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Burani E, Marruganti S, Giglioni G, Bonetti F, Ceron D, Cozzi Lepri A. Predictive Factors for Pregnancy-Related Persistent Pelvic Girdle Pain (PPGP): A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2123. [PMID: 38138226 PMCID: PMC10744457 DOI: 10.3390/medicina59122123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). Methods: Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. Data sources: The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). Study appraisal and risk of bias: Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. Synthesis of results: An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. Results: The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. Discussion: The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets.
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Affiliation(s)
- Elisa Burani
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Kura” Clinic, 53047 Siena, Italy
| | - Sharon Marruganti
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Asl Sud-Est, Department of Rehabilitation, Valdichiana Senese, 53045 Siena, Italy
| | - Gloria Giglioni
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Asl Roma 3, Department of Rehabilitation, 00122 Rome, Italy
| | - Francesca Bonetti
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Physioup” Clinic, 00142 Rome, Italy
| | - Daniele Ceron
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Riabilita” Clinic, 35030 Padova, Italy
| | - Alessandro Cozzi Lepri
- Medical Statistics and Epidemiology, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, London NW3 2PF, UK;
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Puri SN, Fating T, Dhage PP. The Impact of Functional Stability Exercises on Alleviating Pelvic Girdle Pain in Pregnancy: A Review. Cureus 2023; 15:e48769. [PMID: 38098896 PMCID: PMC10719549 DOI: 10.7759/cureus.48769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Pelvic girdle pain (PGP) during pregnancy is a major source of stress for mothers. This review summarizes studies on the effectiveness of functional stability exercises (FSEs) in preventing PGP during pregnancy. FSE is a rising area of study in maternal health, focusing on core muscle groups and addressing the biomechanical changes during pregnancy. Although data shows that FSE may relieve PGP and improve the quality of life in pregnant women, the research landscape is defined by limitations and differences in intervention parameters among studies, resulting in contradictory conclusions. As a result, the efficacy of FSE in pregnant women with PGP remains inconclusive. This review can help comprise the existing research on FSE alleviating PGP in pregnancy to provide full knowledge on the topic, analyze long-term effects, and develop practice guidelines. While FSE shows promise, treating the multidimensional nature of PGP in pregnancy requires a comprehensive approach to therapy that incorporates several therapeutic modalities.
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Affiliation(s)
- Saurabh N Puri
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Tejaswini Fating
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Prasad P Dhage
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
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Starzec-Proserpio M, Węgrzynowska M, Sys D, Kajdy A, Rongies W, Baranowska B. Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study. BMC Musculoskelet Disord 2022; 23:928. [PMID: 36266709 PMCID: PMC9585777 DOI: 10.1186/s12891-022-05864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland. Methods This was a prospective, observational study. In phase 1, 411 women were recruited 24–72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report. Results In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43–48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04–4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01–1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34–48.72). Conclusion Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.
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Affiliation(s)
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
| | - Anna Kajdy
- Ist Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education , ul. Żelazna 90 , 01-004 , Warsaw, Poland
| | - Witold Rongies
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, ul. Ks. Trojdena 2C, 02-109, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
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Horibe K, Isa T, Matsuda N, Murata S, Tsuboi Y, Okumura M, Kawaharada R, Kogaki M, Uchida K, Nakatsuka K, Ono R. Association between sleep disturbance and low back and pelvic pain in 4-month postpartum women: A cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2983-2988. [PMID: 33977349 DOI: 10.1007/s00586-021-06847-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 02/20/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Persistent low back and pelvic pain (LBPP) is a postpartum-specific health problem. Sleep disturbances' association with persistent LBPP is not yet clear. We aimed to examine the cross-sectional association between sleep disturbance and persistent LBPP at 4 months postpartum. METHODS We enrolled 120 women with LBPP during pregnancy (mean age, 31.8; standard deviation, 4.9 years). The primary outcome was persistent LBPP. We assessed LBPP severity at 4 months postpartum using the Numerical Rating Scale (NRS), where women with an NRS score of ≥ 4 at 4 months postpartum were allocated to the persistent LBPP group. We assessed sleep disturbance at 4 months postpartum using the Japanese version of the Pittsburgh Sleep Quality Index with a total score of ≥ 6 indicating sleep disturbance. Moreover, we performed univariate and multiple logistic regression analyses to examine the cross-sectional association of sleep disturbance with persistent LBPP. The relevant confounding variables were age, body mass index, parity, and history of LBPP before pregnancy. RESULTS Among the 120 women, 45 women had persistent LBPP (37.5%) with 32 (71.1%) of them reporting sleep disturbance. There was a significant association of sleep disturbance with persistent LBPP (odds ratio [OR], 2.81; 95% confidence interval [95% CI], 1.28-6.19), which remained after adjustments for confounding variables (OR, 2.98; 95% CI, 1.31-6.75). CONCLUSION Our findings indicate that sleep disturbance is associated with persistent LBPP at 4 months postpartum; therefore, it should be taken into consideration in postpartum women with persistent LBPP.
