Category: Anne’s research section

Anne’s research section

Here you can look at some of the recent research papers and studies from around the world that have been highlighted for us by Anne Randi Høidahl. Whether you are interested in research about pregnancy-related Pelvic Girdle Pain (PGP) because you have PGP symptoms or because you are a member who is also a healthcare professional, we hope you will find this an interesting and helpful area.

Anne Randi Høidahl from Norway

Anne has been a long-time supporter of the Pelvic Partnership and a great friend to the charity. Her interest in PGP and her appreciation of the importance of research have meant that she has regularly provided us with findings which she believes may be of interest to the charity and our members. Thank you, Anne!

Topics of the research papers and studies included

The information that Anne has kindly highlighted to us includes research papers and studies about PGP but also related subjects concerning pregnancy and maternity services. The subjects include, for example, pregnancy, pelvic pain, effective physiotherapy treatment options, the benefits of acupuncture for treating pelvic pain, sick leave as a result of PGP, and many more. The research papers and studies are often drawn from Norway where Anne lives but there are others that she has spotted and believes are significant from Europe, India and Egypt, so the expertise and insight into PGP is drawn from all over the world.

How to use the information provided here

We have included research passed to us by Anne in the last couple of years in the order that Anne has sent them to us. In addition, we are providing a little information taken from abstracts for the research papers and studies, a date for the research and a link to find out more. Since some of the information has been translated, the description may not be given in colloquial English. As these studies are usually in the form of research papers, they may include terms and references that are more familiar to medical professionals.

Apologies if any of these links do not work when you come to investigate further (they were checked at the time of presenting in these pages). Some of these websites may require membership or payment before allowing greater access to detailed information.

Please note: we are including these findings to promote awareness of recent research based on pregnancy-related PGP and associated topics; however, the conclusions and findings may not necessarily be in line with the views and experience of the Pelvic Partnership charity. The charity encourages all women to seek a full assessment from an experienced, registered physiotherapist, osteopath or chiropractor who also has experience of treating PGP using manual therapy techniques in their treatment approach.

We welcome your involvement

Do please let us know what you think and if any of the information provided here has been of interest to you. In addition, if you come across any research which you think increases our knowledge of PGP and relevant areas of pregnancy, childbirth, etc, do please send these to us, including information provided along the same lines as provided by Anne here (e.g. summary information and findings with links to enable the reader to find out more). You can contact us via our feedback form. Thank you.

Research studies between 2015 and 2016 added on 17th March 2017:

Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities
by Annelie Gutke, Carola Betten, Kristina Degerskär, Sara Pousette, Monika Fagevik Olsén

June 2015

Abstract
For lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity.

Journal/links for original source
Acta Obstetricia et Gynecologica Scandinavia, Vol 94(11), pp. 1156-1167 (2015)

http://onlinelibrary.wiley.com/doi/10.1111/aogs.12681/abstract;jsessionid=1BD599F7AFA00C9D099EA40A51D69BA0.f01t01#

A pilot randomised controlled trial (RCT) investigating the effectiveness of reflexology for managing pregnancy low back and/or pelvic pain
by Ciara Close, Marlene Sinclair, Julie McCullough, Dianne Liddle, Ciara Hughes

May 2016

Abstract
Many pregnant women with low back and/or pelvic pain (LBPP) use pain medications to manage this pain, much of which is self-prescribed and potentially harmful. Therefore, there is a need to find effective non-pharmacological treatments for the condition. Reflexology has previously been shown to help nonspecific low back pain. Therefore; a pilot RCT was conducted investigating reflexology in the management of pregnancy-LBPP. 90 primiparous women were randomised to either usual care, a reflexology or footbath intervention. Primary outcome measures were; the Pain Visual Analogue Scale (VAS). 64 women completed the RCT; retention rates for the reflexology group were 80%, usual care group 83.33% and footbath group 50%. The reflexology group demonstrated a Clinically Important Change (CIC) in pain frequency (1.64 cm). Results indicate it is feasible to conduct an RCT in this area, although a footbath is an unsuitable sham treatment. Reflexology may help manage pregnancy-LBPP; however a fully powered trial is needed to confirm this.

