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Viroli G, Cerasoli T, Barile F, Modeo M, Manzetti M, Traversari M, Ruffilli A, Faldini C. Diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women: a systematic review of the current literature. Musculoskelet Surg 2024; 108:133-138. [PMID: 37338751 PMCID: PMC11133066 DOI: 10.1007/s12306-023-00786-x] [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: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Abstract
The aim of the present study is to systematically review the current literature about diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about clinical presentation, diagnosis methods and treatment strategies were retrieved from included studies and reported in a table. After screening, five studies on 34 women were included; they were all affected by acute inflammatory sacroiliitis. Clinical examination and magnetic resonance imaging were used to confirm diagnosis. In four studies, patients were treated with ultrasound-guided sacroiliac injections of steroids and local anesthetics, while one study used only manual mobilization. Clinical scores improved in all patients. Ultrasound-guided injections proved to be a safe and effective strategy for inflammatory sacroiliitis treatment during pregnancy or post-partum.
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Affiliation(s)
- G Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - T Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy.
| | - F Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Modeo
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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Kenawy HM, Nuñez MI, Morales X, Lisiewski LE, Burt KG, Kim MKM, Campos L, Kiridly N, Hung CT, Chahine NO. Sex differences in the biomechanical and biochemical responses of caudal rat intervertebral discs to injury. JOR Spine 2023; 6:e1299. [PMID: 38156061 PMCID: PMC10751974 DOI: 10.1002/jsp2.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/26/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023] Open
Abstract
Background Intervertebral disc degeneration (IDD) is a major cause of low back pain (LBP) worldwide. Sexual dimorphism, or sex-based differences, appear to exist in the severity of LBP. However, it is unknown if there are sex-based differences in the inflammatory, biomechanical, biochemical, and histological responses of intervertebral discs (IVDs). Methods Caudal (Coccygeal/Co) bone-disc-bone motion segments were isolated from multiple spinal levels (Co8 to Co14) of male and female Sprague-Dawley rats. Changes in motion segment biomechanics and extracellular matrix (ECM) biochemistry (glycosaminoglycan [GAG], collagen [COL], water, and DNA content) were evaluated at baseline and in response to chemical insult (lipopolysaccharide [LPS]) or puncture injury ex vivo. We also investigated the contributions of Toll-like receptor (TLR4) signaling on responses to LPS or puncture injury ex vivo, using a small molecule TLR4 inhibitor, TAK-242. Results Findings indicate that IVD motion segments from female donors had greater nitric oxide (NO) release in LPS groups compared to male donors. HMGB1 release was increased in punctured discs, but not LPS injured discs, with no sex effect. Although both male and female discs exhibited reductions in dynamic moduli in response to LPS and puncture injuries, dynamic moduli from female donors were higher than male donors across all groups. In uninjured (baseline) samples, a significant sex effect was observed in nucleus pulposus (NP) DNA and water content. Female annulus fibrosus (AF) also had higher DNA, GAG, and COL content (normalized by dry weight), but lower water content than male AF. Additional injury- and sex-dependent effects were observed in AF GAG/DNA and COL/DNA content. Finally, TAK-242 improved the dynamic modulus of female but not male punctured discs. Conclusions Our findings demonstrate that there are differences in rat IVD motion segments based on sex, and that the response to injury in inflammatory, biomechanical, biochemical, and histological outcomes also exhibit sex differences. TLR4 inhibition protected against loss of mechanical integrity of puncture-injured IVD motion segments, with differences responses based on donor sex.
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Affiliation(s)
- Hagar M. Kenawy
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - María I. Nuñez
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Xóchitl Morales
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | | | - Kevin G. Burt
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Min Kyu M. Kim
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Leonardo Campos
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nadia Kiridly
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Clark T. Hung
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nadeen O. Chahine
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
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3
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Filippini C, Saran S, Chari B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 2023:10.1007/s00256-023-04320-9. [PMID: 36917270 DOI: 10.1007/s00256-023-04320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.
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Affiliation(s)
- Claire Filippini
- Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Basavaraj Chari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
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4
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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5
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Santos FF, Lourenço BM, Souza MB, Maia LB, Oliveira VC, Oliveira MX. Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations. Physiotherapy 2023; 118:1-11. [PMID: 36288631 DOI: 10.1016/j.physio.2022.09.004] [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: 03/23/2021] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back (LBP) and pelvic girdle pain (PGP) during pregnancy are related to high direct and indirect costs. It is important to clarify evidence regarding interventions to manage and prevent these conditions. OBJECTIVE Investigate the efficacy and acceptability of the interventions to prevent LBP and PGP during pregnancy. DATA SOURCES Searches were conducted up to January 6th, 2021 in the MEDLINE, PEDro, Cochrane Library, SPORTDiscus, CINAHL, AMED, Embase and PsycInfo databases STUDY ELIGIBILITY CRITERIA: (1) Pregnant women without LBP and/or PGP; (2) any prevention strategy on incidence of LBP and PGP and sick leave; (3) comparison to control; (4) quasi and randomised controlled trial. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers performed screening, data extraction and methodological quality assessments. Meta-analysis was performed and Relative Risks (RRs) and 95% confidence intervals (CIs) were reported. RESULTS Six randomised controlled trials involving 2231 participants were included in the review. Evidence of moderate quality was found that "stand-alone" exercise is acceptable to pregnant women with lumbopelvic pain (LBPP) (RR 0.60 [95%CI 0.42-0.84]) and prevents episodes of LBP (RR 0.92 [95%CI 0.85-0.99]) in the long-term. Moderate to very-low quality evidence was found detailing the lack of efficacy of other interventions in the prevention of these problems in the short and long-term. LIMITATIONS Small number of trials included. CONCLUSIONS Efficacy of prevention strategies for episodes of LBPP and the use of sick leave during pregnancy is not supported by evidence of high quality. Current evidence suggests that exercise is acceptable and promising for the prevention of LBP in the long-term. However, further high-quality trials with larger samples are needed. CONTRIBUTION ON PAPER.
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Affiliation(s)
- Flávia F Santos
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Bianca M Lourenço
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Mateus B Souza
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Laísa B Maia
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Vinicius C Oliveira
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil; Posgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Murilo X Oliveira
- Posgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil; Posgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
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6
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Cerillo JL, Becsey AN, Sanghadia CP, Root KT, Lucke-Wold B. Spine Bracing: When to Utilize-A Narrative Review. BIOMECHANICS (BASEL, SWITZERLAND) 2023; 3:136-154. [PMID: 36949902 PMCID: PMC10029751 DOI: 10.3390/biomechanics3010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient's spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians' understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.
