Effects of Progressive Muscle Relaxation Exercises Accompanied by Music on Low Back Pain and Quality of Life During Pregnancy

Randomised controlled trial of music listening combined with progressive muscle relaxation for mood management in women receiving chemotherapy for cancer

AIMS

To evaluate the effects of passive music listening combined with progressive muscle relaxation on anxiety, depression, stress, coping, and quality-of-life in women with breast and gynaecological cancers receiving chemotherapy.

METHODS

This was an assessor-blinded, randomised wait-list controlled trial. A total of 120 participants were randomly allocated into an intervention group or a wait-list control group. The intervention group received an intervention comprising training on passive music listening and progressive muscle relaxation, with once-daily self-practice at home for 3 weeks. The wait-list control group received the same intervention after the outcome assessment at week 6. All outcome data were collected before (T0) and 3 weeks (T1), 6 weeks (T2), and 12 months (T3) after randomisation. A generalised estimating equations model was used to compare the changes in each outcome at different time points. Process evaluation was conducted using data from the patient's self-report forms and interviews.

RESULTS

The findings indicated that at T1 and T2, the intervention group's reductions in anxiety were significantly larger than those of the control group. Additionally, the intervention group exhibited significantly better decreases in depression at T2, stress at T1, and dysfunctional coping at T2, and a greater improvement in quality-of-life score at T1 and T2 when compared to the control group. Most of the interviewed participants provided positive feedback on the intervention.

CONCLUSIONS

The intervention was beneficial for lowering anxiety, depression, and stress and increasing the quality-of-life of women receiving chemotherapy for breast and gynaecological cancers.

TRIAL REGISTRATION

The trial was prospectively registered with ClinicalTrials.gov on 9 February 2022 (registration number: NCT05262621).

Progressive Muscle Relaxation Training During Pregnancy: Effects on Mental State, Delivery and Labour Pain - a Prospective Study

Introduction

Progressive muscle relaxation is a widely used technique for relaxation, but studies are rare about efficacy on pregnancy and perinatal outcomes. Aim of our study was to determine whether progressive muscle relaxation affects anxiety and depression levels of pregnant women, pregnancy outcomes, labour pain and analgesic requirements.

Materials and Methods

156 pregnant women were enrolled in a prospective non-randomized controlled cohort study. The control group received standard antenatal care and classes only, while the intervention group additionally received progressive muscle relaxation training once a week for six weeks. Anxiety, depression and current strain were measured in a pretest-posttest experimental design using self-report scales at baseline (1 st survey), 5 weeks later (2 nd survey) and during puerperium (3 rd survey). Numeric Rating scales were used for measuring labour pain and satisfaction with analgesic treatment in the 3 rd survey.

Results

Fifty complete questionnaires from each group were analysed. There were no differences in mental status between the groups at baseline. Progressive muscle relaxation training significantly reduced depression levels. Trait anxiety, reflecting a person's basic anxiety decreased significantly in both groups during puerperium. No differences in pregnancy outcomes, labour pain and analgesic requirements could be shown within both groups in general. Nonetheless, women attending more than five progressive muscle relaxation courses reported significantly less labour pain within the group and compared to controls.

Conclusion

Pregnant women could benefit from progressive muscle relaxation training if used continuously. Relaxation methods should be a substantial part of prenatal care and available for everyone.

Effect of Music-Based Interventions on Maternal and Fetal Parameters during Pregnancy: A Systematic Review

INTRODUCTION

Music is a non-pharmacological intervention often used to improve maternal mental health during pregnancy. However, there is limited evidence regarding the effectiveness of music-based interventions on maternal and fetal parameters during pregnancy. We present a systematic review of the available research literature on the effects of music interventions on maternal and fetal parameters.

METHODS

A comprehensive literature search was conducted on the Web of Science, PubMed, ScienceDirect, Scopus, CINAHL, MEDLINE, Cochrane, ProQuest, and Turkish databases. The review included randomized controlled and quasi-experimental studies. Two independent authors evaluated the methodological quality of each study using the Quality Assessment Tool for Quantitative Studies. The study was registered in PROSPERO (CRD42018102914).

RESULTS

The literature review yielded a total of 723 studies. Among these studies, 13 were included in this study. Most of the studies involving low-risk pregnant women reported that music had no effect on stress but reduced anxiety and depression. The effect of music on pregnant women's blood pressure varied depending on the presence of medical conditions that could affect their blood pressure. While some studies showed that music interventions effectively increased fetal movement and acceleration, the available findings were limited.

CONCLUSION

Healthcare professionals can use simple, cost-effective, and practical music interventions to improve maternal mental health during pregnancy without neglecting medical treatment. Future well-designed studies are recommended to investigate the effects of music on maternal psychological, physiological parameters and fetal parameters in high-risk pregnancies.

Healthcare practitioners' experiences and perspectives of music in perinatal care in Ireland: An exploratory survey

INTRODUCTION

Evidence shows that music can promote the wellbeing of women and infants in the perinatal period. Ireland's National Maternity Strategy (2016-2026) suggests a holistic approach to woman's healthcare needs and music interventions are ideally placed as a non-pharmacological and cost-effective intervention to improve the quality of care offered to women and infants. This cross-sectional survey aimed to explore the healthcare practitioners' personal and professional experiences of using music therapeutically and its impact and barriers in practice. The survey also investigated practitioners' knowledge and attitudes towards the use of music as a therapeutic tool in perinatal care.

METHODS

A novel online survey was developed and distributed through healthcare practitioners' electronic mailing lists, social media, Perinatal Mental Health staff App, and posters at the regional maternity hospital during 26th June and 26th October 2020. Survey items included demographics, personal and professional use of music, and perspectives on music intervention in perinatal care.

RESULTS

Forty-six healthcare practitioners from across 11 professions were recruited and 42 were included in this study. 98 % of perinatal practitioners used music intentionally to support their wellbeing and 75 % referred to using music in their work. While 90 % found music beneficial in their practice, 15 % reported some negative effect. Around two-thirds of the respondents were familiar with the evidence on music and perinatal wellbeing and 95 % thought there was not enough guidance. 40 % considered music therapy an evidence-based practice and 81 % saw a role for music therapy in standard maternity service in Ireland. The qualitative feedback on how music was used personally and professionally, its' reported benefits, negative effects, and barriers are discussed.

DISCUSSION

This study offers insights into how healthcare practitioners viewed and applied music in perinatal practice. The findings indicate high interest and positive experiences in using music as a therapeutic tool in perinatal care which highlights the need for more evidence and guidance.