Journal/links for original source
Complementary Therapies in Clinical Practice, Vol 23, pp. 117-124 (2016)

http://www.sciencedirect.com/science/article/pii/S1744388115000419

Pregnancy complications and birth outcomes among women experiencing nausea only or nausea and vomiting during pregnancy (and implications for having PGP)
by Arthur Chortatos, Margaretha Haugen, Per Ole Iversen, Åse Vikanes, Malin Eberhard-Gran, Elisabeth Krefting Bjelland, Per Magnus, Marit B. Veierød

June 2015

Abstract
Pregnancies from the Norwegian Mother and Child Cohort Study (n = 51 675), a population-based prospective cohort study, were examined. Data on nausea and/or vomiting during gestation and birth outcomes were collected from three questionnaires answered between gestation weeks 15 and 30, and linked with data from the Medical Birth Registry of Norway. Chi-squared tests, one way analysis of variance, multiple linear and logistic regression analyses were used.

Women with nausea and vomiting (NVP) totalled 17 070 (33 %), while 20 371 (39 %) experienced nausea only (NP), and 14 234 (28 %) were symptom-free (SF). When compared to SF women, NVP and NP women had significantly increased odds for pelvic girdle pain (adjusted odds ratio, aOR, 2.26, 95 % confidence interval, 95 % CI, 2.09–2.43, and aOR 1.90, 95 % CI, 1.76–2.05, respectively) and proteinuria (aOR 1.50, 95 % CI 1.38–1.63, and 1.20, 95 % CI 1.10–1.31, respectively). Women with NVP also had significantly increased odds for high blood pressure (aOR 1.40, 95 % CI 1.17–1.67) and preeclampsia (aOR 1.13, 95 % CI 1.01–1.27). Conversely, the NVP and NP groups had significantly reduced odds for unfavourable birth outcomes such as low birth weight infants (aOR 0.72, 95 % CI 0.60–0.88, and aOR 0.73, 95 % CI 0.60–0.88, respectively) and small for gestational age infants (aOR 0.78, 95 % CI 0.73–0.84, and aOR 0.87, 95 % CI 0.81–0.93, respectively).We found that women with NVP and NP are more likely to develop pregnancy complications.

Journal/links for original source
BMC Pregnancy and Childbirth, Vol 15, pp 138… (2015)

http://www.biomedcentral.com/1471-2393/15/138

Osteopathic manipulative therapy in women with postpartum low back pain and disability: A pragmatic randomized controlled trial
by Florian Schwerla, Katrin Rother, Denis Rother, Michaela Ruetz, Karl-Ludwig Resch

July 2015

Abstract
Persistent low back pain (LBP) is a common complaint among women during and after pregnancy, and its effects on quality of life can be disabling.

A pragmatic randomized controlled trial was conducted among a sample of women with a history of pregnancy-related LBP for at least 3 months after delivery. Participants were identified from the general population in Germany. By means of external randomization, women were allocated to an OMTh group and a waitlist control group. Osteopathic manipulative therapy was provided 4 times at intervals of 2 weeks, with a follow-up after 12 weeks. The OMTh was tailored to each participant and based on osteopathic principles. The participants allocated to the control group did not receive OMTh during the 8-week study; rather, they were put on a waiting list to receive OMTh on completion of the study. Further, they were not allowed to receive any additional treatment (ie, medication, physical therapy, or other sources of pain relief) during the study period. The main outcome measures were pain intensity as measured by a visual analog scale and the effect of LBP on daily activities as assessed by the Oswestry Disability Index (ODI).

A total of 80 women aged between 23 and 42 years (mean [SD], 33.6 [4.5] years) were included in the study, with 40 in the OMTh group and 40 in the control group. Pain intensity decreased in the OMTh group from 7.3 to 2.0 (95% CI, 4.8-5.9; P<.001) and in the control group from 7.0 to 6.5 (95% CI, -0.2 to -0.9; P=.005). The between-group comparison of changes revealed a statistically significant improvement in pain intensity in the OMTh group (between-group difference of means, 4.8; 95% CI, 4.1-5.4; P<.001) and level of disability (between-group difference of means, 10.6; 95% CI, 9.9-13.2; P<.005). The follow-up assessment in the OMTh group (n=38) showed further improvement.