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Affiliation(s)
- John L. Cerillo
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759, USA
| | | | - Chai P. Sanghadia
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, AZ 85721, USA
| | - Kevin T. Root
- College of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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7
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Onyekere CP, Emmanuel GN, Ozumba BC, Igwesi-Chidobe CN. Minimal-contact physical interventions for pregnant women with musculoskeletal disorders: a systematic review of randomised and non-randomised clinical trials. J OBSTET GYNAECOL 2022; 42:1679-1692. [PMID: 35653767 DOI: 10.1080/01443615.2022.2070731] [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: 10/18/2022]
Abstract
This review summarised minimal-contact physical interventions and their effects on pain, disability and quality of life in pregnant women with musculoskeletal disorders. Twelve bibliographic databases were systematically searched until December 31 2020. PEDro Scale was used for quality assessments. Narrative synthesis of 10 eligible studies was conducted. Education and multimodal home exercises plus handbooks/multimodal individual/group exercises; and self-management programmes improved pain intensity, sick leave and disability in pregnant women with lumbopelvic pain. Individual home-based progressive muscle relaxation exercises; unsupervised water exercises plus information using handbooks/videos/music; group multimodal exercises plus home exercises and information/education; and partner massage plus information using booklets/photographs reduced pain intensity in pregnant women with low back pain. Non-rigid/customised lumbopelvic belts plus information reduced pain intensity more significantly than rigid belts or stabilisation exercises plus information among pregnant women with pelvic girdle pain. Minimal contact interventions are effective and may be utilised during infectious disease pandemics.
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Affiliation(s)
- Chukwuebuka P Onyekere
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Grace N Emmanuel
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Benjamin C Ozumba
- Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Chinonso N Igwesi-Chidobe
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
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8
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Heydari Z, Aminian G, Biglarian A, Shokrpour M, Mardani MA. Comparison of the Modified Lumbar Pelvic Belt with the Current Belt on Low Back and Pelvic Pain in Pregnant Women. J Biomed Phys Eng 2022; 12:309-318. [PMID: 35698541 PMCID: PMC9175122 DOI: 10.31661/jbpe.v0i0.2111-1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Low back pain is one of the most common problems for pregnant women during pregnancy. Most belts are designed for supporting the surface of the symphysis pubis or upper anterior iliac spine without any support in the lumbar region. OBJECTIVE This study aimed to compare the related effects between the new design and the current belt on the pain and function of pregnant women. MATERIAL AND METHODS In this randomized control trial study, 48 pregnant women with pelvic and lumbar pain participated. The participants were randomly divided into three groups: current belt, modified belt, and control. Pain intensity assessment, pelvic girdle (PG), and Oswestry disability index (ODI) questionnaires were utilized at the beginning of the study and three weeks later. RESULTS The pain intensity decreased more in the modified belt group than in the current belt group. ODI and PG scores decreased in two belt groups after three weeks of follow-up. However, this decrease was greater in the modified belt group, there was no statistically significant difference. CONCLUSION The disability decreased in both groups using the belts, and their function was improved. Accordingly, the use of a modified belt with lumbar and PG support can significantly reduce back and pelvic pain in pregnant women compared to the current pelvic belt.
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Affiliation(s)
- Zhaleh Heydari
- PhD Candidate, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Aminian
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- PhD, Department of Biostatistics and Epidemiology, Social Determinants of Health Research center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Shokrpour
- MD, Department of Gynecology and Obstetrics, School of Medicine, Endocrinology and Metabolism Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Ali Mardani
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- PhD, Red Crescent Society of Yazd Province, Yazd, Iran
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9
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How Does the Lumbopelvic Complex Cope with the Obstetrical Load during Standing? Ergonomic Aspects of Body Posture in Pregnant Women. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pregnancy induces numerous modifications in the musculoskeletal system of the female body. Since one of the essential roles of the lumbopelvic structure is to support mechanical loads in the upright position, this study was designed to simulate the response of this complex to the growing foetus in pregnant women. The authors hypothesized that posture (i.e., lordosis and muscle involvement) under pregnancy conditions might be adjusted to minimize the demands of the obstetrical load. The analysis of the load on the musculoskeletal system during gestation was made based on numerical simulations carried out in the AnyBody Modeling System. The pregnancy-related adjustments such as increased pelvic anteversion and increased lumbar lordosis enhance the reduction of muscle activation (e.g., erector spinae, transversus abdominis or iliopsoas), muscle fatigue and spinal load (reaction force). The results may help develop antenatal exercise programs targeting core strength and pelvic stability.
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10
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Onyemaechi NO, Chigbu CO, Ugwu EO, Omoke NI, Lasebikan OA, Ozumba BC. Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria. Niger J Clin Pract 2021; 24:1573-1581. [PMID: 34782493 DOI: 10.4103/njcp.njcp_522_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. Aim The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. Patients and Methods A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Results A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. Conclusion MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.
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Affiliation(s)
- N O Onyemaechi
- Department of Surgery, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - C O Chigbu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - E O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - N I Omoke
- Department of Surgery, Ebonyi State University/Federal Teaching Hospital Abakaliki, Nigeria
| | - O A Lasebikan
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Enugu, Nigeria
| | - B C Ozumba
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
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11
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Shrestha A, Prowak M, Berlandi-Short VM, Garay J, Ramalingam L. Maternal Obesity: A Focus on Maternal Interventions to Improve Health of Offspring. Front Cardiovasc Med 2021; 8:696812. [PMID: 34368253 PMCID: PMC8333710 DOI: 10.3389/fcvm.2021.696812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Maternal obesity has many implications for offspring health that persist throughout their lifespan that include obesity and cardiovascular complications. Several different factors contribute to obesity and they encompass interplay between genetics and environment. In the prenatal period, untreated obesity establishes a foundation for a myriad of symptoms and negative delivery experiences, including gestational hypertensive disorders, gestational diabetes, macrosomia, and labor complications. However, data across human and animal studies show promise that nutritional interventions and physical activity may rescue much of the adverse effects of obesity on offspring metabolic health. Further, these maternal interventions improve the health of the offspring by reducing weight gain, cardiovascular disorders, and improving glucose tolerance. Mechanisms from animal studies have also been proposed to elucidate the signaling pathways that regulate inflammation, lipid metabolism, and oxidative capacity of the tissue, ultimately providing potential specific courses of treatment. This review aims to pinpoint the risks of maternal obesity and provide plausible intervention strategies. We delve into recent research involving both animal and human studies with maternal interventions. With the increasing concerning of obesity rates witnessed in the United States, it is imperative to acknowledge the long-term effects posed on future generations and specifically modify maternal nutrition and care to mitigate these adverse outcomes.