The Effect of Jacobson Relaxation Technique on Sleep Quality of Patients With Cancer Under Chemotherapy: A Randomized Clinical Trial

Introduction

Sleep is one of the most crucial basic human needs in Maslow's hierarchy, while sleep disorders are the most commonly occurring complications of chemotherapy.

Objective

This study was conducted to determine the effect of progressive muscle relaxation techniques on the sleep quality of patients with cancer undergoing chemotherapy.

Methods

This study was a randomized clinical trial performed on patients with cancer undergoing chemotherapy. Ninety cancer patients were selected by the convenience sampling method and randomly assigned into two groups; the progressive muscle relaxation group and the control group. Before the intervention, the Pittsburgh Sleep Quality Questionnaire (PSQQ) was completed for patients in both groups. In the intervention group, progressive muscle relaxation was performed for 4 weeks (twice daily and 20 min each time). In the control group, patients only received routine care. After the intervention, the PSQQ was completed again for patients in both groups. The data were analyzed using SPSS version 23.

Results

The mean and standard deviation of age were 45.95 ± 10.26 years. The samples of the intervention and control groups were homogeneous in terms of demographic characteristics. The results showed a significant improvement in the Pittsburgh Sleep Quality Index in the intervention group before and after the intervention (P < .001, Z = 5.09). However, this rate was not different in the control group. The sleep level of the intervention and control groups was not different at the beginning of the study. However, at the end of the study, the sleep score in the intervention group had decreased significantly (P < .001, Z = 3.52).

Conclusion

The results of the present study showed that progressive muscle relaxation improves the sleep quality of patients with cancer undergoing chemotherapy. Therefore, relaxation can be considered a useful and effective intervention for improving sleep quality of patients with cancer.

Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial

Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy.

METHODS

The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points.

RESULTS

A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future.

CONCLUSIONS

Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

Mind-body practice as a primer to maintain psychological health among pregnant women-YOGESTA-a randomized controlled trial

Objective

The objective of this study was to investigate the impact of Gestational Yoga-YOGESTA (Gestational Yoga), on the neuropsychology, quality of life, and personality of pregnant women.

Design

Open label, randomized controlled trial, used allocation concealment to allocate the treatment.

Setting

Department of Obstetrics and Gynecology and Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Participants

We recruited a total of 100 pregnant women visiting the Outpatient Department of Obstetrics and Gynecology. Participants were aged between 18 and 35 with uncomplicated pregnancies and they were randomly assigned to either the Yoga group (YG) or the usual care group (UCG). A total of 77 pregnant women completed both the pre- and post-survey, with 34 participants in the Yoga group and 43 in the Usual care group.

Intervention

Pregnant women in their second and third trimesters were provided with a 16-week online Prenatal Yoga intervention. The intervention began after enrollment in the 2nd trimester, specifically between the 16th and 20th week, and was conducted 5 days a week until delivery, with an average intervention period of 47.18 ± 2.031 (mean ± SEM) days.

Chief outcome measures

We measured Perceived stress, Depression, Anxiety, Stress, and quality of life by using standard questionnaires.

Results

A total of 77 participants were included in the analysis, with 34 assigned to the Yoga group and 43 assigned to the control group. Most of the measured parameters demonstrated significant changes. The Yoga group exhibited a noteworthy decrease in perceived stress, depression, anxiety, and psychological stress, as well as an improvement in the psychological and environmental domains of QOL-BREF. Conversely, the control group demonstrated a significant increase in perceived stress, depression, anxiety, and psychological stress, along with a reduction in the physical, psychological, and social domains of QOL-BREF at the follow-up stage. Although the two groups were similar at baseline, the Yoga group showed substantial enhancements in perceived stress, depression, anxiety, physiological stress, and overall quality of life when compared to the control group at follow-up.

Conclusion

The study's findings indicate that stress, anxiety, and depression are more likely to occur as gestational age progresses during pregnancy. Nevertheless, practicing Prenatal Yoga can effectively manage these changes and enhance the quality of life for expectant mothers.Clinical trial registration: Clinical Trials Registry-India, Identifier CTRI/2021/01/030827.

Effects of Conventional Exercises on Lower Back Pain and/or Pelvic Girdle Pain in Pregnancy: A Systematic Review and Meta-Analysis

Pregnant women frequently complain of low back discomfort associated with their pregnancies. On their quality of life, it could have a detrimental effect. Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) are associated with substantial direct and indirect expenditures. Evidence addressing strategies to treat and prevent these illnesses needs to be clarified. This review aimed to examine the connection between exercise, LBP, and PGP. To find relevant studies (in the English language) that matched the inclusion and exclusion criteria, a systematic search of peer-reviewed literature was carried out using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Scopus, the Web of Science, Pub Med, and ClinicalTrials.Gov. The publishing window was limited to the previous 10 years (2012-2022). Utilizing Review Manager version 5.4 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen), the results were examined. JADAD ratings were used to evaluate the quality of the included studies. To analyze the endpoints, the mean, standard mean difference (SMD), and 95% confidence intervals (CI) were determined. We chose 16 randomized controlled trials (RCTs) that included 1885 pregnant individuals with pelvic girdle and/or lower back discomfort. The combined data showed that the exercise group had lower VAS scores than the control group. The final result, however, did not significantly differ. Most of the studies had high JADAD scores, ranging from 3 to 5 points. Lower back pain and/or pelvic girdle discomfort during pregnancy are not influenced by exercise; however, women who are provided with a regular exercise program appear to manage the condition effectively with improved functional status.

The effect of progressive muscle relaxation exercise on the intensity of symptoms and quality of sleep and quality of life in pregnant women with restless leg syndrome

OBJECTIVE

This study, accordingly, was conducted with the purpose of investigating the effect of progressive muscle relaxation exercise on the intensity of restless leg syndrome (RLS) and RLS-related quality of life and sleep in pregnant women with RLS.

METHODS

This one-centered, parallel randomized controlled study was conducted with 52 pregnant women. 27-28th of pregnancy, progressive muscle relaxation exercises training was shown and they were asked to practice them 3 times a week for 8 weeks.

RESULTS

It was found that the RLS Intensity Scale and PSQI posttest mean scores of the women in experiment group are lower on a statically significant level than the mean scores of the women in control group (p = 0.000 and p = 0.001). It was detected that the RLS-Qol posttest mean scores of the women in the experiment group are higher than the mean scores in the control group on a statistically significant level (p = 0.000).

