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Johnson F, Frygner Holm S, Hess Engström A. Experiences of digital physiotherapy during pregnancy and after childbirth: A qualitative study. Internet Interv 2024; 38:100768. [PMID: 39262406 PMCID: PMC11388370 DOI: 10.1016/j.invent.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
Background Pelvic girdle pain, low back pain, and pelvic floor dysfunction can affect women's mobility, quality of life, and well-being during pregnancy and the postpartum period. Digital interventions for treating perinatal depression and lifestyle changes have been studied. Research on digital physiotherapy for musculoskeletal issues related to pregnancy and the postpartum period is sparse. Methods This qualitative study involved in-depth, semi-structured interviews with 19 participants, of whom six were pregnant and 13 had given birth. Participants were recruited from a private clinic in Sweden through convenience sampling and had received digital physiotherapy prior to the interviews. An interview guide with questions exploring participants' experiences of digital physiotherapy, including its impact on musculoskeletal issues and daily life, and their motivation for seeking digital healthcare was used. Data were analyzed using a qualitative content analysis with an inductive approach. Results The analysis resulted in two main categories: Finding a new way into physiotherapy treatment and Personalized progress through tailored physiotherapy. These main categories encompassed four generic categories: Convenience and dissatisfaction motivators for digital physiotherapy, A dual experience - appreciated but not always comprehensive, Being involved in the rehabilitation process, and Perceived physical and mental improvements after digital physiotherapy. Conclusion Digital physiotherapy was well-accepted and perceived as beneficial for managing musculoskeletal symptoms during pregnancy and after childbirth. High accessibility and flexibility were considered advantages. However, inability to undergo a physical assessment was a challenge. Digital physiotherapy may be recommended as a complement to usual care, particularly for women with limited access to a physiotherapist specialized in women's health. Future studies exploring digital physiotherapy's efficacy for musculoskeletal issues during pregnancy and after childbirth are highly recommended.
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Affiliation(s)
- Frida Johnson
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - Sara Frygner Holm
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - Andrea Hess Engström
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
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2
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Blanco R, Ansari T. Transitional pain services updates and a novel service for the obstetric population. Curr Opin Anaesthesiol 2024; 37:513-519. [PMID: 39087394 DOI: 10.1097/aco.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF REVIEW This paper is an update of the publications on Transitional Pain Services and explores the viability of a dedicated transitional pain service for women. RECENT FINDINGS We address common pain pathologies establishing referral criteria, pathways, and effective strategies to decrease chronification of pain during pregnancy. SUMMARY This review highlights the importance establishing transitional pain service models at every institution and in particular in obstetric population as pain is normalized by Society during pregnancy.
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Affiliation(s)
- Rafael Blanco
- Anesthesiology Department, Pain Division, Corniche Hospital, Abu Dhabi, UAE
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Adane HA, Iles R, Boyle JA, Collie A. Do current policies reflect current evidence on the relationship between occupational risks and preterm birth, and are they consistent? A policy content analysis. Public Health 2024; 235:84-93. [PMID: 39084047 DOI: 10.1016/j.puhe.2024.07.001] [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: 04/18/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Preterm birth is a leading cause of neonatal mortality and the second-leading cause of death among children under five worldwide. Recent systematic reviews have demonstrated an increased risk of preterm birth in women exposed to workplace physical and psychosocial risks during pregnancy. The extent to which this evidence is reflected in policy remains unclear. This study aimed to determine the extent to which current policies reflect the current evidence regarding the association between occupational risks and preterm birth. STUDY DESIGN Policy content analysis. METHODS This study used a three-step search strategy: searching electronic databases (Embase and Scopus), policy databases (Overton, Dimension, and Google Advanced), and websites of global and national agencies/organisations focused on occupational or women's health policies. Data were analysed through descriptive and interpretive content analyses. Eligible documents were publicly available in full text, published from 2000 onwards by credible sources, and written in English. RESULTS Thirteen eligible policy documents were identified. Of these, eight concluded that the evidence for the relationship between occupational risks and preterm birth was inconclusive. The remaining five documents report that occupational risks may be associated with an increased risk of preterm birth. Nine documents offered recommendations to address this risk. These included four recommending job redesign, two information/education, and three a combination of job redesign, job transfer, information/education, and changes to workplace policy. Three were developed by a multidisciplinary stakeholder group, six by a multidisciplinary clinical group, and four by unidisciplinary clinicians. CONCLUSIONS Most current policies partially reflect the current evidence on the relationship between occupational risks and preterm birth. Development of most policy documents did not use rigorous methods and did not involve multidisciplinary stakeholder groups. There is an urgent need for the development of evidence-based policies grounded in robust research methods.