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Affiliation(s)
- Akriti Shrestha
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | - Madison Prowak
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | | | - Jessica Garay
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | - Latha Ramalingam
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
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12
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Iuamoto L, Ferreira V, Hsing W. Multidisciplinary management of musculoskeletal pain during pregnancy: A review of literature. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Whiles E, Shafafy R, Valsamis EM, Horton C, Morassi GL, Stokes O, Elsayed S. The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review. Global Spine J 2020; 10:908-918. [PMID: 32905728 PMCID: PMC7485082 DOI: 10.1177/2192568219886264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature. METHODS Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications. RESULTS Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%). CONCLUSION There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.
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Affiliation(s)
- Emily Whiles
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK
| | - Roozbeh Shafafy
- Royal London Hospital, Barts Health NHS Trust, London, UK,Roozbeh Shafafy, Department of Spinal
Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1
1RD, UK.
| | | | - Chris Horton
- Sir William Dunn School of Pathology, University of Oxford, Oxford,
UK
| | | | - Oliver Stokes
- Royal Devon & Exeter NHS Foundation Trust, London, UK
| | - Sherief Elsayed
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK,NMC Spine, Dubai, United Arab Emirates
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Vesentini G, Prior J, Ferreira PH, Hodges PW, Rudge M, Ferreira ML. Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta-analysis. Eur J Pain 2020; 24:1865-1879. [PMID: 32735717 DOI: 10.1002/ejp.1636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE It has been suggested that pelvic floor dysfunction may contribute to the development of lumbopelvic pain as a result of changes in trunk muscle control. However, there is limited evidence that pelvic floor muscle training (PFMT) can improve clinical outcomes in women with lumbopelvic pain. DATABASES AND DATA TREATMENT Six databases were searched for randomized controlled trials (RCTs) comparing the effectiveness of PFMT to other conservative interventions (usual physiotherapy care or minimal intervention), no treatment or placebo interventions on pain and disability in women with lumbopelvic pain. RESULTS We included eight RCTs totalling 469 participants. PFMT was more effective than minimal intervention for lumbopelvic pain [mean difference (MD) 15.9/100 (95% confidential interval (CI), 8.2 to 23.6; p = 0.00; I2 = 3.92%)] and disability [standardized mean difference (SMD) 0.5 (95% CI 0.1-0.9; p = 0.00; I2 = 0%)] during pregnancy. PFMT was more effective than usual physiotherapy care for pain (MD 11.7/100 [95% CI 7.5-15.9; p = 0.00; I2 = 94.14%]) and disability (SMD 0.3 (95% CI 0.0-0.6; p = 0.01; I2 = 82.54%]) in non-pregnant women. Effect sizes were in general of arguable clinical relevance. CONCLUSIONS Overall, the certainty of the evidence was very low to low. There is no conclusive evidence that the addition of PFMT to usual physiotherapy care or minimal intervention is superior to minimal intervention and usual care alone given the small number of studies and high levels of heterogeneity of included studies. Further well-designed trials are needed to establish the effectiveness of PFMT for lumbopelvic pain in women.
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Affiliation(s)
- Giovana Vesentini
- Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.,Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Joanna Prior
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Paul W Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Marilza Rudge
- Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Risk Factors Associated with Low Back Pain among A Group of 1510 Pregnant Women. J Pers Med 2020; 10:jpm10020051. [PMID: 32549306 PMCID: PMC7354496 DOI: 10.3390/jpm10020051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Low Back Pain (LBP) is a frequent, very common, and costly health problem. LBP, which occurs during pregnancy, may become a lifelong problem. The aim of this study was to determine the risk factors associated with LBP in pregnant women. Methods: The study included 1510 pregnant women. A questionnaire assessing demography, lifestyle, prevalence, and characteristics was designed and used in the study. Pain intensity was assessed with the VAS (Visual Analogue Scale). The RMDQ (Roland Morris Disability Questionnaire) was used to assess the effect that low back pain had on the functional capacity of a pregnant woman. Middle (thoracic) and low back pain disability was measured with the help of the ODI (Oswestry Disability Index) questionnaire. Results: The study confirmed that lying/sleeping (49.6%) and sitting positions (38.7%) as well as walking (37.2%) are the most significant factors causing LBP. It was also found that women who had not engaged in physical activity were more likely to experience LBP. Conclusions: Predisposing factors for LBP in pregnancy are LBP in previous pregnancies, back pain during menstruation, a younger age and a lack of physical activity. Most women in pregnancy with LBP experienced minimal and mild disability.
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Meucci RD, Perceval AH, Lima DRD, Cousin E, Marmitt LP, Pizzato P, Silva PAD, Jesien S, Cesar JA. Occurrence of combined pain in the lumbar spine, pelvic girdle and pubic symphysis among pregnant women in the extreme south of Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200037. [PMID: 32491051 DOI: 10.1590/1980-549720200037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and characterize the occurrence of low back pain (LBP), posterior pelvic girdle pain (PPGP) and pubic symphysis pain (PSP) among pregnant women resident in Rio Grande, RS. METHODS This was a cross-sectional study of all postpartum women who gave birth in 2016. Two pictures were used to investigate the presence of LBP, PPGP and PSP, both isolated and combined. Multinomial logistic regression was used to evaluate the factors associated with each symptom. RESULTS LBP was reported by 42.2%, PSP by 4.9%, and PPGP by 2%, while LBP + PSP was reported by 9%, LBP and PPGP by 2.8% and PPGP + PSP by 1.1%, and pain in all three regions was reported by 3.9% of the sample. The more advanced the age of the pregnant women, the risk for LBP and of LBP combined with one of the pelvic girdle regions was reduced, while the risk for PPGP + PSP was increased. Depression during pregnancy increased the risk for all symptom combinations. CONCLUSION This study provided a detailed description of the occurrence of the evaluated outcomes and its associated factors. Studies like this are rare in Brazil, especially a census with low rates of losses and refusals. The high prevalence of the evaluated symptoms suggests that it should be investigated routinely in prenatal care, taking into account the age of the pregnant women, depressive symptoms and those experiencing combined or intense pain.
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Affiliation(s)
- Rodrigo Dalke Meucci
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Aline Henriques Perceval
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Daniele Ramos de Lima
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Ewerton Cousin
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luana Patrícia Marmitt
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Paula Pizzato
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Priscila Arruda da Silva
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Stephanie Jesien
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Juraci Almeida Cesar
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
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Vincent R, Blackburn J, Wienecke G, Bautista A. Sacroiliac Joint Pain in Pregnancy: A Case Report. A A Pract 2019; 13:51-53. [PMID: 30829683 DOI: 10.1213/xaa.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sacroiliac joint pain is one of the most common causes of low back pain in pregnant women. We present a case of a 30-year-old G2P1 at 20 weeks gestation presenting with intractable low back pain refractory to conservative management. History and physical examination revealed sacroiliac joint as the pain generator. We elected to do an ultrasound-guided sacroiliac joint injection that significantly abated her pain. This article aims to review the diagnosis, pathophysiology, and treatment approaches to adequately manage sacroiliac joint pain in pregnant women.