During 8 weeks, OMTh applied 4 times led to clinically relevant positive changes in pain intensity and functional disability in women with postpartum LBP. Further studies that include prolonged follow-up periods are warranted. (German Clinical Trials Register: DRKS00006280.)

Journal/links for original source
The Journal of the American Osteopathic Association, Vol 115, pp. 416-425 (2015)

http://jaoa.org/Article.aspx?articleid=2362399#.Va7AXIAnofA.facebook

Also included in ScienceDaily:
http://www.sciencedaily.com/releases/2015/06/150630141713.htm

The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: A descriptive qualitative study
by Francesca Wuytack, Elizabeth Curtis, Cecily Begley

November 2015

Abstract
To explore the health-seeking behaviours of primiparous women with pelvic girdle pain persisting for more than three months post partum. A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. Transcripts were analysed using thematic analysis. A purposive sample of 23 consenting first-time mothers with pelvic girdle pain persisting for at least three months post partum.

‘They didn’t ask, I didn’t tell’ was a key theme, which included emerging categories of a perceived lack of follow-up post partum, and feeling ignored by healthcare professionals. The theme ‘Seeking advice and support’ describes women’s role of talking to others, and triggers and barriers to getting help. ‘Coping strategies’ was the third theme emerging from the interviews, whereby participants described different strategies they used to deal with their symptoms, although many expressed uncertainty about what to do or who to see.

Our findings show the importance of appropriate information and follow-up care for women with pelvic girdle pain and highlight barriers they encounter in seeking help. They also question the duration of postnatal care as participants felt that postnatal care was stopped too early. The findings may assist maternity care providers in addressing mothers׳ expectations and needs related to persistent pelvic girdle pain.

Journal/links for original source
Midwifery, Vol 31(11), pp. 1104-1109 (2015)

http://www.midwiferyjournal.com/article/S0266-6138(15)00204-1/abstract

Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial
by Serpil Ozdemir, Hatice Bebis, Tulay Ortabag, Cengizhan Acikel

March 2015

Abstract
To evaluate the effect of exercise programs on pregnant women with pregnancy-related low back and pelvic pain. Low back and pelvic pain during pregnancy is a major health problem due to its frequent occurrence and such pain can limit pregnant women in many of their daily activities.

A randomized trial with a control group (n = 48) and an intervention group (n = 48).

Department of Obstetrics and Gynecology, between December 2011–May 2012, an Education and Research Hospital in Turkey. Based on the intention-to-treat principle, all pregnant women were analysed according to the group they were assigned to, regardless of whether they received the intervention or not. Participants in the intervention group received health counselling and exercised regarding low back and pelvic pain for four weeks. The pregnant women in the control group received usual care, comprised of routine clinical practice for pregnancy-related low back and pelvic pain.

According to Mann–Whitney U test analysis results, there was a statistically significant difference between the control and intervention groups’ Visual Analogue Scale during relaxation scores and Visual Analogue Scale during activity scores at the end of the study. According to Mann–Whitney U test analysis results, the change in the mean Oswestry Disability Index score for the intervention group and the difference in the mean scores between the two groups was statistically significant.

A four-week exercise program including individualized health counselling to relieve low back and pelvic pain improved the functional status in pregnant women.