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Affiliation(s)
- H A Adane
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - R Iles
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J A Boyle
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - A Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Halliday B, Chatfield S, Hosking J, Freeman J. The prevalence of depression in women with pregnancy-related pelvic girdle pain: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2308. [PMID: 39144405 PMCID: PMC11322010 DOI: 10.1002/hsr2.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/14/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
Background and Aims Pregnancy-related pelvic girdle pain (PPGP) is estimated to affect between 20% and 70% of pregnant women with 10% experiencing it for more than 3 months postpartum. Women may also experience depression during this period. Understanding the prevalence of depression in women with PPGP is important to inform clinical management. This systematic review aimed to examine the prevalence of depression in women with PPGP in the antepartum and postpartum periods. Methods A systematic review and meta-analysis. Seven databases were searched from inception until May 24, 2023, combining keywords relating to pelvic girdle pain (PGP), depression, and pregnancy. Two investigators independently screened study titles and abstracts against the eligibility criteria, extracting data characteristics of all included studies. Included articles were assessed for risk of bias. Summary estimates of the prevalence of depression were calculated with a random effects meta-analysis (stratified by antepartum and postpartum periods). Results Eleven studies (3172 participants) were included with nine suitable for meta-analysis. The overall summary estimate of prevalence of depression among women with PPGP was 24% (95% confidence interval [CI] = 15%-37%), with significant heterogeneity between studies (I 2 = 97%, p < 0.01). Among individual studies, the estimates ranged from 18% to 48% in the antepartum PGP population and from 5% to 39% in the postpartum PGP population. The summary estimate in the antepartum group was 37% (95% CI = 19%-59%; prediction interval 8%-81%) and 15% (95% CI = 7%-30%; prediction interval 3%-56%) in the postpartum group, although time (antepartum vs. postpartum) did not have a statistically significant moderating effect (p = 0.06). Two thirds of the studies were undertaken with Scandinavian populations, limiting the generalizability of these findings. Conclusion Summary estimates for the prevalence of depression in women with PPGP are similar to previous studies investigating depression in the general peri-natal population.
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Chua SC, Wu MH, Kuo YL, Lin KY, Tsai YJ. Altered Abdominal Muscle Recruitment and Declined Physical Function in Postpartum Individuals With Pregnancy-Related Pelvic Girdle Pain: A Matched Case-Control Study. J Midwifery Womens Health 2024. [PMID: 39044446 DOI: 10.1111/jmwh.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/13/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION The influence of pregnancy-related pelvic girdle pain (PPGP) on lumbopelvic muscles has not been comprehensively examined in postpartum individuals. Previous research also presented self-reported activity limitations without objective measures. METHODS Thirty postpartum individuals with PPGP (PPGP group) and 30 age-, parity-, and postpartum duration-matched asymptomatic individuals (healthy group) were recruited. Transabdominal ultrasonography was used to measure muscle thickness or activation changes of the external oblique (EO), internal oblique (IO), transverse abdominals, lumbar multifidus, and pelvic floor muscles (PFMs) during rest and while performing the active straight leg raise (ASLR). Muscle changes were compared separately in the painful and nonpainful sides between the PPGP and health control group. Physical function was assessed using the ASLR fatigue (ASLRF), timed up-and-go, and 6-m walking (6MW) tests. RESULTS The PPGP group had greater thickening changes in the bilateral IO during ASLR compared with the healthy group (nonpainful side, 16.34 vs 3.52 mm; P = .010; painful side, 18.83 vs 6.60 mm; P = .02) but became thinner in the EO (nonpainful side, -2.19 vs 19.97 mm; P < .001; painful side, -5.97 vs 21.43 mm; P < .001). Thicker IO and EO on the nonpainful side (IO, 6.60 vs 5.78 mm; P = .004; EO, 5.37 vs 4.54 mm; P = .011) and a lower bladder base (indication of PFMs) (91.87 vs 78.61 mm; P = .002) during rest were also observed in the PPGP group. Furthermore, the performance of the ASLRF and 6MW tests was poorer in the PPGP than in the healthy group (ASLRF nonpainful side, 82.36 vs 59.09 sec; P = .01; painful side, 75.73 vs 59.26 sec; P = .04; 6MW, 3.48 vs 3.17 sec; P = .02). DISCUSSION Postpartum individuals with PPGP demonstrated altered abdominal muscle recruitment strategies during loading tasks, with objectively impaired physical functions. These findings are critical for developing effective muscle training interventions for PPGP.