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Affiliation(s)
- Ryan Vincent
- From the Department of Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Restriction in Pelvis and Trunk Motion in Postpartum Runners Compared With Pre-pregnancy. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/jwh.0000000000000129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Case report: Femoral neuropathy with conduction block. J Neurol Sci 2019; 401:17-18. [DOI: 10.1016/j.jns.2019.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
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Biviá-Roig G, Lisón JF, Sánchez-Zuriaga D. Effects of pregnancy on lumbar motion patterns and muscle responses. Spine J 2019; 19:364-371. [PMID: 30144534 DOI: 10.1016/j.spinee.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The kinematics of the lumbar region and the activation patterns of the erector spinae muscle have been associated with the genesis of low back pain, which is one of the most common complications associated with pregnancy. Despite the high prevalence of pregnancy-related low back pain, the biomechanical adaptations of the lumbar region during pregnancy remain unknown. PURPOSE This study analyzes lumbar spine motion and the activation pattern of the lumbar erector spinae muscle in healthy pregnant women. STUDY DESIGN A case-control study. PATIENT SAMPLE The study involved 34 nulliparous women (control group) and 34 pregnant women in the third trimester (week 36 ± 1). OUTCOME MEASURES We recorded the parameters of angular displacement of the lumbar spine in the sagittal plane during trunk flexion-extension, and the EMG activity of the erector spinae muscles during flexion, extension, eccentric and concentric contractions, and the myolectrical silence. METHODS The participants performed several series of trunk flexion-extension movements, which were repeated 2 months postpartum. The position of the lumbar spine was recorded using an electromagnetic motion capture system. EMG activity was recorded by a surface EMG system and expressed as a percentage of a submaximal reference contraction. RESULTS Antepartum measurements showed a decrease (relative to control and postpartum measurements) in lumbar maximum flexion (52.5 ± 10.5° vs 57.3 ± 7.7° and 58.7 ± 8.6°; p < .01), the percentage of lumbar flexion during forward bending (56.4 ± 5.6% vs 59.4 ± 6.8% and 59.7 ± 5.6%; p < .01), and the time keeping maximum levels of lumbar flexion (35.7 ± 6.7% vs 43.8 ± 5.3% and 50.1 ± 3.7%; p < .01). Higher levels of erector spinae activation were observed in pregnant women during forward bending (10.1 ± 4.8% vs 6.3 ± 2.4% and 6.6 ± 2.7%; p < .01) and eccentric contraction (12.1 ± 5.2% vs 9.4 ± 3.1% and 9.1 ± 2.9%; p < .01), as well as a shortened erector spinae myoelectric silence during flexion. CONCLUSIONS Pregnant women show adaptations in their patterns of lumbar motion and erector spinae activity during trunk flexion-extension. These changes could be associated with the genesis of pregnancy-related low back pain, by means of biomechanical protection mechanisms against the increase on abdominal mass and ligamentous laxity.
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Affiliation(s)
- Gemma Biviá-Roig
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
| | - Juan Francisco Lisón
- Department of Medicine, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
| | - Daniel Sánchez-Zuriaga
- Department of Anatomy and Human Embryology, Facultat de Medicina i Odontologia, Universitat de València, Av Blasco Ibáñez, 15, 46010 València, Spain.
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Kesikburun S, Güzelküçük Ü, Fidan U, Demir Y, Ergün A, Tan AK. Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Ther Adv Musculoskelet Dis 2018; 10:229-234. [PMID: 30515249 PMCID: PMC6262502 DOI: 10.1177/1759720x18812449] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background Pregnancy-induced hormonal and physiologic changes increase the risk of musculoskeletal problems in pregnancy. The purpose of this report is to provide a comprehensive look at the musculoskeletal pain and symptoms experienced during pregnancy. Methods A total of 184 women (mean age 30.9 ± 5.0 years) who gave birth in the obstetrics clinic of a tertiary hospital were included in the study. The participants who had given birth at 37-42 weeks of pregnancy (term pregnancy) and aged over 18 years were selected for participation. Basic demographic and clinical characteristics of the participants including age, body mass index, weight gained during pregnancy, education level, occupation, parity, sex of baby, and exercise habits were collected from the medical chart and face-to-face interviews. Musculoskeletal pain sites were defined as hand-wrist, elbow, shoulder, neck, back, low back, hip, knee, and ankle-foot in a diagram of the human body. The interviews with participants were performed to assess their musculoskeletal pain separately at each trimester follow-up visit. Results The most frequent musculoskeletal complaints during pregnancy were low back pain (n = 130, 70.7%), back pain (n = 80, 43.5%), hand-wrist (n = 61, 33.2%) and hip pain (n = 59, 32.1%). The participants experienced musculoskeletal pain most in the third trimester except for elbow, shoulder and neck pain compared with the first and second trimesters (p < 0.05). Conclusions The results of the study suggest that numerous musculoskeletal problems may complicate pregnancy especially in the third trimester.
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Affiliation(s)
- Serdar Kesikburun
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim Araştırma Hastanesi 06800 Bilkent-Ankara, Turkey
| | - Ümüt Güzelküçük
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
| | - Ulaş Fidan
- Department of Gynecology and Obstetrics, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
| | - Ali Ergün
- Department of Gynecology and Obstetrics, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Arif Kenan Tan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
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Computed Tomographic Assessment of Sagittal Plane Alignment of the Thoracolumbar Junction in a Young Adult Korean Population. World Neurosurg 2018; 121:e351-e357. [PMID: 30261381 DOI: 10.1016/j.wneu.2018.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine reference values for the sagittal plane alignment of the thoracolumbar junction (TLJ) in a young adult Korean population. METHODS Thoracolumbar computed tomography (CT) scans of 1000 individuals (age range, 20-39 years; 500 men and 500 women) from Hanyang University Health Care Center were reviewed. All subjects had no spinal pathology or a history of previous spinal surgery. The segmental (each level from T11 to L2) and global (T11-L1 and T11-L2) Cobb angles of the TLJ of the spine were measured in midsagittal CT scans. Moreover, comparisons between the 2 age groups (20s and 30s) and sexes were performed. RESULTS The segmental Cobb angles of T11, T12, L1, and L2 were 6.5° ± 3.9°, 5.5° ± 4.1°, 2.2° ± 4.7°, and -3.3° ± 5.3°, respectively. The global Cobb angles of T11-L1 and T11-L2 were 6.5° ± 5.2° and 0.5° ± 6.1°, respectively. There were no differences in the sagittal alignment between the 2 age groups. Women presented less kyphotic and more lordotic alignment in the lumbar spine (L1 and L2) than men; however, the thoracic spine (T11 and T12) alignment was not different between the 2 groups. CONCLUSIONS This study provides reference values with a wide physiologic range for the sagittal alignment of the TLJ of the spine in a young adult Korean population.