Journal/links for original source
Journal of Advanced Nursing, Vol 71(8), pp. 1926-1939 (2015)

http://onlinelibrary.wiley.com/doi/10.1111/jan.12659/abstract;jsessionid=F1FF5B85B466CBFA55DD6F83A8AD1070.f02t03

Disturbed body perception, reduced sleep, and kinesiophobia in subjects with pregnancy-related persistent lumbopelvic pain and moderate levels of disability: An exploratory study
by Darren Beales, Alison Lutz, Judith Thompson, Benedict Martin Wand, Peter O’Sullivan

July 2015

Abstract
For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. While multiple factors may contribute to disability in this group, previous studies have not investigated sleep impairments, body perception or mindfulness as potential factors associated with disability post-partum. This study compares women experiencing no pain post-pregnancy with those experiencing pregnancy-related persistent lumbopelvic pain (either low- or high-level disability) across multiple biopsychosocial domains.

Participants completed questionnaires for thorough profiling of factors thought to be important in pregnancy-related lumbopelvic pain. Specific measures were the Urinary Distress Inventory, Medical Outcomes Study Sleep Scale, Back Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Depression Anxiety Stress Scale, Coping Strategies Questionnaire, Pain Catastrophising Scale, The Fremantle Back Awareness Questionnaire and the Mindful Attention Awareness Scale.

Women where categorised into three groups; pain free (n = 26), mild disability (n = 12) and moderate disability (n = 12) (based on Oswestry Disability Index scores). Non-parametric group comparisons were used to compare groups across the profiling variables.

Differences were identified for kinesiophobia (p = 0.03), body perception (p = 0.02), sleep quantity (p < 0.01) and sleep adequacy (p = 0.02). Generally subjects in the moderate disability group had more negative findings for these variables.

Disturbances in body-perception, sleep and elevated kinesiophobia were found in pregnancy-related lumbopelvic pain subjects with moderate disability, factors previously linked to persistent low back pain. The cross-sectional nature of this study does not allow for identification of directional pathways between factors. The results support the consideration of these factors in the assessment and management of pregnancy-related lumbopelvic pain.

Journal/links for original source
Musculoskeletal Science & Practice, Vol 21, pp. 69-75 (2016)

http://www.manualtherapyjournal.com/article/S1356-689X(15)00107-1/abstract

Prevalence of Patterns of Pregnancy induced Pelvic Girdle Pain and Low Back Pain in a Tertiary Care Centre- a Cross Sectional Study

by Arati Mahishale, Sudini Santosh S Borkar

July 2015

Abstract
Biomechanical changes during pregnancy impose postural deviations, leading to various musculoskeletal pain syndromes. Commonly noted are the pelvic girdle pain and low back pain which is experienced by pregnant women globally. The prevalence of pregnancy related pelvic girdle pain and low back pain in western population is known. Data of the same in Indian pregnant population lacks evidence.

To study the prevalence of pattern of pregnancy related pelvic girdle pain and low back pain in a tertiary care centre. A total of 225 pregnant women were screened for inclusion criteria. Confirmation of diagnosis of pelvic girdle pain and low back pain was done using Modified Oswestry Disability Index questionnaire (MODI) and the pelvic girdle questionnaire (PGQ). Once diagnosed, all participants were subjected to nine clinical tests to differentiate the site of pain and to classify them accordingly into 3 different groups namely Group A (Low back pain LBP), Group B (Posterior pelvic pain PPP) and Group C (Anterior pelvic pain APP) respectively.

The point prevalence of pain in group A (LBP) was 31%, group B (PPP) was 65% and group C (APP) was 15% respectively. All subjects with mean age of 23 years and mean gestational age of 38 weeks showed to have PPP. 70% of them were primparous. However APP was more in subjects with 24.5 years of age.

The prevalence rate of PPP (65%) is higher as compared to LBP (31%) and APP (15%). Also PPP is reported to be highest in primiparous with gestational age of 38 weeks.

Journal/links for original source
International Journal of Therapies and Rehabilitation Research, Vol 4(4), pp. 122-125 (2015)

http://www.ejmanager.com/mnstemps/12/12-1434019256.pdf


Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women
by Katrine Mari Owe, Elisabeth K Bjelland, Britt Stuge, Nicola Orsini, Malin Eberhard-Gran, Siri Vangen

2016

Abstract
To examine whether an association exists between exercise levels pre-pregnancy and pelvic girdle pain in pregnancy. Pelvic girdle pain in pregnancy has been associated with physical inactivity, a risk factor for adverse pregnancy outcomes.