CONCLUSIONS

It was seen that progressive muscle relaxation exercises alleviate RLS intensity and symptoms and improve RLS-related quality of life and sleep in pregnant women.

PRACTICE IMPLICATION

Progressive muscle relaxation exercises are beneficial for pregnant women and can be easily integrated into practice.

Effects of progressive muscle relaxation exercises on patients with epilepsy on level of depression, quality of sleep, and quality of life: A randomized controlled trial

OBJECTIVE

This study aims to evaluate the effects of progressive relaxation exercises applied to patients with epilepsy on patients' depressive symptom severity, quality of sleep, and quality of life.

METHODS

The study was designed as a randomized controlled interventional study with a control group and pre-and post-test intervention. It was conducted with 70 patients with epilepsy, 35 in the intervention group and 35 in the control group, between November 1, 2021, and April 15, 2022. The patients in the intervention group were required to perform 12 progressive muscle relaxation exercise sessions 3 days a week for a total of 4 weeks. No interventions were made in the control group during the study. The data were collected with a "Personal Information Form," "Pittsburgh Sleep Quality Index (PSQI)," "Beck Depression Inventory (BDI)," and "Quality of Life in Epilepsy Inventory (QUOLIE -31)."

RESULTS

The mean PSQI total score, subscale scores, and mean BDI total scores of the patients in the intervention group decreased significantly compared to those in the control group after the intervention (p<0.05). Additionally, a significant difference was found between the mean QUOLIE-31 total scores and subscale scores of the patients in the intervention and control group after the intervention (p<0.05), the mean scores of the intervention group were significantly higher than those of the control group (p<0.05).

CONCLUSION

Progressive muscle relaxation exercises decreased depressive symptoms severity and improved sleep and life quality in patients with epilepsy. Progressive relaxation exercises may be recommended as a complementary nursing intervention in treating epilepsy.

The effect of exercise on health-related quality of life in persons with musculoskeletal pain: A meta-analysis of randomised control trials

OBJECTIVES

Exercise has positive effects on musculoskeletal pain. In this project, the impact of exercise was studied on improving health-related quality of life in persons with musculoskeletal pain.

METHOD

The study design was a systematic review and meta-analysis. A search was conducted to find original studies in four sources, including PubMed, Web of Science, the Cochrane Library and Scopus, and this search was limited to the original articles published until April 2021, which were in English. For each study, the effect size was calculated. The analysis was based on the random-effects method.

RESULT

Twenty-Seven randomised control trial studies were included in the meta-analysis. The total population of participants in the meta-analysis was 1927 persons. Exercise improves health-related quality of life in these persons and the hedges' g was 0.66 (95% CI = 0.38-0.94; I²  = 88.29%).

DISCUSSION

Overall, based on the findings, exercise is associated with improving the health-related quality of life of persons with musculoskeletal pain, and therefore the health implications of this finding are beneficial to the general population and professionals.

Quality of Life During Pregnancy from 2011 to 2021: Systematic Review

Purpose

Health-related quality of life (HRQoL) has emerged as a key concern in patient care. It has become one of the major objectives of clinical trials. Our study aims to describe the quality of life (QoL) during uncomplicated pregnancy and to assess its associated factors.

Patients and Methods

The search of articles was carried out using the online database of PUBMED and Web of Science with a limit of time between 2011 and 2021. Data were retrieved by two independent reviewers.

Results

721 publications responding to keywords were identified, of which 73 articles on the topic were selected. The main countries that have published on this subject are Australia (n = 10) and China (n = 7). Twenty-three articles deal with QoL for pathological pregnancies. All the pathologies studied have a negative impact on the HRQoL of pregnant women, and its improvement depends on the type of treatment. Obesity, low back, and pelvic girdle pain, and hyperemesis gravidarum were the frequent pathologies during pregnancy. Socio-demographic characteristics related to improved well-being (favorable economic status, social support). Similarly, better sleep quality and moderate physical exercise were linked to an increased QoL. Physical and psychological factors were associated with a lower QoL.

Conclusion

The HRQoL refers to patients’ subjective evaluation of physical, mental, and social components of well-being. Optimizing the QoL during pregnancy necessitates a deeper understanding of their issues as well as counseling which provides support wherever needed.

Comparing the Effectiveness of Multicomponent Sleep-Promoting Interventions on the Sleep Quality of Menopausal Women: A Quasi-Experimental Study

Sleep disturbance is considered one of the hallmarks of the common symptoms experienced by women during and after menopause. This study aimed to compare the effectiveness of two different multiple-component, sleep-promoting interventions on the sleep quality of menopausal women. A quasi-experimental study and repeated measured design, with a four-week sleep-promoting intervention, was conducted. A total of 123 eligible participants were recruited from a health center in northern Taiwan and divided into the progressive muscle relaxation plus sleep hygiene (PMRS), the meditative movement relaxation plus sleep hygiene (MMRS), or control group at a 1:1:1 ratio. The Chinese version of Pittsburgh sleep quality index and actigraphy were used to assess the sleep disturbances of menopausal women. The subjective sleep data was collected before, immediately after the intervention, 8 weeks, and 12 weeks after the intervention. The results showed that the global score of subjective sleep quality and its components were significantly improved after both interventions. Additionally, the MMRS was superior to the PMRS for subjective sleep quality. Moreover, the objective sleep indices indicated that sleep latency was reduced after both the interventions. These findings can serve as a reference for nurses when caring for menopausal women with sleep disturbance.

Hypnosis As A Therapy for Chronic Lower Back Pain

PURPOSE OF REVIEW

Chronic lower back pain is a crippling condition for the individual and a significant burden on society. It is notoriously challenging to manage despite access to invasive interventions. Understanding hypnosis as a powerful therapeutic adjunct to this condition allows holistic treatment of patients in distress.

RECENT FINDINGS

In addition to classic etiologies of chronic lower back pain, hypnosis has proven to be beneficial in chronic back pain caused by pregnancy, diabetic and HIV neuropathy. Combination of hypnosis with other mind-body techniques such as olfactory stimulation, music therapy and patient education offers further promise to this treatment modality. Our review provides a run-through of the fundamental mechanisms of hypnosis in moderating chronic back pain, its quantifiable benefits, its novel areas of use and its potentials in the future based on the most recent and relevant peer-reviewed literature in order to guide clinicians to better deploy this valuable resource.

Effect of birth ball abdominal core training on pregnancy fatigue, waist pain and delivery outcomes

OBJECTIVE

To evaluate the effect of birth ball abdominal core training on fatigue, waist pain, and delivery outcomes in middle and late pregnancy.