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Affiliation(s)
- Kana Horibe
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Tsunenori Isa
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Naoka Matsuda
- Division of Rehabilitation Medicine, Kobe Mariners Hospital, Kobe, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Yamato Tsuboi
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Maho Okumura
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Rika Kawaharada
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Masahumi Kogaki
- Takumi Day-Care Facility in Children, Nishinomiya, Hyogo, Japan
| | - Kazuaki Uchida
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Kiyomasa Nakatsuka
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan.
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Stendal Robinson H, Lindgren A, Bjelland EK. Generalized joint hypermobility and risk of pelvic girdle pain in pregnancy: does body mass index matter? Physiother Theory Pract 2021; 38:2222-2229. [PMID: 33849378 DOI: 10.1080/09593985.2021.1913774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive. Objectives: In this prospective cohort study of 283 pregnant women in Norway, we aimed to study the association of generalized joint mobility with pelvic girdle pain, and to evaluate if pre-pregnancy body mass index was a modifier of the association. Methods: Generalized joint hypermobility was defined as a score of ≥5/9 positive tests on the Beighton score measured in early pregnancy. Primary outcome was evening pain intensity in gestation week 30, measured by a 100 mm visual analogue scale. We applied linear regression analyses to estimate age-adjusted unstandardized beta coefficients. Results: Evening pain intensity was similar among women with Beighton score ≥ 5/9 and women with Beighton score < 5/9 (age-adjusted mean difference 2.8 mm; 95% CI: -9.2 to 14.9 mm). Women with Beighton score ≥ 5/9 and pre-pregnancy body mass index ≥ 25 kg/m2, reported higher evening pain than women with Beighton score < 5/9 and pre-pregnancy body mass index <25 kg/m2 (age-adjusted mean difference 28.7 mm; 95% CI: 14.3-43.1 mm). Conclusions: Overall, evening pain intensity was similar among pregnant women with and without generalized joint hypermobility. However, women with a combination of generalized joint hypermobility and body mass index ≥25 kg/m2 reported higher evening pain compared to women with normal joint mobility and body mass index <25 kg/m2, suggesting that body mass index may modify the association. The estimates could be imprecise due to the small study sample, and our findings should be interpreted with caution.
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Affiliation(s)
- Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Lindgren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden
| | - Elisabeth Krefting Bjelland
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Valinger Aggeryd K, Bergström C, Mogren I, Persson M. A limited life - a mixed methods study on living with persistent pregnancy-related lumbopelvic pain more than 12 years postpartum in Sweden. Disabil Rehabil 2021; 44:3062-3070. [PMID: 33511884 DOI: 10.1080/09638288.2020.1852447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The scope of this study is women's descriptions of symptoms experienced through persistent pregnancy-related lumbopelvic pain (PPLP) as well as their strategies to cope with the condition. METHODS This is a mixed-method study based on questionnaire responses and inductive interviews with 12 Swedish women with self-reported PLP during pregnancy 2002 partaking in a 12-year postpartum follow-up questionnaire cohort. Test of statistical differences between the interview cohort and the total cohort was performed and the interviews were analysed through inductive qualitative content analysis. RESULTS The questionnaire data showed that the interview sample reported significantly more pain than the questionnaire respondents but resembled the questionnaire respondents on most other characteristics. The theme "Balancing avoidance and activity" and its sub-themes illustrate the strategies the participants used to manage their situation on a daily basis. The pain was a constant reminder that led to evaluation of pros and cons for physical, social, and mental activities as well as the search for therapies and treatments. CONCLUSIONS For the women who participated in the interviews, living with persistent pregnancy-related lumbopelvic pain caused limitations and negatively affected various and major parts of life to a far greater extent than previously known.Implications for rehabilitationPersisting pregnancy-related lumbopelvic pain affects various and major parts of life, including working, physical and social activities, and psychological well-being.Rehabilitation should focus on individualized physical activities and effective coping strategies.Effort should be put into helping the patient find fulfilling explanatory reasons for the persisting pregnancy-related lumbopelvic pain.