We used data from a population-based cohort study including 39 184 nulliparous women with a singleton pregnancy enrolled in the Norwegian Mother and Child Cohort study. Pre-pregnancy exercise frequency and types were assessed by questionnaire in pregnancy week 17. Pelvic girdle pain, defined as combined pain in the anterior pelvis and in the posterior pelvis bilaterally, was self-reported in pregnancy week 30. Multivariable Poisson regression estimated risks of pelvic girdle pain associated with pre-pregnancy exercise. We examined a dose–response association of pre-pregnancy exercise frequency using restricted cubic splines. A test for non-linearity was also conducted. Final models were adjusted for pre-pregnancy BMI, age, education, history of low back pain and history of depression.

4069 women (10.4%) reported pelvic girdle pain in pregnancy and the prevalence among women who were non-exercisers prepregnancy was 12.5%. There was a non-linear association for pre-pregnancy exercise and risk of pelvic girdle pain (test for non-linearity, p=0.003). Compared to non-exercisers, women exercising 3–5 times weekly pre-pregnancy had a 14% lower risk of developing pelvic girdle pain in pregnancy (aRR 0.86, 95% CI 0.77 to 0.96). Taking part in high-impact exercises such as running, jogging, orienteering, ballgames, netball games and high-impact aerobics were associated with less risk of pelvic girdle pain.
Women who exercise regularly and engage in high-impact exercises before the first pregnancy may have a reduced risk of pelvic girdle pain in pregnancy.

Journal/links for original source
British Journal of Sports Medicine, Vol 50(13), pp. 817-822 (2016)

http://bjsm.bmj.com/content/early/2015/09/15/bjsports-2015-094921

The association between pelvic girdle pain and sick leave during pregnancy; a retrospective study of a Norwegian population
by Stefan Malmqvist, Inger Kjaermann, Knut Andersen, Inger Økland, Jan Petter Larsen, Kolbjørn Brønnick

October 2015

Abstract
PGP is a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP we found that work satisfaction, problems with lifting and sleeping, and pain intensity were risk factors for sick leave. In addition, women with longer education, higher work satisfaction and fewer problems with sitting, walking and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave.

A coping factor in pregnant women with PGP was discovered, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. We recommend these issues to be further examined in a prospective longitudinal study since it may have important implications for sick leave frequency during pregnancy.

Journal/links for original source
BMC Pregnancy and Childbirth, Vol 15, pp. 237… (2015)

http://www.biomedcentral.com/1471-2393/15/237

Experiences of First-Time Mothers With Persistent Pelvic Girdle Pain After Childbirth: Descriptive Qualitative Study
by Francesca Wuytack, Elizabeth Curtis, Cecily Begley

October 2015

Abstract
Pelvic girdle pain (PGP) is common during pregnancy and negatively affects women’s lives. When PGP persists after the birth, the way it affects women’s lives may change, particularly for first-time mothers as they adjust to motherhood, yet the experiences of women with persistent PGP remain largely unexplored.

The objective of this study was to explore primiparous women’s experiences of persistent PGP and its impact on their lives postpartum, including caring for their infant and their parental role.

This was a descriptive qualitative study.

Following institution ethical approval, 23 consenting primiparous women with PGP that had started during pregnancy and persisted for at least 3 months postpartum participated in individual interviews. These interviews were recorded, transcribed, and analyzed using thematic analysis.

Four themes emerged: (1) “Putting up with the pain: coping with everyday life,” in which women put up with the pain but had to balance activities and were grateful for support from family and friends to face everyday challenges; (2) “I don’t feel back to normal,” in which women’s feelings of physical limitations, frustration, and a negative impact on their mood were described; (3) “Unexpected,” in which persistent symptoms were unexpected for women due to a lack of information given about PGP; and (4) “What next?,” in which the future of women’s symptoms was met with great uncertainty, and they expressed worry about having another baby.