METHODS

A prospective study of 209 primipara in total with 24-27 weeks of gestation were recruited and divided into the training group (109 cases) and the control group (100 cases). The control group received routine prenatal exercise. On the basis of routine prenatal exercise, pregnant women in the training group were given birth ball exercises based on abdominal core training. The difference in pregnancy fatigue, waist discomfort, and delivery outcomes between the two groups were compared.

RESULTS

The waist pain and fatigue ratings of women were significantly lower and the vaginal delivery rate (74.3%) was significantly higher (62%) (P < 0.001) in the training group. There were no significant differences in the total stage of labor, postpartum hemorrhage, neonatal weight and 1-min neonatal Apgar score between the two groups. The rate of episiotomy in the training group (14.7%) was significantly lower than that in the control group (25.0%) (P < 0.05).

CONCLUSION

Birth ball exercises can relieve fatigue and waist pain in middle and late 2021 pregnancy, reduce the rate of episiotomy, and promote spontaneous vaginal delivery.

Non-pharmacological therapies for pain management in Parkinson's disease: A systematic review

Among the various non-motor symptoms of Parkinson's disease (PD), pain is often cited as the most common and debilitating feature. Currently, the literature contains gaps in knowledge with respect to the various forms of treatment available, particularly non-pharmacological therapies. Thus, the purpose of this systematic review is to provide an examination of the literature on non-pharmacological therapies for pain in PD. We compared the findings of research articles indexed within various literature databases related to non-pharmacological treatments of pain in PD patients. Our review identified five major non-pharmacological methods of pain therapy in PD: acupuncture, hydrotherapy, massage therapy, neuromodulation, and exercise. Treatments such as exercise therapy found a reduction in pain perception due to various factors, including the analgesic effects of neurotransmitter release during exercise and increased activity leading to a decrease in musculoskeletal rigidity and stiffness. By the same token, hydrotherapy has been shown to reduce pain perception within PD patients, with authors often citing a combined treatment of exercise and hydrotherapy as an effective treatment for pain management. Multiple methods of neurostimulation were also observed, including deep brain stimulation and spinal cord stimulation. Deep brain stimulation showed efficacy in alleviating certain pain types (dystonic and central), while not others (musculoskeletal). Hence, patients may consider deep brain stimulation as an additive procedure for their current treatment protocol. On the other hand, spinal cord stimulation showed significant improvement in reducing VAS scores for pain. Finally, although the literature on massage therapy and acupuncture effectiveness on pain management is limited, both have demonstrated a reduction in pain perception, with common reasons such as tactile stimulation and release of anti-nociceptive molecules in the body. Although literature pertaining to non-pharmacological treatments of pain in PD is sparse, there is copious support for these treatments as beneficial to pain management. Further exploration in the form of clinical trials is warranted to assess the efficacy of such therapies.

Mind-Body Techniques in Pregnancy and Postpartum

Maternal stress can perturb physiology and psychiatric health leading to adverse outcomes. This review investigates the effectiveness of several mind-body therapies-namely biofeedback, progressive muscle relaxation, guided imagery, tai chi, and yoga-as interventions in reducing maternal stress and other pregnancy-related conditions. Through randomized trials, these techniques have shown promising benefits for reducing pain, high blood pressure, stress, anxiety, depressive symptoms, labor pain and outcomes, and postpartum mood disturbances. As these interventions are easy to implement, low cost, and safe to perform in pregnancy, they should be considered as alternative, nonpharmaceutical interventions to use during pregnancy and postpartum care.

The Feasibility and Efficacy of Self-help Relaxation Exercise in Symptom Distress in Patients With Adult Acute Leukemia: A Pilot Randomized Controlled Trial

AIMS

To examine the feasibility and efficacy of self-help relaxation exercises in alleviating symptom distress in adult patients with acute leukemia (AL).

METHODS

A pilot randomized controlled trial was used. Thirty adult patients with AL who were hospitalized in a teaching hospital were enrolled and randomly divided into a wait-list control group or an intervention group. The intervention group received self-help relaxation exercise twice per day for 4 weeks. The feasibility indicators, patients' symptom distress were assessed by a blinded data collector.

RESULTS

Twenty-nine patients completed the study. The recruitment rate, retention rate, and adherence rate was 65.2%, 93.3%, and 98.2%, respectively. The intervention group had a significantly decreased distress score for pain symptoms (F_{1, 27} = 6.594, P = .016, the partial η² = 0.20, 90% confidence interval = 0.02-0.39).

CONCLUSIONS

Self-help relaxation exercises were feasible for the AL patients and significantly reduced their pain symptoms. Minor revision of the protocol for future definitive trials is needed.

Community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions: protocol for a systematic review with meta-analyses

INTRODUCTION

Twenty five per cent of pregnant women with musculoskeletal pain have disabling symptoms that negatively influence quality of life. Studies have reported varying effects of non-pharmacological interventions including exercise, manipulation and pelvic belts for pregnant women with musculoskeletal problems. The overall effectiveness and acceptability of these interventions is uncertain due to lack of synthesised evidence. This protocol is for the first systematic review of community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions from studies published until August 2020.

METHODS AND ANALYSIS

A detailed search of PubMed, CINAHL, CENTRAL, Global Index Medicus, African Index Medicus, African Journal Online, Western Pacific Region Index Medicus, Latin American and Caribbean Centre on Health Science Information, Index Medicus for South-East Asia Region, IRIS (WHO digital publications), British Library for Development Studies and Google Scholar. Additional studies will be located from the reference list of identified studies and relevant systematic reviews. The databases will be searched from inception to August 2020. Appraisal of study quality will be performed with the Mixed Methods Appraisal Tool. Data will be synthesised using a mixed-studies synthesis design-the convergent synthesis. The description of interventions in all study designs will be summarised narratively. Meta-analyses will be used to statistically summarise the effectiveness of interventions in randomised controlled trials and the factors that influence these. Other quantitative studies will be summarised narratively to answer the objectives. Thematic synthesis will be used to summarise results of qualitative studies. The outcomes of interest include pain, disability and quality of life. This paper is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guidelines.

ETHICS AND DISSEMINATION

Ethical clearance is not required. Findings will be presented at conferences and published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020189535.

Comparative Efficacy and Safety of Conservative Care for Pregnancy-Related Low Back Pain: A Systematic Review and Network Meta-analysis

OBJECTIVE

More than one-half of pregnant women experience pregnancy-related low back pain (LBP). Pregnancy-related LBP greatly affects activities of daily life, and although many interventions have been proposed, the optimal treatment for pregnancy-related LBP remains unclear. The purpose of this study was to compare conservative care strategies on their efficacy and safety for women with pregnancy-related LBP through systematic review with pairwise meta-analysis and network meta-analysis.