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Affiliation(s)
- Sze Chee Chua
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Hsing Wu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Liang Kuo
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Yin Lin
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kiil RM, Weber U, Jurik AG. Magnetic Resonance Imaging Topography of Bone Marrow Edema in the Sacroiliac Joint of Postpartum Women. ACR Open Rheumatol 2024. [PMID: 38943255 DOI: 10.1002/acr2.11707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE A traditional monoplanar semicoronal and a biplanar magnetic resonance imaging (MRI) assessment method were used to compare the topographical distribution of postpartum strain-related bone marrow edema (BME) at the sacroiliac joint (SIJ). METHODS The presence and topographical location of SIJ BME were assessed independently by three readers in 71 women 12 months postpartum. A traditional monoplanar semicoronal and a biplanar BME evaluation by 8 (upper and lower) and 12 joint (upper, middle, and lower) regions, respectively, was performed with >4 weeks between the two assessments. Descriptive results were reported as mean ± SD and ranges, and interreader agreement by intraclass correlation coefficient (ICC). RESULTS By semicoronal assessment, 38 (53.5%) women had BME with a mean ± SD SPARCC score of 2.3 ± 4.0 (range 0-22; ICC 0.93, 95% confidence interval [CI] 0.92-0.94). Forty-one (57.8%) had BME by biplanar assessment with a mean ± SD sum score of 2.9 ± 5.8 (range 0-32.7; ICC 0.89, 95% CI 0.88-0.91). By semicoronal assessment, the highest frequency and mean SPARCC scores were in the anterior upper regions of ilium (24%, mean 0.6) and sacrum (21%, mean 0.3) followed by the posterior upper sacral (20%, mean 0.4) and posterior lower iliac (20%, mean 0.3) regions. By biplanar assessment, the anterior middle joint regions had highest BME frequency and sum scores, sacral side (32%, mean 1.9) and iliac side (27%, mean 2.0), respectively; frequencies and sum scores were generally higher in the anterior compared to the posterior joint regions. CONCLUSION The 12-region biplanar assessment revealed a predominantly anterior middle location of postpartum SIJ BME whereas the 8-region monoplanar approach did not demarcate distinct strain-prone SIJ regions. Complementing traditional monoplanar semicoronal SIJ MRI evaluation by a semiaxial assessment may facilitate discrimination of strain-related conditions from early axial spondyloarthritis.
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González-Muñoz A, Pruimboom L, Navarro-Ledesma S. The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:591. [PMID: 38674236 PMCID: PMC11052353 DOI: 10.3390/medicina60040591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.
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Affiliation(s)
- Ana González-Muñoz
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071 Granada, Spain
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
| | - Leo Pruimboom
- Chair in Clinical Psychoneuroimmunology, Faculty of Health Sciences, Campus of Melilla, University of Granada and PNI Europe, 2518 JP The Hague, The Netherlands; (L.P.); (S.N.-L.)
| | - Santiago Navarro-Ledesma
- Chair in Clinical Psychoneuroimmunology, Faculty of Health Sciences, Campus of Melilla, University of Granada and PNI Europe, 2518 JP The Hague, The Netherlands; (L.P.); (S.N.-L.)
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
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Li W, Cheng H, Wu L, Wu H, Deng Y. Characteristics and effects on daily lives of pelvic girdle pain during early postpartum in Beijing women, China. Women Health 2024; 64:330-340. [PMID: 38556776 DOI: 10.1080/03630242.2024.2334691] [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: 11/28/2022] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
Pelvic girdle pain (PGP) is a common problem during pregnancy and postpartum and negatively affects women's well-being. Yet it is not well known in China. This study assessed PGP's intensity, location, and quality and the status of daily activities on postpartum women with pain, and explored the relationship between pain and the prevalence of depressive symptoms. A cross-sectional study recruiting 1,038 eligible women at 6 weeks postpartum from the obstetric clinic of a hospital was conducted in Beijing, China. Data were collected using self-reported questionnaires, including Introductory information form, Body chart, Number Rating Scale, McGill Pain Questionnaire-2, Pelvic Girdle Questionnaire, and Edinburgh Postnatal Depression Scale. In this study, 32.2 percent women experienced pain. The mean (SD) pain intensity score was 3.07 ± 1.60. About 50.6 percent women experienced sacroiliac joint pain, and 25.5 percent women experienced pain in a combination of locations. About 73.1 percent women experienced aching pain, and 57.5 percent experienced more than one kind of pain quality. The mean total score, which assesses activity and symptom limitations, was 21.93 ± 17.35 (percent), of which a normal sex life (1.29 ± 0.94) was made more challenging due to pain. In mental health, the prevalence of depressive symptoms coincided with the prevalence of pain (p = 0.008). Postpartum PGP still needs to be taken seriously, and women with pain require further support. The above knowledge offers information to manage pain, daily lives and depressive symptoms, contributes to think about strategies to better promote postpartum women physical and mental health in the future.