For first-time mothers, having persistent PGP postpartum affects their daily lives in many ways. These findings provide important information for health care providers, which will improve their understanding of these women’s experiences, will enhance rapport, and can be used to provide information and address concerns to optimize maternity care during pregnancy and beyond.

Journal/links for original source
Physical Therapy, Vol 95(10), pp. 1354-1364 (2015)

https://academic.oup.com/ptj/article-abstract/95/10/1354/2686428/Experiences-of-First-Time-Mothers-With-Persistent?redirectedFrom=fulltext

Web-based Discussion Forums on Pregnancy Complaints and Maternal Health Literacy in Norway: A Qualitative Study
by Eva Haukeland Fredriksen, Janet Harris, Karen Marie Moland

May 2016

Abstract
The Internet is one of the fastest growing information sources for pregnant women and seems to be used across social and economic strata. However, we still lack knowledge on how interaction in Web-based discussion forums influence maternal health literacy, in terms of how pregnant women access, appraise, and apply information to promote and maintain good health.

The aim of this study was to understand how Web-based discussion forums influence maternal health literacy; hence, we explored the role of interactions in Web-based discussion forums among women who experienced health problems during pregnancy. More specifically, we explored why media-literate women experiencing the medically unexplained condition, pelvic girdle pain (PGP), during pregnancy participated in Web-based discussion forums and how they appraised and applied the information and advice that they gained from the Web-based interaction with other women.

Women were invited to participate in the study via postings on 3 different open websites for pregnant women and mothers. The sample included 11 Norwegian women who participated in open Web-based discussion forums when experiencing PGP in pregnancy. The data were collected using synchronous qualitative email interviews and were analyzed using thematic analysis.

In our study sample, interaction in Web-based discussion forums influenced maternal health literacy in terms of increased health-related knowledge and competencies, increased awareness of health promotion and health protection, and increased system navigation. The women appraised and selectively applied information and advice that resonated with their own experiences. For many, the information provided online by other women in the same situation was valued more highly than advice from health professionals. Women reported that they used their knowledge and competency in encounters with health professionals but hesitated to disclose the origin of their knowledge. Those with a high level of education in medicine-related fields raised a concern about the Internet as a source of horror stories and erroneous information and were actively engaged in trying to minimize potential negative effects, by providing biomedical information.

The popularity of Web-based discussion forums among pregnant women suggests that this group needs additional sources of information and support to complement traditional consultations with the health professionals. The professionals need to recognize that pregnant women access Web-based discussion forums for support and information to increase their ability to take better health decisions for themselves. This is a potential resource that health professionals may find useful in consultations with pregnant women.

Journal/links for original source
Journal of Medical Internet Research, Vol 18(5), pp. 113… (2016)

http://www.jmir.org/2016/5/e113/

Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study
by Helen Elden, Annelie Gutke, Gunilla Kjellby-Wendt, Monika Fagevik-Olsen, Hans-Christian Ostgaard

July 2016

Abstract
Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women’s health and function up to 11 years after pregnancy.

A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP.

A total of 371/530 (70 %) women responded and 37/ 371 (10 %) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR = 1.79), history of low back pain (LBP) (OR = 2.28), positive symphysis pressure test (OR = 2.01), positive Faber (Patrick’s) test (OR = 2.22), and positive modified Trendelenburg test (OR = 2.20). Women with PGP had significantly decreased ability to perform daily activities (p < .001), lower self-efficacy (p = 0.046), decreased HRQL (p < .001), higher levels of anxiety and depression (p < .001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p = 0.032) compared to women with no PGP.

This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11 years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.

