Procedures
RECRUITMENT
First, all participants signed an informed consent form with the right to withdraw at any time. After recruitment, a qualified therapist will explain the study procedures and collect demographic data at the initial assessment following recruitment. Throughout the study, confidentiality will be maintained.Participants were assigned to the Mulligan manipulative therapy group or the health education group in a 1:1 ratio. Randomisation was computer generated centrally by the Clinical Evaluation Centre of the first affiliated hospital of Zhejiang Chinese Medical University, China. The randomization method achieved allocation concealment using randomization envelopes that were opaque and sealed randomization envelopes. The allocation scheme of two groups was placed in envelopes with the serial number of the group on the outside and the group printed on the inside of the envelope. The envelopes with numerical identifiers were sequentially unsealed in accordance with the order of patients who were still not being attended to and the administration of treatment was carried out according to the specified interventions outlined within the envelopes and treatment was administered according to the interventions requested within the envelopes. The treatment regimen received by each subject was determined by the generated randomized sequence. The Clinical Evaluation Centre of the first affiliated hospital of Zhejiang Chinese Medical University was responsible for the efficacy evaluation to achieve blinding of patients and statistical evaluators. A sample expansion of 20% was proposed, given the possibility of attrition in the study (Fig. Consolidated Standards of Reporting Trials (CONSORT) diagram showing the enrollment patients in this study.