METHODS

MEDLINE, Embase, the Cochrane Library, AMED, CINAHL, PEDro, PsycINFO, and ClinicalTrials.gov were searched from inception to November 2019. Randomized controlled trials and observational controlled studies were included without restriction to language, sample size, or duration of follow-up. Two independent investigators extracted the data and assessed the risk of bias. The quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Twenty-three studies were included in the qualitative synthesis (18 randomized controlled trials were included in the network meta-analysis). For women with LBP during pregnancy, progressive muscle relaxation therapy (mean difference = -3.96; 95% CI = -7.19 to -0.74; moderate-quality evidence) and Kinesio Taping (mean difference = -3.71; 95% CI = -6.55 to -0.87; low-quality evidence) reduced pain intensity (Visual Analog Scale, range = 0 to 10) compared with placebo. Moderate-quality evidence suggested that transcutaneous electrical nerve stimulation improved physical function (mean difference = -6.33; 95% CI = -10.61 to -2.05; Roland Morris Disability Questionnaire, range = 0-24) compared with placebo.

CONCLUSION

For patients with LBP during pregnancy, progressive muscle relaxation therapy and Kinesio Taping may help to decrease pain, and transcutaneous electrical nerve stimulation may improve physical function.

IMPACT

This review helps fill the gap in evidence regarding optimal treatment for pregnancy-related LBP.

LAY SUMMARY

If you have LBP during pregnancy, your physical therapist has evidence to support the use of progressive muscle relaxation therapy and Kinesio Taping to help decrease pain and the use of transcutaneous electrical nerve stimulation to help improve physical function.

The Effectiveness of Non-Pharmaceutical Interventions Upon Pregnancy-Related Low Back Pain: A Systematic Review and Meta-Analysis

Introduction: Low back pain (LBP) is a very common pathology among pregnant women and various methods are used to reduce the pain. The aim of this study is to conduct an evidence-based systematic review and meta-analysis regarding the effectiveness of the interventions used to reduce low back pain related to pregnancy. 

Methods and materials: The PEDro database, PubMed, and Cochrane Library were searched from January 2012 until December 2020 as well as the reference lists from identified articles. Studies of any non-pharmaceutical treatment to decrease low back pain were included but only randomized controlled trials were selected. The articles found were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) question. Details about the type of intervention, sample size, outcome measures, results, and statistical significance were extracted from the selected studies. A meta-analysis for pain intensity was conducted and the I² index as well as x² test were used to determine the heterogeneity between studies. A random-effects meta-analysis was carried out. The aim was to compare the effectiveness between various methods and the typical care provided on low back pain during pregnancy. 

Results: From all the articles found in the mentioned databases only 13 studies met the criteria. In these studies, exercise, manipulation, ear acupuncture, Kinesio tape, transcutaneous electrical nerve stimulation (TENS), and neuroemotional technique were the interventions used. In the meta-analysis, six studies with 693 participants were included. The interventions were found to have in total a statistically significant effect on low back pain in comparison with the control group that included the typical care provided to pregnant women (95%CI: 0.08 (0.02,0.31), p<0,01) and they had a high heterogeneity (considerable, Tau² = 2.70; Chi² = 64.11, I² = 91%). Exercise and TENS were determined as more effective than the other types of interventions.

Conclusions: TENS and progressive muscle relaxation exercises accompanied by music were found to be the most effective interventions. Although exercise decreased LBP it was not found to have a statistically significant result even though it seems to improve the disability and quality of life of pregnant women. Osteopathic manual treatment (OMT), Kinesio tape, and ear acupuncture affected the lumbar pain intensity but the difference compared to typical care or sham treatment was not statistically significant, while yoga did not improve pregnancy-related LBP. Further research is needed to determine the effectiveness of the interventions mentioned. 

The effect of progressive muscle relaxation on the postpartum depression risk and general comfort levels in primiparas

In the postpartum period, mode of delivery, planned pregnancy, rapid changes in estrogen and progesterone hormone concentrations, quality of care, and environmental conditions affect the postpartum depression and comfort of the women. This study was conducted to evaluate the effect of progressive muscle relaxation (PMR) on the postpartum depression risk and general comfort levels in primiparas. A quasi-experimental design was used with pretest, post-test, and control group. The intervention and control groups consisted of 35 women each. PMR was applied to intervention group for 8 weeks. There was a statistically significant difference between Edinburgh Postnatal Depression Scale pretest and third follow-up scores of the intervention group (p < .05). There was a statistically significant difference between the intervention and control groups in the mean General Comfort Questionnaire scores at the first, second, and third follow-ups (p < .05). PMR may be effective on decreasing the postpartum depression risk and increasing general comfort. PMR could be administered through home visits to help women in postpartum period cope with their mental health problems after discharge.

Effects of Relaxation Techniques on Acute Postlaminectomy Pain: A Three-Arm Randomized Controlled Clinical Trial

PURPOSE

This study compared the effects of Benson relaxation with progressive muscle relaxation on pain severity after laminectomy.

DESIGN

Three-arm randomized, nonblinded, and parallel group trial.

METHODS

The study was conducted with 93 patients who underwent lumbar laminectomy. Patients were randomly assigned to three groups of Benson relaxation + routine care (n = 31), progressive muscle relaxation + routine care (n = 31), and routine care (n = 31). The two relaxation methods were performed at 2 (time 1), 12 (time 2), and 24 (time 3) hours after patients' regaining full consciousness in postoperative wards. Pain severity was assessed using the visual analog scale once before laminectomy, before and also 20 minutes after each relaxation session. In the control group, pain severity was measured at the same times as in the two relaxation groups.

FINDINGS

Both Benson relaxation and progressive muscle relaxation resulted in a significant reduction in pain severity in comparison with the control group at all three measurement times (except at time 1 in the progressive muscle relaxation group). However, no significant differences were found between Benson relaxation and progressive muscle relaxation in any of the three times.

CONCLUSIONS

The results suggest that both Benson and progressive muscle relaxation techniques can decrease acute postlaminectomy pain in the immediate postoperative period in adult patients.

The Effect of Progressive Muscle Relaxation Exercises on Pain on Patients with Sickle Cell Disease: Randomized Controlled Study

PURPOSE

The study aimed to evaluate the effect of progressive muscle relaxation exercises on pain in patients with sickle cell disease.