Journal/links for original source
BMC Musculoskeletal Disorders, Vol 17, pp. 276… (2016)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941027/

Physical therapy interventions for pelvic girdle pain (PGP) after pregnancy
Gunvor Hilde, Annelie Gutke, Susan C Slade, Britt Stuge

November 2016

Abstract
This is a protocol for a Cochrane Review (Intervention). The primary objective of this systematic review is to assess the efficacy of a range of physical therapy interventions for the management of PGP following pregnancy. We will assess efficacy in terms of reduced pain, improved disability/functional status, improved overall health/health-related quality of life, and treatment success (participant-reported). We will compare each intervention/modality of physical therapy considered as a relevant intervention in the treatment of pelvic girdle pain (PGP) after pregnancy to: no treatment; placebo/sham treatment; or conservative treatments not considered as physical therapy (such as acupuncture, cognitive-behavioral treatment etc.). In subsequent investigations we will compare the efficacy of different physical therapy interventions/modalities when compared against each other (head-to-head comparison). We will do this for the same outcomes as above (reduced pain and disability and improved health-related quality of life).

Journal/links for original source
Cochrane Database of Systematic Reviews, (11) (2016)

http://www.cochrane.org/CD012441/BACK_physical-therapy-interventions-pelvic-girdle-pain-pgp-after-pregnancy

Comparative study of occurrence of postpartum low back and pelvic pain (LBPP) after normal delivery versus caesarean section (CS) following spinal anaesthesia and its rehabilitative management
by Anil Kumar Joshi, Chitra Joshi

2016

Abstract
Low back and pelvic pain is very commonly encountered ailment in pregnancy and postpartum in women of childbearing age group. It can account for around half of the women of childbearing age. The pathophysiology of low back pain during pregnancy and postpartum is still poorly understood.

The study was to compare low backache after normal delivery and after caesarean section following spinal anaesthesia, and its persistence after pregnancy. More over women were educated to regain the pre-pregnancy state uneventfully.

Postpartum backache at 1 month incidence in our study was 49%. Remission of pain occurred in 51% at 1 month and 78% at 6 months in caesarean section group, while in the normal vaginal delivery group 55% at 1 month and 85% in the 6th month had remission of pain.

Women who had caesarean section with spinal anaesthesia had more chances to develop low back pain than women with normal vaginal delivery. Pre-pregnancy state can be achieved by supervised exercise regime.

Journal/links for original source
International Journal of Therapies and Rehabilitation Research, Vol 5(4), pp. 24-27 (2016)

http://www.scopemed.org/fulltextpdf.php?mno=216220

Low back pain in pregnancy (Review Article)
by Vikram Khanna, Ranjana Khanna, Parul Gupta

January 2016

Abstract
Low back pain in pregnancy is a common complaint. Psychologically, it has a negative effect on the patient, adversely affecting the quality of life. Presenting either as pelvic girdle or as lumbar pain, accurate and early diagnosis is essential for adequate management of patients with low back pain in pregnancy. The mainstay of management is conservative. There is no established protocol and the treatment has to be tailored for each patient.

Lower back pain during pregnancy is one of the most disabling features, which has a negative psychological impact on the patient. Although the treatment may not be curative, with early diagnosis and prompt management this can very well controlled.

Journal/links for original source
International Journal of Recent Surgical and Medical Sciences, Vol 2(1), pp. 23-27 (2016)

http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=9539&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=728&Value=-1&isPDF=YES

The relationship between the daily step counts and low back pain during pregnancy
by S. Morino, Y. Kajiwara, M. Ishihara, S. Nishiguchi, N. Fukutani, Y. Tashiro, M. Yamada, M. Yamashita, T. Aoyama

January 2016

Abstract
To investigate the relationship between the change of daily step counts and low back pain (LBP) during pregnancy.

Pregnant women at less than eight weeks of gestation (WG) were recruited. Daily step counts were measured with a pedometer. To assess LBP, the Oswestry disability index (ODI) score was recorded. Thirty-six individuals were divided into the LBP and non-LBP groups. The effect of step counts on LBP between the two groups was analyzed.

At 16-19 WG, step counts were not considerably changed in the non-LBP group but were significantly increased in the LBP group. At 24-27 and 32-35 WG, step counts were increased in the non-LBP group but were significantly decreased in the LBP group.

Acute increase of daily step counts in early pregnancy is a risk for LBP, and gradual increases of step counts after mid-pregnancy is recommended for women.