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Affiliation(s)
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umea, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umea, Sweden
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Srisopa P, Lucas R. Women's Experience of Pelvic Girdle Pain After Childbirth: A Meta-Synthesis. J Midwifery Womens Health 2020; 66:240-248. [PMID: 33314586 DOI: 10.1111/jmwh.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/14/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Persistent pelvic girdle pain (PGP) and the resulting consequences may occur for more than 10 years after birth. The purpose of this meta-synthesis is to provide a new interpretation and deeper understanding of women's experience of living with PGP postpartum. METHODS A literature review of CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertations was conducted for any qualitative study addressing PGP after birth and published in English from 2000 to 2019. A meta-synthesis using Noblit and Hare's meta-ethnography approach was performed. RESULTS Seven studies were found describing the experiences of women living with PGP from birth to 13 years after birth. Six themes emerged that represented women's experience: invisible pain, life being restrained, failure to perform the maternal role, experiencing downward emotional spiral, need for active social support, and adaptation to a new conditional life. DISCUSSION The experiences of women living with PGP after birth highlight the need for holistic care. Interventions by health care providers should support the ability of women to perform daily functions and adapt to their new reality instead of a disease-focused intervention. In addition, women with PGP emphasize the importance of active social support from family members and health care providers. Future research that examines the differences between PGP during the first 3 months postpartum versus that which persists later is needed to develop targeted interventions.
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Affiliation(s)
- Pornpan Srisopa
- The School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Ruth Lucas
- The School of Nursing, University of Connecticut, Storrs, Connecticut
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Filipec M, Matijević R. Expert advice about therapeutic exercise during pregnancy reduces the symptoms of sacroiliac dysfunction. J Perinat Med 2020; 48:559-565. [PMID: 32621735 DOI: 10.1515/jpm-2020-0143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/04/2020] [Indexed: 11/15/2022]
Abstract
Objectives There are growing evidence that exercise improves sacroiliac dysfunction symptoms in pregnant women; but no data about the effect of expert advice regarding this matter. The aim of this study was to assess the effectiveness of expert advice about therapeutic exercise on sacroiliac dysfunction in pregnancy. Methods A total of 500 women with sacroiliac dysfunction diagnosed in pregnancy were randomized in study and control group. Study group has conducted expert advice on therapeutic exercise; while control group continued with their normal lifestyle. Pain intensity by Visual Analog Scale (VAS) and degree of functional disability by Quebec scale were assessed at enrolment and after 3 and 6 weeks. Results Significantly better reduction in pain intensity assessed by VAS (p=0.001) and degree of functional disability assessed by Quebec scale (p=0.001) was noted in study compared to control group. Better results for both outcome measures were obtained if intervention was implemented earlier i.e., in second (p=0.001; p=0.001) compared to third (p=0.005; p=0.001) trimester. Strong positive correlation was found between pain intensity and degree of functional disability in both groups. Conclusions Expert advice on therapeutic exercise is effective in reduction of sacroiliac dysfunction symptoms during pregnancy. Trial registration ACTRN12617000556347.
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Affiliation(s)
- Manuela Filipec
- Department of Physical Medicine and Rehabilitation, Clinical hospital "Sveti Duh", Zagreb, Croatia
| | - Ratko Matijević
- Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia.,School of Medicine, Merkur University Hospital, Zagreb, Croatia
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Girard MP, O'Shaughnessy J, Doucet C, Ruchat SM, Descarreaux M. Association Between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women. J Manipulative Physiol Ther 2020; 43:655-666. [PMID: 32709518 DOI: 10.1016/j.jmpt.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Lumbopelvic pain (LBPP) affects 45% to 81% of pregnant women, and 25% to 43% of these women report persistent LBPP beyond 3 months after giving birth. The objective of this study was to investigate the association of physical activity, weight status, anxiety, and evolution of LBPP symptoms in postpartum women. METHODS This was a prospective observational cohort study with 3 time-point assessments: baseline (T0), 3 months (T3), and 6 months (T6). Women with persistent LBPP 3 to 12 months after delivery were recruited. At each time point, pain disability was assessed with the Pelvic Girdle Questionnaire and the Oswestry Disability Index (ODI), physical activity with Fitbit Flex monitors, and anxiety with the French-Canadian version of the State-Trait Anxiety Inventory. Weight was recorded using a standardized method. Pain intensity (numerical rating scale, 0-100) and frequency were assessed using a standardized text message on a weekly basis throughout the study. RESULTS Thirty-two women were included (time postpartum: 6.6 ± 2.0 months; maternal age: 28.3 ± 3.8 years; body weight: 72.9 ± 19.1 kg), and 27 completed the T6 follow-up. Disability, pain intensity, and pain frequency improved at T6 (P < .001). Participants lost a mean of 1.9 ± 4.5 kg at T6, and this weight loss was correlated with reduction in LBPP intensity (r = 0.479, P = .011) and LBPP frequency (r = 0.386, P = .047), Pelvic Girdle Questionnaire score (r = 0.554, P = .003), and ODI score (r = 0.494, P = .009). Improvement in ODI score at T6 was correlated with the number of inactive minutes at T3 (r = -0.453, P = .026) and T6 (r = -0.457, P = .019), and with daily steps at T6 (r = 0.512, P = .006). CONCLUSION Weight loss is associated with positive LBPP symptom evolution beyond 3 months postpartum, and physical activity is associated with reduction in pain disability.