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Managing Spasticity in a Pregnant Woman with Spinal Cord Injury: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Duarte VM, Meucci RD, Cesar JA. Dor lombar intensa em gestantes do extremo Sul do Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:2487-2494. [DOI: 10.1590/1413-81232018238.22562016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/23/2016] [Indexed: 08/30/2023] Open
Abstract
Resumo O objetivo deste artigo é medir a prevalência e identificar fatores associados à dor lombar intensa (DL intensa) entre parturientes do município de Rio Grande, RS, Brasil, em 2013. Questionário padronizado aplicado por entrevistadoras previamente treinadas em até 48 horas após o parto. Realizou-se análise multivariável utilizando regressão de Poisson tendo a razão de prevalência como medida de efeito. Dentre as 2685 parturientes incluídas no estudo, 51,2% referiram dor lombar gestacional e 27,3% tinham DL intensa, com maior probabilidade de ocorrência entre adolescentes, mulheres com sobrepeso/obesidade, ex-fumantes e naquelas que praticaram atividade física na gestação. Entre as parturientes que tiveram DL intensa, 29,2%, 37,3% e 33,3% tiveram que deixar de fazer as lidas da casa, faltar ao trabalho e procurar um médico devido à DL, respectivamente. É elevada a prevalência de dor lombar intensa no período gestacional e preocupante seu impacto sobre as atividades da vida diária e utilização de serviços de saúde. Recomenda-se investigação clínica e manejo da dor lombar durante a gestação nas consultas de rotina do pré-natal.
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Krutko AV, Sanginov AJ, Peleganchuk AV, Alshevskaya AA, Moskalev AV, Byvaltsev VA. SURGICAL TREATMENT OF LUMBAR DISC HERNIATION IN PREGNANT WOMEN: REPORT OF TWO CASES AND A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT Objective: To review the surgical treatment of lumbar disc herniation in pregnancy. Methods: We systematically reviewed cases of surgical treatment of pregnant patients with lumbar IVD herniations in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We searched on electronic databases, including PubMed, Scopus, and Google Scholar, to find relevant articles by keywords. Results: A literature review of 42 cases is presented. Conclusions: The authors’ own data and the literature data demonstrate that decompression surgery in pregnancy is effective and safe for both mother and fetus; however, radical surgery (fusion) can lead to very adverse sequelae for the fetus. Level of Evidence III; Systematic reviewb of Level III studies.
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Estimating Co-Contraction Activation of Trunk Muscles Using a Novel Musculoskeletal Model for Pregnant Women. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7101067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eser F, Nebioğlu S, Aliyeva A, Kılıçarslan A, Atalay CR, Özcanlı G, Erten Ş, Uysal F. Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life. Eur J Rheumatol 2017; 5:37-39. [PMID: 29657873 DOI: 10.5152/eurjrheum.2017.16088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/27/2017] [Indexed: 01/22/2023] Open
Abstract
Objectives To investigate the prevalence of neuropathic pain in pregnant women and to state its influence on the functional status and health-related quality of life (HRQoL) in terms of physical, social, and emotional functioning. Methods A total of 90 pregnant women with lumbopelvic pain (LPP) and non-pregnant and healthy controls were included. The presence of neuropathic pain was determined using the Leeds assessment of neuropathic symptoms and signs (LANNS) questionnaire. The HRQoL was assessed using the Nottingham Health Profile (NHP), and the functional status was evaluated using the Oswestry Disability Index (ODI). The severity of pain was measured using a visual analog scale. Results The LANNS score was ≥12 in 34 pregnant women (37.8%). The prevalence of neuropathic pain was higher in pregnant women with LPP (odds ratio=6.22; 95% confidence interval=2.68-14.44) (p<0.001) than in controls. The LANNS score was found to be correlated with the physical mobility subgroup in the NHP at high levels (p=0.002, r=0.32) and with the ODI and pain subgroup in the NHP at moderate levels (p=0.013, r=0.26 and p=0.038, r=0.22, respectively). Conclusion The present study is the first to demonstrate that neuropathic pain is associated with pregnancy-related LPP and strongly correlated with functional impairment and deterioration in the HRQoL. A better understanding of neuropathic pain mechanisms in pregnancy-related LPP will help us find more effective treatment strategies.