MATERIALS-METHOD

This randomized controlled interventional study was conducted in a hospital in Mersin, Turkey between October 2017 and July 2018. The study sample comprised 58 patients who were aged >18 years, conscious, had sickle cell disease, reported pain, and were treated with non-opioid or weak opioid analgesic based on the physician's recommendation (treatment group = 29, control group = 29). Data were collected by the individual presentation form and visual analog scale. During the study, both groups were treated with analgesics prescribed by the physician for three days. In addition to the analgesics, the treatment group was performed progressive muscle relaxation exercises for 30 minutes whereas the control group was rested. Pain level of both groups was evaluated at three time points every day for three days. In the study, frequency distributions and descriptive statistics were presented for categorical and numerical variables, respectively. Chi-square analysis, independent samples t-test, Mann-Whitney U test, three-way ANOVA, and Sidak test were used to analyze the difference between the variables.

RESULTS

The mean age of the patients was 29.59 ± 6.94 years, and 53.4% of the patients were female and 69% were single. The mean pain score of the treatment group at the third time point on days 1, 2, and 3 was significantly lower than the control group (p < .05). There was no statistically significant difference between the two groups in terms of coping methods for pain, pain location, and complaints accompanying pain (p > .05).

CONCLUSION

Progressive muscle relaxation exercises were found to be effective in the pain management of patients with sickle cell anemia.

International Fitness Scale-IFIS: Validity and association with health-related quality of life in pregnant women

This study aimed (a) to examine the construct validity of the International Fitness Scale (IFIS) to discriminate between different objectively measured physical fitness levels in pregnant women and (b) to assess the extent to which IFIS is able to discriminate between pregnant women with different levels of health-related quality of life (HRQoL). A total of 159 pregnant women were involved in the GESTAtion and FITness project: 106 pregnant women (mean age 32.7, SD 4.4 years) were included. Self-reported physical fitness-that is, cardiorespiratory fitness, muscular strength, flexibility, and overall fitness-was assessed with the IFIS. Physical fitness was objectively measured using the Bruce test, the handgrip strength test and the back-scratch test. The HRQoL was assessed with the 36-item Short Form Health Survey (SF-36). Higher self-reported physical fitness measured with IFIS was associated with higher objectively measured physical fitness (P < .05). There was a linear association so that higher self-reported physical fitness (ie, IFIS; regardless of the fitness component) was related to greater General Health dimension scores (P < .05). Moreover, higher self-reported physical fitness (all components except muscular strength) was associated with better Physical Functioning, lower Bodily Pain and higher Vitality scores (ie, SF-36 components). This linear trend was not seen for objectively measured physical fitness. The results of this study suggest that IFIS might be a useful tool for identifying pregnant women with low or very low physical fitness and with low quality of life health-related. Further research should elucidate whether IFIS can identify women with pregnancy complications before it can be implemented in clinical practice.

Enfermagem e a prática avançada da acupuntura para alívio da lombalgia gestacional

Resumo Objetivo Avaliar os efeitos da prática de acupuntura realizada no alívio da dor lombar em gestantes que se encontram no segundo e terceiro trimestre de gravidez, bem como na execução das atividades diárias. Métodos Estudo quase experimental, antes e depois, realizado com 56 gestantes com idade gestacional entre 14 e 37 semanas e queixa referida de dor lombar. Foram realizadas seis sessões de acupuntura, duas vezes por semana, com 30 minutos, cada uma, com a aplicação de pontos sistêmicos e auriculares. Para avaliação da dor utilizou-se a Escala Analógica Visual. Foram calculadas frequência absoluta e relativa para variáveis categóricas e média e desvio padrão para variáveis numéricas. Os testes utilizados para associação foram o Wilcoxon, para medidas pareadas, e teste de McNemar. Resultados Encontrou-se redução significante (p<0,05) dos escores do índice de dor. A média da dor diminuiu na avaliação da segunda (4,92), quarta (3,24) e sexta (1,00) sessão. Algumas mulheres tiveram sua dor cessada antes de completar as seis sessões e houve melhora nas atividades prejudicadas pela dor. Conclusão A acupuntura proporcionou efeitos favoráveis à saúde das participantes, pois houve redução na dor logo a partir da segunda sessão. Acredita-se que os enfermeiros possam rever a qualidade da assistência às gestantes, a partir do conhecimento de técnicas que contribuem a um cuidado integral, pois a enfermagem tem na sua essência o processo de cuidado holístico do cliente, visando suas necessidades, contribuindo para que suas ações, enquanto profissionais de Medicina Tradicional Chinesa, sejam realizadas de maneira qualificada, eficiente e humanizada.

Effectiveness of self-empowerment-affirmation-relaxation (Self-EAR) program for postpartum blues mothers: A randomize controlled trial

Background and Objecvites:

Approximately 55-85% of women worldwide have experienced postpartum blues (PPB) during 6-9 weeks after delivery without receiving the counseling program; more than 20% of them have developed into postpartum depression. Study objectives were to evaluate the effect of the Self-EAR program to improve the postpartum blues scores and serum allopregnanolone level among newly blues mothers.

Methods:

During June 2015 to May 2016, the randomized controlled trial was conducted among 76 Nulliparous blues mothers who were screened with Stein’s postpartum blues scores ≥ 3. All participants were randomly assigned either to the intervention group (Self-EAR program) and the control group (standard postpartum care program). The Self-EAR program was transformed into audio files which were installed in an MP3 digital device before providing it to the intervention group in order to be implemented at home three times per day for four weeks. Participants were assessed at baseline, 1-month, 2-month and 3-month follow-up for serum allopregnanolone level. Data were analyzed by using descriptive statistic, chi-square test, t-test, and repeated measure analysis of variance.

Result:

After the 3-month follow-up, the results revealed positive effects of the Self-EAR program on postpartum blues scores (p-value=0.002) and serum allopregnanolone concertation (p-value=0.001). The participants in the intervention group had experienced significantly lower postpartum blues scores; on the other hand, they had significantly higher serum allopregnanolone level when compared with the control group.

Conclusions:

The findings suggested that the Self-EAR program was effective to improve postpartum blues scores and allopregnanolone level among newly postpartum blues mothers.