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Affiliation(s)
- Marie-Pier Girard
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Julie O'Shaughnessy
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Chantal Doucet
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Stephanie May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
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Association Between Excessive Weight Gain During Pregnancy and Persistent Low Back and Pelvic Pain After Delivery. Spine (Phila Pa 1976) 2020; 45:319-324. [PMID: 31593058 DOI: 10.1097/brs.0000000000003271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the association between gestational weight gain (GWG) during pregnancy and persistent low back and pelvic pain (LBPP) after delivery. SUMMARY OF BACKGROUND DATA Persistent LBPP after delivery is a risk factor for developing depression and chronic pain as well as incurring sick leave. Women experience weight gain during pregnancy. Excessive weight gain places a greater burden on the musculoskeletal system. However, little is known about how GWG is associated with LBPP after delivery. METHODS After Ethics Committee approval, we analyzed 330 women at 4 months after delivery who had LBPP during pregnancy. The exclusion criteria were as follows: specific low back pain, multiple birth, and incomplete data. Four months after delivery, LBPP was assessed using a self-report questionnaire. Persistent LBPP was defined as pain at 4 months after delivery with an onset during pregnancy or within 3 weeks after delivery. GWG was calculated as the difference between the pregnancy weight and the prepregnancy weight, which we categorized into three groups: <10, 10 to <15, and ≥15 kg. Other confounding factors including age, height, weight at 4 months after delivery, parity, gestational week, mode of delivery, weight of the fetus, and prepregnancy LBPP were assessed. We used logistic regression analysis to calculate LBPP odds ratios (ORs) according to GWG. RESULTS The prevalence of persistent LBPP was 34.1% (n = 113). Compared with women with a GWG of <10 kg, women with a GWG of ≥15 kg had a higher prevalence of persistent LBPP (OR = 2.77, 95% confidence interval (95% CI) = 1.28-5.96, adjusted OR = 2.35, 95% CI = 1.06-5.21); however, no significant difference was found for women with a GWG of 10 to <15 kg (OR = 1.18, 95% CI = 0.72-1.92, adjusted OR = 1.02, 95% CI = 0.61-1.72). CONCLUSIONS Our study showed that excessive weight gain during pregnancy is one of the risk factors of persistent LBPP. Appropriate weight control during pregnancy could help prevent persistent LBPP after delivery. LEVEL OF EVIDENCE 3.
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Gausel AM, Malmqvist S, Andersen K, Kjærmann I, Larsen JP, Dalen I, Økland I. Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:556-563. [PMID: 31950350 DOI: 10.1007/s00586-020-06288-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/06/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the subjective recovery from pregnancy-related pelvic girdle pain (PGP) during the first 6 weeks after delivery and to detect possible risk factors for a poor recovery. METHODS The participants were included in this study at the routine ultrasound examination at 18 weeks of pregnancy. The women received a weekly SMS with the question "How many days during the last week has your PGP been bothersome?" The SMS-track from the final 10 weeks of pregnancy and first 6 weeks after delivery were assessed and sorted, based on individual graphs. A total of 130 women who reported PGP during pregnancy and met for clinical examination 6 weeks after delivery were included in the study. RESULTS In all, 83% of the women experienced substantial recovery from severe or moderate PGP within 6 weeks after delivery. Of these, 44% reported a substantial recovery already within 2 weeks after delivery. More multiparous women, women reporting PGP the year before pregnancy, and women with high pain intensity during pregnancy had a poor recovery. CONCLUSIONS The prognosis following PGP in pregnancy is good and the majority of women recovered substantially from severe and moderate pregnancy-related PGP within 6 weeks after delivery. For many women, a subjective substantial recovery occurred within 2 weeks after delivery. Predictors for a poor recovery were multiparity, PGP the year before pregnancy and a high pain intensity during pregnancy. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Anne Marie Gausel
- Department of Obstetrics and Gynecology, Stavanger University Hospital, P.O. Box 8100, Stavanger N-4068, Stavanger, Norway.
| | - Stefan Malmqvist
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Sundbybergskliniken, Sundbyberg, Sweden
| | - Knut Andersen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Inger Kjærmann
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, P.O. Box 8100, Stavanger N-4068, Stavanger, Norway
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12
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ElDeeb AM, Abd-Ghafar KS, Ayad WA, Sabbour AA. Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2020; 32:693-700. [PMID: 30636728 DOI: 10.3233/bmr-181258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. OBJECTIVE This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. METHODS Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. RESULTS Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). CONCLUSIONS PFM training should be an essential part in rehabilitation programs of PGP postpartum.
