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Starzec-Proserpio M, Vandyken C. Telerehabilitation for persistent Pelvic Girdle Pain within a biopsychosocial framework - A case report. Physiother Theory Pract 2023; 39:2251-2261. [PMID: 35481796 DOI: 10.1080/09593985.2022.2069618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Persistent pregnancy-related pelvic girdle pain (PGP) and the resulting consequences may considerably influence a woman's quality of life. The complexity of this condition requires a whole-person centered approach. In response to COVID-19 outbreak, telerehabilitation has emerged as a promising alternative to traditional in-person visits. PURPOSE The aim of this report was to present the potential of telerehabilitation for persistent postpartum PGP within the biopsychosocial framework. CASE DESCRIPTION A 26-year-old female presented with persistent pregnancy-related PGP of 8 months duration after her first vaginal delivery. The video-consults were performed using telerehabilitation platform. The patient received six telerehabilitation consults of 45 min duration over five weeks. Assessment of physical and psychosocial factors, cognitively focused strategies including pain neurophysiology education, sensory-motor remapping exercises, and graded increase of activity were administered. Rehabilitation was divided into the following phases: assessment, desensitization, graded exposure, and supported independence. OUTCOMES The Pelvic Girdle Questionnaire (PGQ) score was significantly reduced from 72.2 during the assessment to 15.3 at discharge. This change was significantly more substantial than the minimal clinically important change estimated for the PGQ. CONCLUSION Physiotherapists can utilize telerehabilitation to assist them with enacting appropriate care measures for persistent PGP within a biopsychosocial framework.
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Westergren J, Sjöberg V, Vixner L, Nyberg RG, Moulaee Conradsson D, Monnier A, LoMartire R, Enthoven P, Äng BO. Acute exercise as active inference in chronic musculoskeletal pain, effects on gait kinematics and muscular activity in patients and healthy participants: a study protocol for a randomised controlled laboratory trial. BMJ Open 2023; 13:e069747. [PMID: 37258077 PMCID: PMC10255138 DOI: 10.1136/bmjopen-2022-069747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain is a highly prevalent, complex and distressing condition that may negatively affect all domains of life. In view of an active inference framework, and resting on the concept of allostasis, human movement per se becomes a prerequisite for health and well-being while chronic pain becomes a sign of a system unable to attenuate an allostatic load. Previous studies on different subgroups of chronic pain conditions have demonstrated alterations in gait kinematics and muscle activity, indicating shared disturbances in the motor system from long-term allostatic load. We hypothesise that such alterations exist in heterogenous populations with chronic musculoskeletal pain, and that exposure to acute and controlled exercise may attenuate these alterations. Therefore, the main aim of this study is to investigate the acute effects of exercise on gait kinematics and activity of the back and neck muscles during diverse walking conditions in patients with chronic musculoskeletal pain compared with a reference sample consisting of healthy participants. METHODS AND ANALYSIS This two-sample two-armed parallel randomised controlled laboratory trial will include 40 participants with chronic musculoskeletal pain (>3 months) and 40 healthy participants. Participants will be randomly allocated to either 30 min of aerobic exercise or rest. Primary outcomes are gait kinematics (walking speed, step frequency, stride length, lumbar rotation, gait stability) and muscular activity (spatial and temporal) of the back and neck during diverse walking conditions. Secondary outcomes are variability of gait kinematics and muscle activity and subjective pain ratings assessed regularly during the trial. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Review Board in Uppsala, Sweden (#2018/307). Findings will be disseminated via conference presentations, publications in peer-reviewed journals and engagement with patient support groups and clinicians. TRIAL REGISTRATION NUMBER NCT03882333.
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Affiliation(s)
- Jens Westergren
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Roger G Nyberg
- School of Information and Engineering, Dalarna University, Borlänge, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Medical unit Occupational therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Monnier
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Björn O Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
- Regional Board Administration, Region Dalarna, Falun, Sweden
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