The Effectiveness of Group Hope Therapy in Labor Pain and Mental Health of Pregnant Women

In the present study, the effect of group hope therapy on labor pain and mental health of pregnant women was investigated, in consideration of the Iranian health policy’s emphasis on encouraging women to have a healthy delivery. The research plan was a semiexperimental pretest–posttest design with a control group. A total of 36 pregnant women were assigned to the treatment and control group using a random procedure. General Health Questionnaire and a Visual Analog Scale were used to collect data about dependent variables. For the analysis of hypotheses, independent samples t test and covariance analysis were used. The findings showed that hope therapy had a significant effect on labor pain (t = 5.17; P < 0.001) and mental health (F = 28.21; P < 0.001). In general, the findings of the present study confirm the application of group hope therapy in relieving labor pain and increasing the mental health of pregnant women. This therapeutic approach can simultaneously reduce the labor pain, generate positive emotions in women, and turn the experience of delivery into a pleasant one.

Effect of telephone-supported ergonomic education on pregnancy-related low back pain

This study investigated the effect of telephone-supported ergonomic education on pregnancy-related low back pain. This study was performed at Trakya University Hospital in Edirne, Turkey between December 15, 2016 and April 4, 2017. One hundred ten pregnant women were included in the study and randomly assigned to one of two groups. Sixty pregnant women received one face-to-face session of ergonomic education followed by three weekly sessions of telephone-supported ergonomic education (intervention group). Fifty pregnant women received only one session of standard face-to-face ergonomic education. Before and after the intervention, low back pain was evaluated using the Visual Analog Scale. Pain-related disability was evaluated with the Oswestry Disability Index, and health-related quality of life was evaluated with the SF-36. Telephone-supported ergonomic education was more effective than standard ergonomic education and can be used as an effective solution for pregnancy-related low back pain.

The effectiveness of progressive muscle relaxation on the postpartum quality of life

PURPOSE

This study aimed to determine the effectiveness of progressive muscle relaxation (PMR) on the quality of life women during postpartum period.

METHODS

A quasi-experimental design was used. The participants consisted of primiparous women who had experienced a vaginal birth in the obstetrics department of a hospital. Thirty women in the intervention group and 30 women in the control group were included. Data were collected by questionnaire and Maternal Postpartum Quality of Life Questionnaire (MAPP-QoL) between June 2016 and April 2017. Progressive muscle relaxation were applied to the intervention group. PMR were performed as contracting a muscle group, then relaxing it, moving (or progressing) from one muscle group to another.

RESULTS

The mean pre-test and post-test scores of the MAPP-QoL in the intervention group were 24.43 ± 4.58 and 26.07 ± 4.58, respectively (t = -2.73, p < .05). The mean pre-test and post-test scores of the MAPP-QoL in the control group were 23.29 ± 4.37 and 21.99 ± 5.58, respectively (t = 2.23, p < .05). The difference between the mean scores of the women in the intervention and control groups before PMR was not statistically significant (t = 0.99, p > .05), whereas the difference between the groups after PMR was found to be statistically significant (t = 3.09, p < .05.

CONCLUSIONS

Postpartum quality of life of women was increased after PMR. Progressive muscle relaxation should be taught to women who are admitted to obstetrics and outpatient clinics, that home visits be completed in order to expand the use of PMR.

Comparing the Effects of Progressive Muscle Relaxation and Physical Activity on Pregnant Women's General Health

Background:

Pregnancy is important because maternal health and well-being directly affects another person's life. This study aimed to compare the effects of progressive muscle relaxation (PMR) and physical activity (PA) on the general health of pregnant women.

Materials and Methods:

This randomized clinical trial was conducted among 96 primiparous women enrolled in a prenatal clinic in Tehran (Iran) between May 3, 2013 and August 7, 2013. The participants were selected through convenience sampling over 3 weeks and randomly assigned to the PMR, PA, and control groups, comprising 32 participants each. Six participants did not complete the follow-up measurement (N = 90). The PMR group underwent three sessions of 1.5–2 h in theoretical and practical training, and in the PMR group, training was given in groups of three to four persons. Both groups performed exercises at home for 8 weeks and recorded them in daily report sheets. The general health of all three groups was assessed before and after intervention by using the General Health Questionnaire-28.

Results:

Differences in the mean (SD) general health scores obtained before and after intervention in the PMR, PA, and control groups were 15.63 (5.73), 19.11 (7.79), and 8.27 (2.14), respectively. One-way analysis of variance test showed a significant difference between the three groups (F = 28.10; p < 0.001).

Conclusions:

As the study results confirm the positive effects of PMR and PA on the subscales of the general health of pregnant women, the two techniques are recommended to promote the general health of pregnant women.

Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors

OBJECTIVES

To investigate the prevalence of pregnancy-related low back pain (PRLBP) in women in Turkey, identify the factors associated with PRLBP and predict the risk of PRLBP.

MATERIALS AND METHODS

This cross-sectional study included a total of 1500 pregnant women admitted to a prenatal care clinic in a secondary care hospital in Turkey between August 2011 and September 2014. All participants were asked to complete a survey questionnaire. The pregnant women who reported recurrent or continuous pain in the lumbar spine or pelvis for more than 1 week were offered a clinical examination for PRLBP by the spine physiatrist. The main outcome measure was the presence of PRLBP. We collected data on sociodemographic factors, previous obstetric history, daily habits, history of LBP, and functional disability scores as assessed by the Oswestry Disability Index (ODI).

RESULTS

The mean age of the 1500 women was 26.5±5.5 years. The prevalence of PRLBP was 53.9%, mostly in the third trimester. Women with PRLBP in the third trimester were more disabled than those in the first and second trimesters (mean ODI 40.0±16.7 vs. 34.9±19.2 and 37.4±15.3, respectively). Risk factors of PRLBP were history of LBP, PRLBP, and menstruation-related LBP as well as no housework assistance (OR=5.394, 95% CI: 3.128-9.300, P<0.001; 3.692, 2.745-4.964, P<0.001; 2.141, 1.563-2.932, P<0.001; 1.300, 1.029-1.64, P=0.028, respectively).

CONCLUSION

This cross-sectional study is the largest study of PRLBP in the literature and showed that about 1 in 2 women have PRLBP in any stage of pregnancy. History of LBP related and unrelated to previous pregnancy and menstruation are strong risk factors for PRLBP. Receiving no housework assistance is another risk factor.

Contribution of Benson's Relaxation Technique and Brief Psycho-Educational Intervention on Quality of Life of Primary Caregivers of Iranian Children with Chronic Diseases

BACKGROUND

Chronic diseases leave a significant effect on not only the afflicted children but also their parents. Chronic diseases in children may also influence their parents' or primary caregivers' quality of life (QoL).

OBJECTIVE

To determine the effectiveness of a Brief Psycho-educational Intervention (BPI) and Benson's Relaxation Technique (BRT) on the QoL of primary caregivers of children with chronic diseases.