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Affiliation(s)
- Abeer M ElDeeb
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Dokki, Giza, Egypt
| | - Khaled S Abd-Ghafar
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Dokki, Giza, Egypt
| | - Waled A Ayad
- Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhr University, Nasr City, Cairo, Egypt
| | - Adly A Sabbour
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Dokki, Giza, Egypt
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13
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Gausel AM, Dalen I, Kjærmann I, Malmqvist S, Andersen K, Larsen JP, Økland I. Adding Chiropractic Treatment to Individual Rehabilitation for Persistent Pelvic Girdle Pain 3 to 6 Months After Delivery: A Pilot Randomized Trial. J Manipulative Physiol Ther 2019; 42:601-607. [PMID: 31864519 DOI: 10.1016/j.jmpt.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/05/2018] [Accepted: 12/19/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the feasibility of conducting a study examining the influence of individualized rehabilitation and chiropractic treatment, compared with individualized rehabilitation alone, in women with persistent dominating 1-sided pelvic girdle pain (PGP) 3 to 6 months after delivery. METHODS Women were recruited from an outpatient clinic at Stavanger University Hospital, Norway and in a private chiropractic clinic in Stavanger. Those with persistent, dominating 1-sided PGP were included in this pilot study. Those who met inclusion criteria were randomized into 2 groups, one group received individualized rehabilitation and chiropractic treatment and the other group women received individualized rehabilitation alone. Treatment was measured for 20 weeks. RESULTS Of 330 consenting women who were recruited who reported pelvic pain during pregnancy, 68 reported PGP or low back pain, and 63 consented to fill in a questionnaire. Forty-seven women underwent a clinical examination 3 to 6 months after delivery. During the examination, the women were diagnosed into subgroups for PGP. After exclusion of the women with low back pain only, a total of 13 women were diagnosed with dominating 1-sided PGP and thus included in this study. Six were randomized to the individualized rehabilitation and chiropractic treatment group and 5 to the individualized rehabilitation alone group. After 20 weeks of intervention, both groups reported improvement in disability and pain, but not in general health status. No serious or long-lasting adverse events were registered after treatment or training. CONCLUSION We found that a study of this nature is feasible. However, the conditions of patient recruitment need to be considered carefully. We learned that a trial to investigate the effect of chiropractic treatment for PGP pain should include all subgroups of PGP to reach an acceptable sample size.
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Affiliation(s)
- Anne M Gausel
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Inger Kjærmann
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Stefan Malmqvist
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Knut Andersen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
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14
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Tavares P, Barrett J, Hogg-Johnson S, Ho S, Corso M, Batley S, Wishloff K, Weis CA. Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Postpartum Ontario Population. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:473-480. [PMID: 31864910 DOI: 10.1016/j.jogc.2019.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the point prevalence of low back pain (LBP), pelvic girdle pain (PGP), and/or combination pain (COMBO pain) and period prevalence (presence or absence of any of those pains), as well as to identify risk factors at 1, 3, and 6 months postpartum in a Canadian population. METHODS Participants from a previous pregnancy study participated in a postpartum survey administered over the telephone at 1, 3, and 6 months following delivery. The survey included questions about LBP, PGP, or COMBO pain during the postpartum period, as well as questions related to risk factors (Canadian Task Force Classification II-3). RESULTS At 1, 3, and 6 months postpartum, responses from 46, 58, and 64 participants, respectively, demonstrated that 15%-21% of women experienced LBP and up to 4% of women experienced COMBO pain (point prevalence). At no time point was PGP reported to occur alone. Period prevalence of back pain for the participants returned to pre-pregnancy levels at each time point. Back pain during pregnancy was the only risk factor identified for back pain at 3 and 6 months postpartum. CONCLUSION This study demonstrated that 76% to 80% of respondents were pain free at 1, 3, and 6 months postpartum. Pregnancy-related back pain was the only risk factor associated with postpartum-related pain at the 1 to 3 and 3 to 6 month time interval. Identification of site-specific postpartum-related back pain may assist in determination of management and treatment plans for this population.
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Affiliation(s)
- Patricia Tavares
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON.
| | - Jon Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON
| | - Sara Ho
- Private practice, Toronto, ON
| | | | - Sarah Batley
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON
| | | | - Carol Ann Weis
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON
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15
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Sakamoto A, Gamada K. Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review. J Phys Ther Sci 2019; 31:831-838. [PMID: 31645815 PMCID: PMC6801337 DOI: 10.1589/jpts.31.831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this literature review was to detect the factors associated with
pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We
performed a broad literature search for eligible studies published before May 1, 2018
using electronic databases and processed the data using a review process. [Results] In the
initial online search, we identified 12,174 potential studies. Finally, 22 studies met the
specified criteria and were included for examination of risk factors for persistent pelvic
girdle pain after delivery. Pain intensity and disability during pregnancy were risk
factors for pelvic girdle pain persisting for over 6 months after delivery. The active
straight leg raising test predicted the risk of persistent pelvic girdle pain after
delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent
pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive
provocation tests, active straight leg raising test, and musculoskeletal mechanics were
positively associated with pelvic girdle pain persisting for over 3 months after
delivery.