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Affiliation(s)
- Weitao Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Cheng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Liping Wu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huiling Wu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yafang Deng
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Buin L, Joaquim RHVT, Strong J, Robinson K. The Experience of Pregnancy-Related Lumbopelvic Pain: A Qualitative Evidence Synthesis. Can J Occup Ther 2024; 91:29-43. [PMID: 37170547 DOI: 10.1177/00084174231172037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background. Pregnancy-related lumbopelvic pain is common and can impact quality of life. Purpose. To synthesize existing qualitative research on people's experiences of pregnancy-related lumbopelvic pain in pregnancy and during the postpartum period. Method. A keyword search of four electronic databases between 2000 and 2022 was completed. Included studies were appraised and synthesized using a meta-ethnographic approach. Findings. Twenty-three studies were included. Analysis identified four core themes: (1) uncertainties about pregnancy-related lumbopelvic pain, (2) struggles to attain achieve treatment and pain management, (3) profound activity consequences, and (4) emotional wellbeing, relationship, and identity impacts of pregnancy-related lumbopelvic pain. Implications. The occupational therapy role with this population has not to our knowledge yet been described. Given the centrality of occupational disruption to the experience of this population we argue that developing and evaluating occupational therapy interventions to address functional, work, parenting and wellbeing outcomes for this population is warranted and should be prioritized.
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Lan Q, Fu ACL, McKay MJ, Simic M, Castrillon CM, Wei Y, Ferreira P. The association between musculoskeletal pain during pregnancy and pregnancy outcomes: A systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol 2024; 294:180-190. [PMID: 38286038 DOI: 10.1016/j.ejogrb.2024.01.027] [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: 07/03/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To systematically investigate the association between musculoskeletal pain during pregnancy and birth outcomes including caesarean section, newborn birthweight, newborn birth length, and gestational age at birth. METHODS Medline, Embase, Web of Science, Cinahl and Scopus were systematically searched to identify eligible studies. Odds ratios, mean differences, and confidence intervals were used to describe results. Risk of Bias was assessed using the Newcastle-Ottawa Scale for observational studies. GRADE (The Grading of Recommendation Assessment, Development, and Evaluation) was used to assess the quality of each outcome. RESULTS Seven studies were included with a total population of 85,991 participants. There is low- quality evidence that pregnant women with musculoskeletal pain had 1.59 greater odds to experience delivery by caesarean section compared to those without musculoskeletal pain ([OR] 1.59, 95 % confidence interval [CI] 1.09 to 2.31). Both newborn birth weight (Mean Difference [MD] 77.79 g, 95 % [CI] -23.09 to 178.67) and newborn birth length ([MD] 0.55 cm, 95 % [CI] -0.47 to 1.56) were not affected by musculoskeletal pain, with very low-quality and low-quality evidence, respectively. There was moderate evidence that pregnant women with musculoskeletal pain had shorter gestational age (weeks), although the effect was small and possibly not clinically relevant ([MD] -0.41, 95 % [CI] -0.41 to -0.07). CONCLUSION Pregnant women experiencing musculoskeletal pain are at greater odds of delivering their babies via caesarean than those without musculoskeletal pain, however, musculoskeletal pain during pregnancy does not appear to affect newborn birth weight, length, or gestational age at birth.
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Affiliation(s)
- Qianwen Lan
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Allan Chak Lun Fu
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Marnee J McKay
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Carlos Mesa Castrillon
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Yuanye Wei
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, China.