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Affiliation(s)
- Filiz Eser
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Saniye Nebioğlu
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Aygün Aliyeva
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Kılıçarslan
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Cemal Reşat Atalay
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Gizem Özcanlı
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Şükran Erten
- Department of Rheumatology, Yıldırım Beyazıt University Atatürk Training and Research Hospital, Ankara, Turkey
| | - Funda Uysal
- Department of Physical Treatment and Rehabilitation, Yenimahalle Training and Research Hospital, Ankara, Turkey
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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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López-López D, Rodríguez-Vila I, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, Romero-Morales C, Becerro-de-Bengoa-Vallejo R. Impact of the quality of life related to foot health in a sample of pregnant women: A case control study. Medicine (Baltimore) 2017; 96:e6433. [PMID: 28328852 PMCID: PMC5371489 DOI: 10.1097/md.0000000000006433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/26/2022] Open
Abstract
Pregnancy women coincide with numerous anatomical and physiological changes, which are believed to have a harmful effect on the quality of life related to foot health. The goal of this research was to identify and compare the impact foot health and overall health in a sample of pregnancy women and women without pregnancies with normalised reference values.A sample of 159 participants of a mean age of 30.13 ± 6.28 came to the area of midwifery center where self-reported data were registered, informants' with a 1 or various pregnancy was determined and the scores obtained were compared in the foot health status questionnaire (FHSQ). This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health, and footwear.The pregnant women group showed a worse quality of life related to health in general and to foot health specifically at the following domains, foot function, footwear, general foot, health, physical activity, social capacity, and vigor (P < 0.05) and there were no differences at foot pain and general health (P > 0.05).Pregnant women present a negative impact on the quality of life related to foot health, which appears to be associated with the pregnancy period.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña
| | - Inés Rodríguez-Vila
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña
| | | | - David Rodríguez-Sanz
- Physical Therapy & Health Sciences Research Group, European University of Madrid, Villaviciosa de Odón, Madrid
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, University of León, Ponferrada, León
| | - Carlos Romero-Morales
- Physical Therapy & Health Sciences Research Group, European University of Madrid, Villaviciosa de Odón, Madrid
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Newton ER, May L. Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2017; 10:1179562X17693224. [PMID: 28579865 PMCID: PMC5428160 DOI: 10.1177/1179562x17693224] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Abstract
Only 50 years ago obstetric care providers and women had many concerns regarding whether exercise during pregnancy created a harmful competition for substrate resources between the fetus and the mother. Animal and human research in the past 50 years, which includes acute and chronic aerobic exercise during pregnancy, has a reassuring margin of safety throughout gestation in women. Maternal physiology adapts to pregnancy changes involving the cardiorespiratory and glucometabolic alterations. Due to these changes, pregnant women have slight differences in response to acute exercise sessions. Chronic exposure to aerobic exercise before and during pregnancy is associated with numerous maternal and neonatal adaptations which may have short- and long-term benefits to maternal and child health. On the basis of the consistent evidence of safety of exercise during pregnancy, multiple nations and health care organizations, including the American College of Obstetrics and Gynecology, recommend moderate exercise for 20 to 30 minutes most days of the week. Despite the 15 to 20 years since the first recommendations were made, only 10% to 15% of pregnant women meet this recommendation. It seems there may be 2 foci for failure to achieve these exercise recommendations: patient specific and culturally driven and/or obstetric provider not recommending regular exercise due to lack of knowledge or motivation. This article addresses the provider knowledge by a review of the normal (at rest) physiologic adaptation to pregnancy. Then, we provide a detailed description of the type and intensity of controlled experiments that document the safety of exercise during pregnancy. The short- and long-term benefits are reviewed, including the safety in moderate-risk women.
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Affiliation(s)
- Edward R Newton
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Brody School of Medicine and Vidant Medical Center, East Carolina University, Greenville, NC, USA
| | - Linda May
- Foundational Sciences and Research, East Carolina University, Greenville, NC, USA
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Anselmo DS, Love E, Tango DN, Robinson L. Musculoskeletal Effects of Pregnancy on the Lower Extremity A Literature Review. J Am Podiatr Med Assoc 2017; 107:60-64. [PMID: 28271938 DOI: 10.7547/15-061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.
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Affiliation(s)
- Derek S. Anselmo
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Ebony Love
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Dana N. Tango
- Gait Study Center, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Lesly Robinson
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
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Pathologies lombo-abdominales et ceintures de série. ACTUALITES PHARMACEUTIQUES 2016. [DOI: 10.1016/j.actpha.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Michoński J, Walesiak K, Pakuła A, Glinkowski W, Sitnik R. Monitoring of spine curvatures and posture during pregnancy using surface topography - case study and suggestion of method. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:31. [PMID: 27785470 PMCID: PMC5073404 DOI: 10.1186/s13013-016-0099-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Low back and pelvic pain is one of the most frequently reported disorders in pregnancy, however etiology and pathology of this problem have not been fully determined. The relationship between back pain experienced during pregnancy and posture remains unclear. It is challenging to measure reliably postural and spinal changes at the time of pregnancy, since most imaging studies cannot be used due to the radiation burden. 3D shape measurement, or surface topography (ST), systems designed for posture evaluation could potentially fill this void. A pilot study was conducted to test the potential of monitoring the change of spine curvatures and posture during pregnancy using surface topography. A single case was studied to test the methodology and preliminarily assess the usefulness of the procedure before performing a randomized trial. The apparatus used in this study was metrologically tested and utilized earlier in scoliosis screening. Case presentation The subject was measured using a custom-made structured light illumination scanner with accuracy of 0.2 mm. Measurement was taken every 2 weeks, between 17th and 37th week of pregnancy, 11 measurements in total. From the measurement the thoracic kyphosis and lumbar lordosis angles, and vertical balance angle were extracted automatically. Custom-written software was used for analysis. Oswestry Low Back Pain Disability Questionnaire (ODI) was done with every measurement. The values were correctly extracted from the measurement. The results were: 50.9 ± 2.4° for kyphosis angle, 58.1 ± 2.1° for lordosis angle and 4.7 ± 1.7° for vertical balance angle. The registered change was 7.4° in kyphosis angle, 8.4° in lordosis angle and 5.5° in vertical balance angle. The calculated ODI values were between moderate disability and severe disability (22 to 58 %). Conclusions This case study presents that surface topography may be suitable for monitoring of spinal curvature and posture change in pregnant women. The ionizing radiation studies are contraindicated during pregnancy. Surface topography data connected with information from pain level questionnaires allows to investigate the connection between changes in posture and back pain.
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Affiliation(s)
- Jakub Michoński
- Department of Virtual Reality Techniques, Institute of Micromechanics And Photonics, Boboli 8, Warsaw, 02-525 Poland
| | - Katarzyna Walesiak
- Department of Orthopedics and Traumatology of the Locomotor System, Baby Jesus Clinical Hospital, Lindleya 4, Warsaw, 02-005 Poland
| | - Anna Pakuła
- Department of Virtual Reality Techniques, Institute of Micromechanics And Photonics, Boboli 8, Warsaw, 02-525 Poland
| | - Wojciech Glinkowski
- Department of Orthopedics and Traumatology of the Locomotor System, Baby Jesus Clinical Hospital, Lindleya 4, Warsaw, 02-005 Poland ; Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Banacha 1a, Warsaw, 02-097 Poland
| | - Robert Sitnik
- Department of Virtual Reality Techniques, Institute of Micromechanics And Photonics, Boboli 8, Warsaw, 02-525 Poland
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Ogamba MI, Loverro KL, Laudicina NM, Gill SV, Lewis CL. Changes in Gait with Anteriorly Added Mass: A Pregnancy Simulation Study. J Appl Biomech 2016; 32:379-87. [PMID: 26958743 PMCID: PMC4988898 DOI: 10.1123/jab.2015-0178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During pregnancy, the female body experiences structural changes, such as weight gain. As pregnancy advances, most of the additional mass is concentrated anteriorly on the lower trunk. The purpose of this study is to analyze kinematic and kinetic changes when load is added anteriorly to the trunk, simulating a physical change experienced during pregnancy. Twenty healthy females walked on a treadmill while wearing a custom made pseudo-pregnancy sac (1 kg) under 3 load conditions: sac-only condition, 10-lb condition (4.535 kg added anteriorly), and 20-lb condition (9.07 kg added anteriorly), used to simulate pregnancy in the second trimester and at full-term pregnancy, respectively. The increase in anterior mass resulted in kinematic changes at the knee, hip, pelvis, and trunk in the sagittal and frontal planes. In addition, ankle, knee, and hip joint moments normalized to baseline mass increased with increased load; however, these moments decreased when normalized to total mass. These kinematic and kinetic changes may suggest that women modify gait biomechanics to reduce the effect of added load. Furthermore, the increase in joint moments increases stress on the musculoskeletal system and may contribute to musculoskeletal pain.