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Affiliation(s)
- Asuka Sakamoto
- Graduated School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurosegakuendai, Higashihirsoshima-shi, Hiroshima 739-2631, Japan.,Faculty of Rehabilitation Sciences, Nishikyushu University, Japan
| | - Kazuyoshi Gamada
- Graduated School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurosegakuendai, Higashihirsoshima-shi, Hiroshima 739-2631, Japan
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16
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Saleh MSM, Botla AMM, Elbehary NAM. Effect of core stability exercises on postpartum lumbopelvic pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2019; 32:205-213. [PMID: 30282349 DOI: 10.3233/bmr-181259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Core stability exercises have been widely advocated for management of patients with different musculoskeletal conditions, even though its effect on postpartum Lumbopelvic Pain (LPP) has not been fully investigated. OBJECTIVE This study was conducted to investigate the effect of core stability exercises on postpartum LPP. METHODS Thirty four women suffering from postpartum LPP were randomly assigned to the study or control group. The control group (n= 17) received traditional treatment (infrared radiation and continuous ultrasound) on lumbosacral region (L1-S5), whereas the study group (n= 17) received core stability exercises in addition to traditional treatment three sessions a week for six weeks. Pain Pressure Threshold (PPT), Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed for all participants in both groups before and after the treatment program. RESULTS There was a significant improvement in PPT, VAS and ODI post-treatment compared with the pre-treatment in both groups (p= 0.001). There was a significant improvement in participants who received core stability exercises in addition to traditional treatment as compared to participants treated with the traditional treatment only in PPT (P= 0.001), VAS (P= 0.001) and ODI (P= 0.009). CONCLUSIONS Core stability exercises in addition to traditional treatment significantly decreased pain and improved function for women with postpartum LPP.
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17
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The association between pregnancy, pelvic girdle pain and health-related quality of life - a comparison of two instruments. J Patient Rep Outcomes 2018; 2:45. [PMID: 30363290 PMCID: PMC6165829 DOI: 10.1186/s41687-018-0069-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background The main purposes in this cross-sectional study were to study the impact of pregnancy and pelvic girdle pain (PGP) on health related quality of life (HRQoL), by comparing the scores on different domains of two HRQoL instruments in pregnant women with population norms as well as in women with severe and less severe PGP. Further, to explore the association between PGP and HRQoL and whether the two instruments differ in the way they assess the influence of PGP on HRQoL. Methods Pregnant women in gestation week 30 completed questionnaires containing the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP). Additional variables, self-reported PGP, pain location in the pelvis and response on clinical tests were also collected. HRQoL scores were compared with expected age adjusted mean scores and comparisons between groups with different severity of PGP were made, using Mann-Whitney U, t-tests and Hodges-Lehman method. Results Two hundred eighty-three pregnant women, mean age 31.3 (SD 4.2) years, participated. We found statistical significant differences in all domains of both HRQoL instruments in late pregnancy compared to the expected age-adjusted means of the reference populations (p ≤ 0.003) except for Social isolation (p = 0.775). Women with PGP had lower HRQoL than women without, and the most affected women scored lowest. SF-36 detected a deficit in Social Function compared to norms whereas the NHP showed no evidence of Social Isolation. Conclusions Both instruments revealed changes in HRQoL in pregnant women compared with population norms. Pregnancy itself influences HRQoL and having PGP gave an additional impact. The consistency of the correlations between SF-36 and NHP domains across the sub-groups found in this study suggests convergent validity across levels of impairment. The results in social domains vary between SF-36 and NHP in pregnant women and might be due to the basic design (construction) of the tools.
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18
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Beales DJ, Gaynor O, Harris J, Fary R, O’Sullivan PB, Slater H, Graven-Nielsen T, Palsson TS. Correlations between the active straight leg raise, sleep and somatosensory sensitivity during pregnancy with post-partum lumbopelvic pain: an initial exploration. Scand J Pain 2018; 19:53-60. [DOI: 10.1515/sjpain-2018-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Indexed: 01/22/2023]
Abstract
Abstract
Background and aims
For some women, lumbopelvic pain (LPP) developed during pregnancy becomes a continuing post-partum problem. Increased understanding of potential prognostic factors is required. This study investigated whether active straight leg raise (ASLR), sleep dysfunction and pressure pain sensitivity during pregnancy are correlated with LPP intensity and quality, disability, and physical health-related quality of life (HRQoL) post-partum.
