant characteristics [age], by control intervention groups [minimal
intervention versus other forms of intervention], by the timing of intervention protocol [short

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

Fig 2. Subgroup analyses.

https://doi.org/10.1371/journal.pone.0264230.g002

term versus medium/long term], and meta-regression to test the impact of dose on effect size)
(Fig 2).
Sensitivity, inflation bias (“p-hacking”) and publication bias statistical analyzes will be con-
sidered when justified to assess robustness of the synthetized results (e.g., funnel plots, Egger´s
test, “p-curve”). We will also consider whether there is selective reporting of outcomes, check-
ing the outcomes reported in the published trials and those established in its protocols. When
no protocol is available, outcomes reported in the methods and results sections of the pub-
lished study will be checked for comparison. The Outcome Reporting Bias in Trials (ORBIT)
classification system will be used for this task [41].
In situations where statistical pooling is not possible, the results of the systematic review will
only be presented in a narrative form, exploring the relationship and findings within and between
the included trials in line with the guidance from the Economic and Social Research Council
(ESRC) [42]. For that, the synthesis will be described using information presented in the text and
in tables to summarize and explain the characteristics and findings of the included studies.

Certainty of evidence
Certainty of evidence for each outcome across studies will be assessed using the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) comprehensive
approach [43]. The final rating for certainty of evidence may be: high, moderate, low, or very
low [43]. GRADEpro computer software (McMaster University, Ontario) will be used to facili-
tate the process of developing GRADE evidence profiles (EPs) and Summary of Findings
(SoFs) tables [44,45].
The rating will be conducted independently by two review authors (FB and AGS) for each
outcome considered. Any disagreement will be discussed and resolved by consensus, if neces-
sary, with a third review author (EC).

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

Discussion
The proposed systematic review intends to assess the effectiveness of applying NM techniques
in comparison with other therapeutic interventions in adults and older adults with musculo-
skeletal pain.
In addition to pain, disability and aspects related to physical performance are also relevant
variables that may be compromised in musculoskeletal disorders [2–5]. Thus, it is important
to investigate therapeutic interventions aimed at improving these dysfunctions of signs and
symptoms related to musculoskeletal conditions.
Although NM has shown some positive effects in treating people with musculoskeletal pain
[6–9], previous systematic reviews have shown limited or inconclusive evidence to support the
use of this intervention in these population. As stated before, most previous reviews have
focused only on specific musculoskeletal conditions or only on limited outcomes of interest,
with a narrow approach of the NM application [17,46–51], with the exception of three of them
[14,16,18].
Taking this into account, we intend to develop a broad systematic review encompassing
studies related to any musculoskeletal condition and developed in any setting context. This
will allow to provide a comprehensive view of the real scientific evidence on the use of NM
techniques in people who suffer the consequences of musculoskeletal disorders. Because of
this, and considering that interpretation of results in broad systematic reviews may be difficult
and evidence sparse [52], we plan narrative descriptions and statistical analyzes that can
explain the high heterogeneity we expect to find.
A comprehensive summary of the scientific evidence on the effectiveness of using NM in
the treatment of musculoskeletal pain is crucial for the development of protocols involving
this specific intervention, as well as to allow the design of future methodological strategies in
conducting randomized controlled trials that make it possible to respond to the research gaps
that still exist.
Considering the high variability in the application of NM techniques (e.g., passive versus
active approach, sliding versus tensioning techniques, global versus local tissue mobilization),
systematic assessment of aspects of this intervention in existing trials could contribute valuable
insights into which neural mobilization works best to relieve pain, improve functioning, and
physical performance characteristics in people with musculoskeletal pain.

Supporting information
S1 Checklist. PRISMA-P checklist.
(DOC)
S1 Appendix. Search strategy.
(XLSX)

Author Contributions
Conceptualization: Frederico Mesquita Baptista, Anabela G. Silva.
Investigation: Frederico Mesquita Baptista.
Methodology: Frederico Mesquita Baptista, Vera Afreixo, Anabela G. Silva.
Project administration: Anabela G. Silva.
Supervision: Eduardo Brazete Cruz, Anabela G. Silva.
Validation: Eduardo Brazete Cruz, Vera Afreixo, Anabela G. Silva.

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PLOS ONE Effectiveness of neural mobilization in adults with musculoskeletal pain—A protocol for a systematic review

Visualization: Frederico Mesquita Baptista, Anabela G. Silva.

Writing – original draft: Frederico Mesquita Baptista, Anabela G. Silva.
Writing – review & editing: Eduardo Brazete Cruz, Vera Afreixo, Anabela G. Silva.

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