1
|
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.
Collapse
|
2
|
Ertmann RK, Nicolaisdottir DR, Siersma V, Overbeck G, Strøyer de Voss S, Modin FA, Lutterodt MC. Factors in early pregnancy predicting pregnancy-related pain in the second and third trimester. Acta Obstet Gynecol Scand 2023; 102:1269-1280. [PMID: 37771202 PMCID: PMC10541159 DOI: 10.1111/aogs.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy. MATERIAL AND METHODS Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis. RESULTS A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores. CONCLUSIONS When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.
Collapse
|
3
|
Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2920. [PMID: 36833617 PMCID: PMC9957354 DOI: 10.3390/ijerph20042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Fear is a significant factor affecting successful return to sport following an anterior cruciate ligament (ACL) injury. However, there is a lack of understanding of the emotional drivers of fear and how fear beliefs are formed. This study qualitatively explored the contextual and emotional underpinnings of fear and how these beliefs were formed, with reference to the Common-Sense Model of Self-Regulation. Face-to-face online interviews were conducted with ACL-injured participants (n = 18, 72% female) with a mean age of 28 years (range 18-50 years). Participants were either 1 year post ACL reconstruction surgery (n = 16) or at least 1 year post injury without surgery (n = 2) and scored above average on a modified Tampa Scale of Kinesiophobia. Four participants were playing state-level sport or higher. Five themes emerged describing factors contributing to fear: 'External messages', 'Difficulty of the ACL rehabilitation journey', 'Threat to identity and independence', 'Socioeconomic factors', and 'Ongoing psychological barriers'. A sixth theme, 'Positive coping strategies', provided insight into influences that could reduce fear and resolve negative behaviors. This study identified a broad range of contextual biopsychosocial factors which contribute to fear, supporting the notion that ACL injuries should not be treated through a purely physical lens. Furthermore, aligning the themes to the common-sense model provided a conceptual framework conveying the inter-related, emergent nature of the identified themes. The framework provides clinicians with a means to understanding fear after an ACL injury. This could guide assessment and patient education.
Collapse
Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| |
Collapse
|
4
|
Pulsifer J, Britnell S, Sim A, Adaszynski J, Dufour S. Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. Br J Sports Med 2022; 56:1262-1265. [PMID: 35948414 DOI: 10.1136/bjsports-2022-105724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Jodie Pulsifer
- Full Circle Physiotherapy, Vancouver, British Columbia, Canada
| | | | - Adrienne Sim
- Full Circle Physiotherapy, Langley, British Columbia, Canada
| | | | - Sinead Dufour
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Jafarian FS, Jafari-Harandi M, Yeowell G, Sadeghi-Demneh E. The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40553. [PMID: 35857366 PMCID: PMC9350821 DOI: 10.2196/40553] [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: 06/27/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP. OBJECTIVE This study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP. METHODS This study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences. RESULTS Recruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022. CONCLUSIONS This study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40553.
Collapse
Affiliation(s)
- Fahimeh-Sadat Jafarian
- Musculoskeletal Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmonir Jafari-Harandi
- Department of Obstetrics & Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ebrahim Sadeghi-Demneh
- Musculoskeletal Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
The Association between Postpartum Pelvic Girdle Pain and Pelvic Floor Muscle Function, Diastasis Recti and Psychological Factors-A Matched Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106236. [PMID: 35627771 PMCID: PMC9141269 DOI: 10.3390/ijerph19106236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 12/10/2022]
Abstract
There is uncertainty regarding the association between abdominal morphology, pelvic floor function, and psychological factors in women with postpartum pelvic girdle pain (PGP). The aim of this case-control study was to evaluate the differences between women with and without persistent PGP regarding pelvic floor function, diastasis recti, and psychological factors 6−24 weeks postpartum. Pelvic floor manometry, palpation examination of abdominal muscles, the International Consultation on Incontinence Questionnaire Short Form, The Depression, Anxiety and Stress Scale—21, and the Pain Catastrophizing Scale were used. The PGP group presented with lower vaginal resting pressure (p < 0.001), more tenderness (p = 0.018) and impaired voluntary activation of pelvic floor muscles (p ≤ 0.001). Women with pain also had more distortion on the level of the anterior abdominal wall (p = 0.001) and more severe diastasis recti (p = 0.046) when compared to pain-free controls. Lower vaginal resting pressure was the strongest factor explaining PGP (OR 0.702, 95%CI 0.502−0.981). There were no differences in terms of the pelvic floor strength, endurance, severity of urinary incontinence and reported distress between the groups. Women with PGP 6−24 weeks postpartum differ in pelvic floor and abdominal muscle function from the pain-free controls. Vaginal resting pressure may be an important factor in pelvic girdle pain shortly postpartum. Further studies are needed to see a trend in changes over time.