Methods
An exploratory, prospective cohort study design was used. Baseline factors of interest were: (1) ASLR, (2) Pittsburgh Sleep Quality Index, and (3) pressure pain thresholds (PPTs) collected from pregnant women from sites local and distal to the lumbopelvic area. Follow-up data collected 11–18 months post-partum (n=29) were: (1) pain intensity score (numerical rating scale), (2) pain quality (McGill Pain Questionnaire), (3) disability (Pelvic Girdle Questionnaire), and (4) HRQoL (36-item Short Form Health Survey). Correlation analysis was performed.
Results
Greater difficulty with an ASLR during pregnancy correlated with lower post-partum physical HRQoL scores (r=−0.563, p=0.002). Likewise, reduced PPTs at the sacrum during pregnancy was correlated with a higher post-partum pain quality score (r=−0.384, p=0.040).
Conclusions
In this cohort, findings indicate that poor ASLR performance and localised pressure pain hypersensitivity at the pelvis during pregnancy are correlated with post-partum physical HRQoL and pain quality, respectively.
Implications
Pain sensitivity may contribute to the prognosis of women with LPP during pregnancy. These explorative findings may be important for designing larger prognostic studies and may assist in directing potential pain management in post-partum LPP.
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Affiliation(s)
- Darren John Beales
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Odette Gaynor
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Jasmine Harris
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Robyn Fary
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Peter Bruce O’Sullivan
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science , Curtin University , Perth, Western Australia , Australia
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Thorvaldur Skuli Palsson
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
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19
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Opala-Berdzik A, Błaszczyk JW, Świder D, Cieślińska-Świder J. Trunk forward flexion mobility in reference to postural sway in women after delivery: A prospective longitudinal comparison between early pregnancy and 2- and 6-month postpartum follow-ups. Clin Biomech (Bristol, Avon) 2018; 56:70-74. [PMID: 29807274 DOI: 10.1016/j.clinbiomech.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/13/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been documented that pregnancy-related increased connective tissue laxity may persist postpartum; however, it is still unclear for how long. This longitudinal study aimed to compare total trunk forward flexion mobility in women between their first trimester of pregnancy and at 2- and 6-month postpartum follow-ups. We also searched for a correlation between women's trunk flexibility and their postural stability in the sagittal plane. METHODS Seventeen healthy women participated in the study. Data were collected at their 7-12 weeks gestation appointments and at 6-10 and 25-28 weeks postpartum. At each session, the women performed a finger floor distance test, and data were collected on their waist circumference and BMI. The women's center of foot pressure mean velocity in the anterior-posterior direction was computed from 30-s long quiet-standing trials on a stationary force plate. FINDINGS Total trunk forward flexion mobility was significantly higher at 2 and 6 months postpartum compared to that in early pregnancy (P < 0.05). At 6 months postpartum, a moderate negative correlation between finger floor distance test values and their anterior-posterior center of foot pressure mean velocity was observed (r = -0.6, P < 0.05). INTERPRETATION Increased total trunk flexibility may be present in women 6 months postpartum. During that period, women with higher trunk flexibility may be more likely to present higher anterior-posterior postural sway velocity in quiet standing.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland.
| | - Janusz W Błaszczyk
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland; Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Świder
- Institute of Computer Science, Silesian University of Technology, Gliwice, Poland
| | - Joanna Cieślińska-Świder
- Department of Physiotherapy of the Nervous and Locomotor Systems, Academy of Physical Education, Katowice, Poland
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20
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Chortatos A, Iversen PO, Haugen M, Eberhard-Gran M, Bjelland EK, Veierød MB. Nausea and vomiting in pregnancy - association with pelvic girdle pain during pregnancy and 4-6 months post-partum. BMC Pregnancy Childbirth 2018; 18:137. [PMID: 29739355 PMCID: PMC5941485 DOI: 10.1186/s12884-018-1764-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum. Methods Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used. Results Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women. Conclusions Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP. Electronic supplementary material The online version of this article (10.1186/s12884-018-1764-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arthur Chortatos
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.,Department of Hematology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424, Oslo, Norway
| | - Margaretha Haugen
- Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Elisabeth Krefting Bjelland
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway
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21
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Almousa S, Lamprianidou E, Kitsoulis G. The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [DOI: 10.1002/pri.1699] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 10/01/2017] [Accepted: 10/10/2017] [Indexed: 01/12/2023]
Affiliation(s)
- S. Almousa
- Faculty of life Sciences and Education; University of South Wales; Pontypridd Wales UK
| | | | - G. Kitsoulis
- Physiotherapy Department; University Hospital of Ioannina; Ioannina Greece
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22