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Affiliation(s)
- Maureen I Ogamba
- College of Health & Rehabilitation Sciences, Sargent College, Department of Physical Therapy and Athletic Training, Boston University, Boston, MA
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Razavizadeh MR, Fazel MR, Mosavi M, Sehat M. The Relationship Between Patients' Anthropometric Characteristics and Depth of Spinal Needle Insertion. Anesth Pain Med 2016; 6:e24993. [PMID: 27252901 PMCID: PMC4886622 DOI: 10.5812/aapm.24993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/04/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Background Many surgeries are performed under spinal anesthesia. Inexperienced practitioners may find it difficult to obtain subarachnoid access. Objectives This study aimed to examine the relationship between patients’ anthropometric characteristics and depth of spinal needle insertion to the subarachnoid cavity. Patients and Methods 385 patients with ASA class I – II, aged 18 - 65 years and undergoing elective surgery of the lower abdomen and extremities under spinal anesthesia, were selected for this cross-sectional study. The patients’ demographic characteristics, body mass index (BMI), and anthropometric characteristics (height, weight, waist circumference, and arm circumference) were recorded. Linear regression and t-student tests were used to study the relationship between anthropometric characteristics and BMI, and depth of needle insertion. Results Of the 385 patients studied, 88 were female and 297 were male. There was a strong correlation between the depth of needle insertion and BMI (24.9 ± 3.9), and between depth and weight/height ratio (r = 0.95 and r = 0.92, respectively). There was no significant correlation between depth of needle insertion and weight, height, gender, or arm circumference, when considered separately. The statistical predicting models showed that the following relationship was observed between the needle depth and the weight/height ratio: A: needle depth = 0.69 + (10.1 × weight/height); B: needle depth = 0.56 + (0.18 × BMI). Conclusions The results of this study show that there is a strong relationship between depth of needle insertion and BMI, and between depth and the weight/height ratio; appropriate depths can be determined according to the equations obtained.
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Affiliation(s)
| | | | - Mahdi Mosavi
- Department of Anesthesiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Recurrent umbilical or epigastric hernia during and after pregnancy: A nationwide cohort study. Surgery 2016; 159:1677-1683. [PMID: 26857642 DOI: 10.1016/j.surg.2015.12.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 12/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Umbilical and epigastric (umb/epi) hernia repairs are performed commonly in fertile female patients. Recent studies suggest mesh repair to be superior to suture repair; however, evidence is lacking concerning the optimal treatment of umb/epi hernias in female patients who might wish future pregnancies. The aim of this study was to compare the cumulative recurrence rate after mesh versus suture repair of umb/epi hernia in female patients subsequently becoming pregnant. METHODS This retrospective nationwide cohort study included female patients who underwent primary umb/epi hernia repair and subsequently became pregnant between 2007 and 2013. The follow-up began at first day of pregnancy and ended May 2015. Data were obtained from the Danish Ventral Hernia Database, Medical Birth Registry, and National Patient Registry. Patients with recurrence before pregnancy were excluded. RESULTS In total, 224 patients were analyzed. The median follow-up was 3.8 years (range 0.1-8.1). The cumulative recurrence rate was 16.3% after mesh repair and 10.9% after suture repair, P = .299. Univariate Cox regression analysis (mesh repair hazard ratio 1.63, 95% confidence interval 0.71-3.72, P = .249) and multivariate analysis adjusted for body mass index and hernia defect size (mesh repair hazard ratio 2.77, confidence interval 0.98-7.85, P = .055) likewise showed no significant difference in the risk of recurrence when we compared mesh and suture repair. CONCLUSION Contrary to findings in the general operative patient, mesh repair was not associated with a lesser risk of recurrence compared with suture repair for treatment of umb/epi hernia in female patients with subsequent pregnancy.
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van Vledder N, Louw Q. The effect of a workstation chair and computer screen height adjustment on neck and upper back musculoskeletal pain and sitting comfort in office workers. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:279. [PMID: 30135880 PMCID: PMC6093093 DOI: 10.4102/sajp.v71i1.279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022] Open
Abstract
Aims To assess the effect of a vertical height adjustment of the chair and visual display unit (VDU) on work-related upper quadrant musculoskeletal pain (WRUQMP) and sitting comfort in office workers. The upper quadrant refers to the occiput, cervical and upper thoracic spine, including the clavicles and scapulae. Methods A single subject (N = 1) study, in which the subject serves as her own control, was conducted using the ABC design. An ergonomic workstation adjustment of VDU and chair height was compared to the subject’s usual workstation settings. Pain and sitting comfort was measured using visual analogue scales (VAS). The subject was assessed over three four-week phases as she performed her typical VDU work. The results were compiled and tabulated. Results Both the mean and variance in pain intensity decreased after the workstation intervention. A deterioration in sitting comfort was noted. Conclusion The vertical height adjustment of the chair and visual display unit may have contributed to a decrease in work-related upper quadrant musculoskeletal pain in this subject. This safe, economical workstation intervention may be a practical management option for the computer user suffering from work-related upper quadrant musculoskeletal pain. Further research into the measurement of comfort whilst sitting at a computer workstation is recommended.
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Affiliation(s)
| | - Quinette Louw
- Division of Physiotherapy, University of Stellenbosch, South Africa
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Abstract
Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.