METHODS

The present quasi-experimental pre-test post-test design was conducted on 100 parents with children who had one chronic disease (50 in each of the control and intervention groups) and were admitted to two state-run pediatric hospitals in Tehran, Iran in 2014. The primary caregivers' QoL was assessed using the SF-36 questionnaire before (T1) and four weeks after the intervention (T2). The training was done in four 60-70minute sessions over one week with a 4-week follow-up. Paired t-test, independent t-test, chi-square and Fisher's exact tests were used to analyze the data.

RESULTS

On average, large effect sizes (ES≥0.80) were observed after interventions in SF-36 subscales that measured the effect of emotional roles. Small (0.20-0.49) to moderate (0.50-0.79) ESs were found in subscales measuring physical functioning, physical-role, bodily pain, vitality, social functioning and mental health. General health scores remained relatively unchanged at T2.

CONCLUSION

These results suggested that BPI and BRT were effective strategies to improve the QoL of primary caregivers. Furthermore, interventions with low cost, and good safety and outcome could improve the QoL of primary caregivers of children with chronic diseases.

Evaluation of the quality of life of pregnant women from 2005 to 2015

Over the past two decades, quality of life has become an essential preoccupation in the care of patients. Many measuring instruments are available to assess physical, psychological and social quality of life. These tools allow healthcare professionals to determine the best quality of their patients. However, the quality of life for the pregnant woman seems to be little studied. This article presents the results of a bibliographic review of publications between 2005 and 2015 - referenced in PUBMED and COCHRANE - on the quality of life of pregnant women giving birth after the 22nd week of amenorrhea. The articles were selected by a reading committee. 195 publications responding to keywords were identified. 75 articles on the problem were selected. The main countries that have published on this subject are Iran (n=11) and Brazil (n=9). France ranks 17th with only one publication. 74% of articles deal with quality of life for pathological pregnancies (gestational or pre-existing pathologies). 23 pathologies were identified, mainly depression (20% of items). This review reveals a growing global interest in quality of life in pregnant women. However, few studies evaluate the impact of care in terms of quality of life in pregnant women, contrary to the recommendations of different health authorities. Finally, the analysis of the various articles shows that, in general, few measurements are made to evaluate the quality of life, not requiring a standardized curve of quality of life during pregnancy. There is thus a significant lack of data to establish a standardized curve for the quality of life of pregnant women, which allows a simple comparison of quality of life measures according to the different clinical management.

Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review

Abstract Introduction: During pregnancy, a woman’s body goes through many changes, and lower back and pelvic pain are common and may persist after pregnancy. Although the literature point physical therapy as an effective therapeutic tool, there are few studies on the effects of physical therapy intervention through exercises for this purpose. Objective: To perform a systematic review on the use of Physiotherapy, through therapeutic exercises, for the prevention and treatment of pregnancy low back and pelvic pain. Methods: A systematic search for randomized trials (RCTs) was conducted on the databases PubMed, PEDro, Cochrane, EMBASE, LILACS and Periódicos Capes. There was no date or language restriction. The terms included in the search were: “pregnancy”, “low back pain”, “pelvic pain”, “exercise therapy” and their descriptors in Portuguese. Methodological quality was assessed using the PEDro scale and a descriptive analysis of the studies was performed. Results: Eight studies, including 1781 pregnant women, were selected. Among them, one study addressed the issue of low back pain, two focused on pelvic pain and five on low back and/or pelvic pain. Seven studies presented high methodological quality, and only one study had low methodological quality. Limited evidence on low back pain was found, and conflicting evidence on pelvic pain, and low and/or pelvic pain. Conclusion: RCTs on the subject are scarce and heterogeneous, making it impossible to reach a consensus or any conclusions about which protocol of therapeutic exercise is more effective in the use of physiotherapy for pregnancy low back and pelvic pain.

The effect of progressive muscle relaxation on pregnant women's general health

Background:

Pregnancy may be accompanied by serious physiological and psychological changes as it is a stressful period in a woman's life. So, this study was conducted to determine the effect of progressive muscle relaxation on pregnant women's general health.

Materials and Methods:

In this clinical trial, 60 primigravida women admitted to the prenatal clinic of selected hospitals in Iran constituted the study population. Using purposive sampling method, the level of general health of the women was measured with General Health Questionnaire-28 (GHQ-28). Then, the samples were randomly divided into control and experimental groups. Three 1.5–2 h relaxation training sessions were held for the experimental group. After 8 weeks, the level of general health of both groups was measured again. Finally, the collected data were analyzed using Chi-square and paired t-test (P < 0.05).

Results:

Total mean score of general health of the experimental group and the control group before the intervention was 35.83 (6.92) and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and 27.85 (8.24). Although after the intervention both groups showed an increased level of general health, the difference in general health between before and after intervention was significant in the experimental group (P < 0.001). Furthermore, comparison of variations in mean scores of general health level before and after intervention in the two groups showed a significant difference (P < 0.001).

Conclusions:

Given that the results showed the effectiveness of progressive muscle relaxation on pregnant women's general health, the prenatal clinics can include a training program for progressive muscle relaxation in the routine training programs for pregnant women.

Perinatal Music Therapy and Antenatal Music Classes: Principles, Mechanisms, and Benefits

Antenatal music activities are in the ascendant. Regarding evidence-based research, the article advocates 5 main aims: music therapeutic control of pre- and perinatal stress, anxiety, and depression; music-related mental and physical birth preparation comprising cognitive adjustment, emotional regulation, physical activity, relaxation and pain management, and social inclusion; music-associated bonding and self-efficacy; prenatal sound stimulation to trigger learning processes, pedagogical priming and brain maturation; music activities to facilitate the child's acculturation and adaptive self-regulation. Underlying mechanisms such as neuroplasticity help to understand the multifaceted effects of music in pre- and perinatal care. Individual conditions and features of the mother and her child have to be taken into account and music interventions to be harmonized with complementary perinatal programs.

Interventions for preventing and treating low-back and pelvic pain during pregnancy

BACKGROUND

More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep.

OBJECTIVES

To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS

We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks' gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians' interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back painResults from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic painResults from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic painResults from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient.

AUTHORS' CONCLUSIONS

There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

[Low back pain during pregnancy. Multidisciplinary approach]

After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.

Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities

OBJECTIVE

To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain.

MATERIAL AND METHODS

Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain.

RESULTS

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

CONCLUSIONS

The levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.