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
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Xu L, Li Y, He Y, Chen M, Zhang Y, Liu C, Zhang L. Knowledge Mapping Analysis of Research on Pregnancy-Related Pelvic Girdle Pain (PPGP) from 2002 to 2022 Using Bibliometrics. J Pain Res 2024; 17:643-666. [PMID: 38371481 PMCID: PMC10874224 DOI: 10.2147/jpr.s431438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Background Pregnancy-related Pelvic Girdle Pain (PPGP) is a prevalent condition characterized by various physiological and pathological processes in the female body. The objective of this study is to offer a comprehensive understanding of the current research landscape, key areas of interest, and potential future directions in the field of PPGP. Methods Using Web of Science, we explored PPGP literature from 2002 to 2022. VOSviewer and CiteSpace facilitated a quantitative analysis, revealing co-authorship patterns, co-occurring themes, citations, and co-citations. Results We identified, peaking at 99 publications in 2021. The United States led with 138 publications and the highest citation count (3160). The Karolinska Institute boasted the highest tally of publications (n = 21). Regarding the volume of publications, the esteemed journal of BMC Pregnancy and Childbirth attained the foremost position. Notably, Gutke, Annelie emerged as the most prolific and highly cited author. The analysis of keyword co-occurrence and co-citation clustering unveiled an intricate tapestry of PPGP studies, spanning various domains including risk factors, mechanistic intricacies, diagnostic benchmark, treatment modalities, and far-reaching ramifications on one's quality of life. Conclusion Research endeavors exploring PPGP have unveiled an enduring trajectory of growth in contemporary times. The existing body of research primarily focuses on delving into the intricate interplay of epidemiological factors and the profound implications of interventions encompassing physical therapy, exercise protocols, and diverse modes of pain management within the domain of PPGP. Multidisciplinary integration encapsulates a prevailing trajectory of progress within this domain, while the focal point of future inquiries into PPGP may revolve around subjects pertaining to standardized outcome reporting.
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Affiliation(s)
- Linli Xu
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuanchao Li
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yanan He
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mengtong Chen
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuting Zhang
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Chunlong Liu
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Li Zhang
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People’s Republic of China
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Burani E, Marruganti S, Giglioni G, Bonetti F, Ceron D, Cozzi Lepri A. Predictive Factors for Pregnancy-Related Persistent Pelvic Girdle Pain (PPGP): A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2123. [PMID: 38138226 PMCID: PMC10744457 DOI: 10.3390/medicina59122123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). Methods: Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. Data sources: The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). Study appraisal and risk of bias: Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. Synthesis of results: An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. Results: The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. Discussion: The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets.
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Affiliation(s)
- Elisa Burani
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Kura” Clinic, 53047 Siena, Italy
| | - Sharon Marruganti
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Asl Sud-Est, Department of Rehabilitation, Valdichiana Senese, 53045 Siena, Italy
| | - Gloria Giglioni
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Asl Roma 3, Department of Rehabilitation, 00122 Rome, Italy
| | - Francesca Bonetti
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Physioup” Clinic, 00142 Rome, Italy
| | - Daniele Ceron
- Musculoskeletal and Rheumatological Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00142 Rome, Italy; (E.B.); (S.M.); (G.G.); (D.C.)
- Private Practice “Riabilita” Clinic, 35030 Padova, Italy
| | - Alessandro Cozzi Lepri
- Medical Statistics and Epidemiology, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, London NW3 2PF, UK;
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Inoue-Hirakawa T, Iguchi S, Matsumoto D, Kajiwara Y, Aoyama T, Kawabe R, Sugiura H, Uchiyama Y. Gap between the prevalence of and consultation rate for lumbopelvic pain in postnatal Japanese women. J Orthop Sci 2023:S0949-2658(23)00278-6. [PMID: 37926616 DOI: 10.1016/j.jos.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/16/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND We aimed to assess the prevalence of lumbopelvic pain (LPP), including low back pain (LBP) and/or pelvic girdle pain (PGP), consultation rate, and desire for treatment of postnatal Japanese women. METHODS We performed a cross-sectional study of 98 postnatal Japanese women within 1 year of childbirth. We retrospectively evaluated the prevalence of LBP before and during pregnancy and the prevalence of LPP after childbirth using a self-administered questionnaire. We used the distribution of pain to differentiate LBP and/or PGP after childbirth and its intensity was assessed using a visual analogue scale. The effects of LPP on daily life were assessed using the Oswestry disability index (ODI). In addition, we assessed the consultation rate for LPP and the desire to consult a healthcare professional, using self-administered questionnaires. RESULTS The prevalence of LPP after childbirth was 66%. Women with a history of LBP before and during pregnancy were more likely to have LPP following childbirth (both P < 0.001). The consultation rate among the postnatal women with LPP was 9%, but 56% of the women wished to consult a healthcare professional. The ODI score was significantly higher in postnatal women who wanted to consult a healthcare professional than in those who did not (P < 0.01). CONCLUSIONS Two thirds of the postnatal Japanese women who participated in this study had LPP, but the consultation rate was low. However, more than half of these women had the desire to consult a healthcare professional.