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Betsch M, Wehrle R, Dor L, Rapp W, Jungbluth P, Hakimi M, Wild M. Spinal posture and pelvic position during pregnancy: a prospective rasterstereographic pilot 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 2014; 24:1282-8. [DOI: 10.1007/s00586-014-3521-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
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Cakmak B, Inanir A, Nacar MC, Filiz B. The Effect of Maternity Support Belts on Postural Balance in Pregnancy. PM R 2014; 6:624-8. [DOI: 10.1016/j.pmrj.2013.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/19/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Malek A, Mattison DR. Drug development for use during pregnancy: impact of the placenta. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Figueira HA, Vale RGDS, Rodrigues WFG, Figueira AA, Figueira JA, Dantas EHM. Pregnancy-Related Low Back Pain Relief after Maximum Static Flexibility Program. Health (London) 2014. [DOI: 10.4236/health.2014.621335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ribeiro AP, João SMA, Sacco ICN. Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy. ACTA ACUST UNITED AC 2013; 9:99-108. [PMID: 23241158 DOI: 10.2217/whe.12.59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this literature review is to evaluate the studies that have investigated static and dynamic biomechanical changes of the lower limbs and gait patterns during pregnancy. Original articles on this subject, published between 1934 and 2012, were considered. In general, pregnant women demonstrated greater hip flexion, more extended knees and less plantar flexion ankles. These changes could explain the gait patterns of pregnant women characterized by increased hip angles, decreased propulsion forces associated with increased durations of stance phase and changes in distributions of the plantar loads with increased loads in the forefoot and decreased ones in the rearfoot. This can lead to arthrokinematic deviations that, with time, contribute to the development of musculoskeletal discomfort. In summary, these findings showed the importance of further longitudinal studies to investigate the relationships between musculoskeletal discomfort in pregnant women in the lower limbs and gait changes observed throughout this period.
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Affiliation(s)
- Ana Paula Ribeiro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânia, 51 Cidade Universitária, 05360-160 São Paulo, Brazil.
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[Is there a correlation between back pain and stability of the lumbar spine in pregnancy? A model-based hypothesis]. Schmerz 2012; 26:36-45. [PMID: 22366932 DOI: 10.1007/s00482-011-1125-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. In the literature different explanations for LBP are given and one of the most common reasons is the anatomical changes of the female body during pregnancy; for instance, there is an increase in the sagittal moments because of the enlarged uterus and fetus and the occurrence of hyperlordosis.The aim of this study was to describe how the anatomical changes in pregnant women affect the stability and the moments acting on the lumbar spine with the help of a simplified musculoskeletal model.A two-dimensional musculoskeletal model of the lumbar spine in the sagittal plane consisting of five lumbar vertebrae was developed. The model included five centres of rotation and three antagonistic pairs of paraspinal muscles. The concept of altered acting torques during pregnancy was explored by varying the geometrical arrangements. The situations non-pregnant, pregnant and pregnant with hyperlordosis were considered for the model-based approach. These simulations were done dependent on the stability of the erect posture and local countertorques of every lumbar segment.In spite of the simplicity of the model and the musculoskeletal arrangement it was possible to maintain equilibrium of the erect posture at every lumbar spinal segment with one minimum physiological cross-sectional area of all paraspinal muscles. The stability of the musculoskeletal system depends on the muscular activity of the paraspinal muscles and diminishing the muscular activity causes unstable lumbar segments.The relationship between the non-pregnant and the pregnant simulations demonstrated a considerable increase of acting segmental countertorques. Simulating an increased lordosis for the pregnant situation in the sagittal plane substantially reduced these acting countertorques and therefore the demand on the segmental muscles.It is assumed that hyperlordosis is a physiological adaptation to the anatomical changes during pregnancy to minimize the segmental countertorques and therefore the demand on the segmental muscles.Further, it can be expected that an enhanced muscle activity caused by selective activity of lumbar muscles increases the stability of the lumbar spine and may improve the situation with LBP during pregnancy.
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Bayliss AJ, Klene FJ, Gundeck EL, Loghmani MT. Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study. J Man Manip Ther 2012; 19:127-34. [PMID: 22851875 DOI: 10.1179/2042618611y.0000000006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.
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Affiliation(s)
- Amy J Bayliss
- Department of Physical Therapy, Indiana University, Indianapolis, IN, USA
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The Effects of Core and Lower Extremity Strengthening on Pregnancy-Related Low Back and Pelvic Girdle Pain. ACTA ACUST UNITED AC 2012. [DOI: 10.1097/jwh.0b013e318276fb16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peterson CD, Haas M, Gregory WT. A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain. Chiropr Man Therap 2012; 20:18. [PMID: 22694756 PMCID: PMC3542201 DOI: 10.1186/2045-709x-20-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/24/2012] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED BACKGROUND This pilot randomized controlled trial evaluated the feasibility of conducting a full scale study and compared the efficacy of exercise, spinal manipulation, and a mind-body therapy called Neuro Emotional Technique for the treatment of pregnancy-related low back pain, a common morbidity of pregnancy. METHODS Healthy pregnant women with low back pain of insidious onset were eligible to enroll in the study at any point in their pregnancy. Once enrolled, they remained in the study until they had their babies. Women were randomly allocated into one of three treatment groups using opaque envelopes. The treatment schedule paralleled the prenatal care schedule and women received individualized intervention. Our null hypothesis was that spinal manipulation and Neuro Emotional Technique would perform no better than exercise in enhancing function and decreasing pain. Our primary outcome measure was the Roland Morris Disability Questionnaire and our secondary outcome measure was the Numeric Pain Rating Scale. Intention to treat analysis was conducted. For the primary analysis, regression was conducted to compare groups on the outcome measure scores. In a secondary responder analysis, difference in proportions of participants in attaining 30% and 50% improvement were calculated. Feasibility factors for conducting a future larger trial were also evaluated such as recruitment, compliance to study protocols, cost, and adverse events. RESULTS Fifty-seven participants were randomized into the exercise (n = 22), spinal manipulation (n = 15), and Neuro Emotional Technique (n = 20) treatment arms. At least 50% of participants in each treatment group experienced clinically meaningful improvement in symptoms for the Roland Morris Disability Questionnaire. At least 50% of the exercise and spinal manipulation participants also experienced clinically meaningful improvement for the Numeric Pain Rating Scale. There were no clinically meaningful or statistically significant differences between groups in any analysis. CONCLUSIONS This pilot study demonstrated feasibility for recruitment, compliance, safety, and affordability for conducting a larger study in the future. Spinal manipulation and exercise generally performed slightly better than did Neuro Emotional Technique for improving function and decreasing pain, but the study was not powered to detect the between-group differences as statistically significant. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT00937365).
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Affiliation(s)
| | - Mitchell Haas
- Division of Research, University of Western States, Portland, OR, USA
| | - W Thomas Gregory
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
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Ribeiro AP, Trombini-Souza F, de Camargo Neves Sacco I, Ruano R, Zugaib M, João SMA. Changes in the plantar pressure distribution during gait throughout gestation. J Am Podiatr Med Assoc 2012; 101:415-23. [PMID: 21957273 DOI: 10.7547/1010415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy. METHODS A prospective longitudinal observational study was conducted with six pregnant women (mean ± SD age, 32 ± 3 years) with a mean ± SD weight gain of 10.0 ± 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance. RESULTS For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester. CONCLUSIONS Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion.
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Affiliation(s)
- Ana Paula Ribeiro
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
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