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Bergström C, Persson M, Nergård KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord 2017; 18:399. [PMID: 28915804 PMCID: PMC5602957 DOI: 10.1186/s12891-017-1760-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/11/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pelvic girdle pain (PGP) is not always a self-limiting condition. Women with more pronounced persistent PGP (PPGP) report poorer health status compared to women with less pronounced symptoms. The knowledge concerning the long-term consequences of PPGP is limited, thus more knowledge in this area is needed. The overall aim was to study the prevalence and predictors of PPGP 12 years after delivery. METHODS This is a long-term follow-up study based on a previous cohort study that commenced in 2002. New questionnaire data 12 years postpartum were collected in 2014 and early 2015. The questionnaire was distributed to a total of 624 women from the initial cohort. RESULTS In total, 295 women (47.3%) responded to the questionnaire where 40.3% (n = 119) reported pain to a various degree and 59% (n = 174) reported no pain. Increased duration and/or persistency of pain, self-rated health, sciatica, neck and/or thoracic spinal pain, sick leave the past 12 months, treatment sought, and prescription and/or non-prescription drugs used were all associated with an statistically significant increase in the odds of reporting pain 12 years postpartum. Widespread pain was common and median expectation of improvement score was 5 on an 11-point numeric scale (interquartile range 2-7.50). More than one of five women (21.8%) reporting pain stated that they had been on sick leave the past 12 months and nearly 11% had been granted disability pension due to PPGP. No statistically significant differences were found between respondents and non-respondents regarding most background variables. CONCLUSIONS This study is unique as it is one of few long-term follow-up studies following women with PPGP of more than 11 years. The results show that spontaneous recovery with no recurrences is an unlikely scenario for a subgroup of women with PPGP. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. Moreover, widespread pain is commonly associated with PPGP and may thus contribute to long-term sick leave and disability pension. A screening tool needs to be developed for the identification of women at risk of developing PPGP to enable early intervention.
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Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | | | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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23
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Kinser PA, Pauli J, Jallo N, Shall M, Karst K, Hoekstra M, Starkweather A. Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain. J Obstet Gynecol Neonatal Nurs 2017; 46:334-346. [DOI: 10.1016/j.jogn.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 10/20/2022] Open
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24
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Beales D, Lutz A, Thompson J, Wand BM, O'Sullivan P. Disturbed body perception, reduced sleep, and kinesiophobia in subjects with pregnancy-related persistent lumbopelvic pain and moderate levels of disability: An exploratory study. ACTA ACUST UNITED AC 2016; 21:69-75. [DOI: 10.1016/j.math.2015.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 04/11/2015] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
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Tseng PC, Puthussery S, Pappas Y, Gau ML. A systematic review of randomised controlled trials on the effectiveness of exercise programs on Lumbo Pelvic Pain among postnatal women. BMC Pregnancy Childbirth 2015; 15:316. [PMID: 26612732 PMCID: PMC4661954 DOI: 10.1186/s12884-015-0736-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023] Open
Abstract
Background A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment.
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Affiliation(s)
- Pei-Ching Tseng
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Shuby Puthussery
- Department of Clinical Education and Leadership & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Meei-Ling Gau
- Graduate Institute of Nurse-Midwifery, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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Owe KM, Bjelland EK, Stuge B, Orsini N, Eberhard-Gran M, Vangen S. 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. Br J Sports Med 2015; 50:817-22. [DOI: 10.1136/bjsports-2015-094921] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/03/2022]
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Chang HY, Jensen MP, Lai YH. How do pregnant women manage lumbopelvic pain? Pain management and their perceived effectiveness. J Clin Nurs 2015; 24:1338-46. [DOI: 10.1111/jocn.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Hao-Yuan Chang
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine; University of Washington; Seattle WA USA
| | - Yeur-Hur Lai
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. ACTA ACUST UNITED AC 2014; 20:200-5. [PMID: 25282439 DOI: 10.1016/j.math.2014.09.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/03/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
Diastasis recti abdominis (DRA) is an impairment characterized by a midline separation of the rectus abdominis muscles along the linea alba. It has its onset during pregnancy and the first weeks following childbirth. There is scant knowledge on both prevalence and risk factors for development of the condition. The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three timepoints postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain. Ultrasound images of inter rectus distance (IRD) were recorded in 84 healthy primiparous women, at three locations on the linea alba. The IRD was measured at: gestational week 35 and 6-8, 12-14, and 24-26 weeks postpartum. Diagnosis of DRA was defined as 16 mm at 2 cm below the umbilicus. Independent sample t-test and binary logistic regression was used to assess differences and risk factors in women with and without DRA and women with and without lumbo-pelvic pain. P < 0.05 was considered statistically significant. The prevalence of DRA decreased from 100% at gestational week 35-39% at 6 months postpartum. No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby's birth weight or abdominal circumference between women with and without DRA at 6 months postpartum. Women with DRA at 6 months postpartum were not more likely to report lumbo-pelvic pain than women without DRA. DRA is prevalent at 6 months postpartum, but is not linked with lumbo-pelvic pain.
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Affiliation(s)
| | | | | | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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