Collapse
|
7
|
Starzec-Proserpio M, Lipa D, Szymański J, Szymańska A, Kajdy A, Baranowska B. Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study. Phys Ther 2022; 102:6497843. [PMID: 35079827 PMCID: PMC9046967 DOI: 10.1093/ptj/pzab311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing. METHODS Women diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case-control study. RESULTS Thirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis. CONCLUSIONS Pain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery. IMPACT This study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.
Collapse
Affiliation(s)
| | - Daria Lipa
- St. Sophia Specialist Hospital, Warsaw, Poland
| | - Jacek Szymański
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agata Szymańska
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
8
|
Ortego G, Lluch E, Herrero P, Boudreau SA, Doménech-García V. Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study. J Clin Med 2022; 11:jcm11051346. [PMID: 35268437 PMCID: PMC8911229 DOI: 10.3390/jcm11051346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls. METHODS A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls. RESULTS After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found. DISCUSSION Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP.
Collapse
Affiliation(s)
- Gorka Ortego
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain; (G.O.); (V.D.-G.)
| | - Enrique Lluch
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Brussels “Pain in Motion” International Research Group, Departments of Human Physiology and Rehabilitation Sciences, Vrije Universiteit Brussels, 1050 Ixelles, Belgium
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-646168248
| | - Shellie Ann Boudreau
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Victor Doménech-García
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain; (G.O.); (V.D.-G.)
| |
Collapse
|
9
|
Kahere M, Ginindza T. The prevalence and psychosocial risk factors of chronic low back pain in KwaZulu-Natal. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 35144452 PMCID: PMC8831989 DOI: 10.4102/phcfm.v14i1.3134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is the leading cause of disability and has been extensively investigated in high-income countries (HICs), with little done in low-and middle-income countries. Biomechanical stressors do not have a major pathogenic role, but psychosocial predisposition is important. The occurrence and progression of CLBP are significantly affected by psychosocial risk factors. Guidelines recommend the early identification of psychosocial factors that could predict CLBP. AIM To determine the prevalence and psychosocial risk factors for CLBP amongst adults in KwaZulu-Natal, South Africa. SETTING The study was conducted at five randomly selected public hospitals in KwaZulu-Natal. METHODS Analytical cross-sectional hospital-based study utilising a self-administered questionnaire to collect data on (1) sociodemographic, (2) disability, (3) fear-avoidance beliefs and (4) illness behaviour. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for data cleaning and descriptive statistics. Chi-square test was used for categorical variables. Standard Edition of the Statistical Software for Data Science version 17.0 (STATA 17.0 SE) was used to identify risk factors using the logistic regression analysis. A p-value of ≤ 0.05 was deemed statistically significant. RESULTS Overall prevalence of CLBP was 22.2% (95% confidence interval [CI]: 18.8-25.9). Females had a higher prevalence of CLBP than males, 23.9% (95% CI: 19.4-28.9) and 19.7% (95% CI: 14.8-25.5), respectively; however, the difference was not significant p = 0.243. The multivariate regression analysis identified the following risk factors: female gender, middle-aged adults 38-47 years, obesity, disease conviction, affective disturbance, denial and fear-avoidance behaviour-work subscale. CONCLUSION There is a high prevalence of CLBP amongst the study participants. Psychosocial factors (disease conviction, affective disturbance and fear-avoidance behaviour about work) are significant predictors of CLBP.