Journal/links for original source
CEOG – Clinical and Experimental Obstetrics & Gynecology (sic), Vol 43(2), pp. 192-197 (2016)

https://www.ncbi.nlm.nih.gov/pubmed/27132408

Does abdominal diastasis influence lumbar pain during gestation?

by Marília Duarte dos Santos, Rafaela de Melo Silva, Mariana Pereira Vicente, Vanessa Pinho Palmezoni, Eliane Maria de Carvalho, Ana Paula Magalhães Resende

January-March 2016

Abstract
To evaluate and compare the presence and size of recti abdominis diastasis in the second and third gestational trimester and to correlate them to lumbar pain incidence and intensity.

This is a cross-sectional observational study with 128 pregnant women divided in two groups: 53 pregnant women in the second gestational trimester and 75 pregnant women in the third gestational trimester. Lumbar pain was evaluated with Roland Morris questionnaire and Pain Visual Analog Scale. Recti abdominis diastasis was measured with a caliper rule. Data were analyzed according to Spearman correlation and Mann-Whitney U test.

Comparison between groups has shown that pregnant women in the third gestational trimester had more recti abdominis diastasis, more reports of severe lumbar pain by the visual analog scale (p=0.0017) and further impact on daily life activities (p=0.0012). There has been positive correlation between recti abdominis diastasis size and scores obtained by Roland Morris questionnaire and visual analog scale.

Recti abdominis diastasis size, pain intensity and incapacity determined by low back pain were more severe in pregnant women in the third gestational trimester.

Journal/links for original source
Revista Dor São Paulo, Vol,17(1), pp. 43-46 (2016)

http://www.scielo.br/pdf/rdor/v17n1/en_1806-0013-rdor-17-01-0043.pdf

Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum
by Cecilia Bergström, Margareta Persson, Ingrid Mogren

February 2016

Abstract
Pregnancy related low back pain (PLBP) and pelvic girdle pain (PGP) are considered common complications of pregnancy. The long-term consequences for women with persistent PLBP/PGP postpartum are under-investigated. The main objective was to investigate the prevalence, pattern and degree of sick leave as well as healthcare utilisation and its perceived effect in women with persistent PLBP/PGP at 12 months postpartum.

This is a follow-up study of a cohort involving of a sample of women, who delivered from January 1st 2002 to April 30th in 2002 at Umeå University Hospital and Sunderby Hospital, and who reported PLBP/PGP during pregnancy. A total of 639 women were followed-up by a second questionnaire (Q2) at approximately 6 months postpartum. Women with persistent PLBP/PGP at the second questionnaire (N = 200) were sent a third questionnaire (Q3) at approximately 12 months postpartum.

The final study sample consisted of 176 women reporting PLBP/PGP postpartum where N = 34 (19.3 %) reported ‘no’ pain, N = 115 (65.3 %) ‘recurrent’ pain, and N = 27 (15.3 %) ‘continuous’ pain. The vast majority (92.4 %) of women reported that they had neither been on sick leave nor sought any healthcare services (64.1 %) during the past 6 months at Q3. Women with ‘continuous’ pain at Q3 reported a higher extent of sick leave and healthcare seeking behaviour compared to women with ‘recurrent’ pain at Q3. Most women with persistent PLBP/PGP had been on sick leave on a full-time basis. The most commonly sought healthcare was physiotherapy, followed by consultation with a medical doctor, acupuncture and chiropractic.

Most women did not report any sick leave or sought any healthcare due to PLBP/PGP the past 6 months at Q3. However, women with ‘continuous’ PLBP/PGP 14 months postpartum did report a higher prevalence and degree of sick leave and sought healthcare to a higher extent compared to women with ‘recurrent’ PLBP/PGP at Q3. Women with more pronounced symptoms might constitute a specific subgroup of patients with a less favourable long-term outcome, thus PLBP/PGP needs to be addressed early in pregnancy to reduce both individual suffering and the risk of transition into chronicity.

Journal/links for original source
Chiropractic & Manual Therapies, Vol 24:7 (2016)

https://umu.diva-portal.org/smash/get/diva2:1043800/FULLTEXT01.pdf

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