Collapse
Affiliation(s)
- Morris Kahere
- Discipline of Public Health Medicine, School of Nursing and Public Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
10
|
Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med 2021; 10:jcm10225397. [PMID: 34830680 PMCID: PMC8622577 DOI: 10.3390/jcm10225397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
Collapse
Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden
- Correspondence:
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden;
- Department of Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium;
| |
Collapse
|
11
|
Diagnostic Accuracy of Clusters of Pain Provocation Tests for Detecting Sacroiliac Joint Pain: Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:422-431. [PMID: 34210160 DOI: 10.2519/jospt.2021.10469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. DESIGN Systematic review of diagnostic test accuracy. LITERATURE SEARCH Seven electronic databases and reference lists of included studies and previous reviews were searched. STUDY SELECTION CRITERIA Studies investigating the diagnostic accuracy of clusters of clinical tests for sacroiliac joint pain were included. DATA SYNTHESIS Bivariate random-effects meta-analysis was employed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to judge credibility of evidence. RESULTS From 2195 records identified in the search, 5 studies were included that assessed clusters of pain provocation tests for the sacroiliac joint. The estimated positive likelihood ratio was 2.13 (95% confidence interval [CI]: 1.2, 3.9), the negative likelihood ratio was 0.33 (95% CI: 0.11, 0.72), and the diagnostic odds ratio was 9.01 (95% CI: 1.72, 28.4). The GRADE ratings for the outcomes were of very low certainty. Assuming a point prevalence of sacroiliac joint pain of 20%, we calculated a positive posterior probability of 35% (95% CI: 32%, 37%) and negative posterior probability of 8% (95% CI: 6%, 10%). CONCLUSION A positive result on a sacroiliac joint pain provocation test cluster gives the clinician 35% certainty of having correctly identified sacroiliac joint pain. Clusters of pain provocation tests for the sacroiliac joint do not provide sufficient diagnostic accuracy for ruling in the sacroiliac joint as the source of pain. Clinicians can rule out the sacroiliac joint as the source of pain with more confidence: the negative posttest probability indicates that the clinician can conclude with 92% certainty that a negative test result is correct. J Orthop Sports Phys Ther 2021;51(9):422-431. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10469.
Collapse
|
12
|
Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Psychological Interventions for Women with Persistent Pelvic Pain: A Survey of Mental Health Clinicians. J Multidiscip Healthc 2021; 14:1725-1740. [PMID: 34262286 PMCID: PMC8275108 DOI: 10.2147/jmdh.s313109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To establish which psychological therapies mental health professionals use with reference to the treatment of women with persistent pelvic pain conditions. This research investigates overall therapies and specific techniques that clinicians believe are the most effective with this patient group, and the challenges mental health clinicians face in administering interventions. The study aims to suggest improvements to clinical practice and establish directions for targeted future research. Design Cross-sectional survey design. Methods An online survey was developed to ask mental health clinicians questions regarding the therapies and techniques they use with women experiencing persistent pelvic pain, their perspective on their practice in this area. The survey was advertised on relevant social media and professional websites. Survey results were tabled, and chi-square statistical analyses were undertaken to examine differences in therapy use according to country and profession. Results Mental health clinicians predominantly utilized cognitive behavioral therapy, acceptance and commitment therapy and associated techniques for women with persistent pelvic pain conditions. The results of the chi-square analyses showed that psychologists were more likely to use cognitive behavioral therapy or acceptance and commitment therapy, than counsellors who preferred counselling interventions. Chi-square analyses showed that Australian clinicians used acceptance and commitment therapy with a higher frequency than mental health clinicians in other countries. Clinicians provided multiple insights into their experiences working with women affected by persistent pelvic pain and their opinions as to valuable future research directions. Conclusion Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness therapies were most commonly used by mental health clinicians working with women with persistent pelvic pain conditions, despite severely limited evidence for the use of these psychological interventions in this client group.
Collapse
Affiliation(s)
- Tiffany Brooks
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Susan Evans
- Welland Health, North Adelaide, South Australia, Australia
| | - John Baranoff
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| |
Collapse
|
13
|
Pool-Goudzwaard A, Beales D, Bussey M. Introduction to the special issue on pelvic pain. Musculoskelet Sci Pract 2020; 48:102168. [PMID: 32560870 PMCID: PMC7146657 DOI: 10.1016/j.msksp.2020.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Annelies Pool-Goudzwaard
- Faculty of Human Movement Sciences, Research Institute MOVE, Vrije Universiteit Amsterdam, Van der Boechorststraat, 9, Amsterdam, 1081 BT, Netherlands.
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Australia.
| | - Melanie Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, New Zealand.
| |
Collapse
|