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Affiliation(s)
- Tomoe Inoue-Hirakawa
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Saki Iguchi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan; Faculty of Medicine, Oita University, Oita, Japan
| | - Daisuke Matsumoto
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Koryo, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Koryo, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rika Kawabe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Uchiyama
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Starzec-Proserpio M, Vandyken C. Telerehabilitation for persistent Pelvic Girdle Pain within a biopsychosocial framework - A case report. Physiother Theory Pract 2023; 39:2251-2261. [PMID: 35481796 DOI: 10.1080/09593985.2022.2069618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Persistent pregnancy-related pelvic girdle pain (PGP) and the resulting consequences may considerably influence a woman's quality of life. The complexity of this condition requires a whole-person centered approach. In response to COVID-19 outbreak, telerehabilitation has emerged as a promising alternative to traditional in-person visits. PURPOSE The aim of this report was to present the potential of telerehabilitation for persistent postpartum PGP within the biopsychosocial framework. CASE DESCRIPTION A 26-year-old female presented with persistent pregnancy-related PGP of 8 months duration after her first vaginal delivery. The video-consults were performed using telerehabilitation platform. The patient received six telerehabilitation consults of 45 min duration over five weeks. Assessment of physical and psychosocial factors, cognitively focused strategies including pain neurophysiology education, sensory-motor remapping exercises, and graded increase of activity were administered. Rehabilitation was divided into the following phases: assessment, desensitization, graded exposure, and supported independence. OUTCOMES The Pelvic Girdle Questionnaire (PGQ) score was significantly reduced from 72.2 during the assessment to 15.3 at discharge. This change was significantly more substantial than the minimal clinically important change estimated for the PGQ. CONCLUSION Physiotherapists can utilize telerehabilitation to assist them with enacting appropriate care measures for persistent PGP within a biopsychosocial framework.
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Bernard-Giglio M, French SD, Myburgh C, de Luca K. Drivers, barriers, and response to care of Australian pregnant women seeking chiropractic care for low back and pelvic girdle pain: a qualitative case study. Chiropr Man Therap 2023; 31:43. [PMID: 37789336 PMCID: PMC10546639 DOI: 10.1186/s12998-023-00516-x] [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: 09/03/2022] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Pregnancy-related low back and/or pelvic girdle pain is common, with a prevalence rate of up to 86% in pregnant women. Although 19.5% of Australian pregnant women visit a chiropractor for pelvic girdle pain, little is known about the experience of pregnant women who seek this care. The aim of this study was to describe and explore the experiences of Australian pregnant women who seek chiropractic care for their current pregnancy-related low back and/or pelvic girdle pain. METHODS A qualitative case study approach with purposive sampling from 27 chiropractic practices was used. A grounded theory approach was informed by a constructivist and interpretivist stance, which provided understanding and meaning to the pregnant women's experiences. Online unstructured interviews were recorded, transcribed, and anonymised. A thematic analysis was subsequently conducted on the primary data. Codes and major themes were developed with the use of critical self- reflection (memos), survey finding triangulation and respondent validation. RESULTS Sixteen potential respondents expressed interest in participating. After eligibility screening and data saturation, nine interviews were undertaken. Four key themes were identified: "Care drivers: what drives care seeking?", "Care barriers: what barriers are encountered?", "Chiropractic treatment: what does treatment consist of?" and "Response to care: what response was there to care?". CONCLUSION Four key themes: care drivers, care barriers, chiropractic treatment, and response to care support an emergent substantive-level theory in women's care seeking experiences for pregnancy-related back pain and chiropractic care. This theory is that chiropractic care for pregnant women experiencing low back pain and pelvic girdle pain may improve pain and function, while reducing pregnancy-related biopsychosocial concerns. The findings may inform antenatal health providers and the chiropractic profession about pregnant women's experience seeking chiropractic care as well as directing future research.
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Affiliation(s)
- Maria Bernard-Giglio
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQ University, Brisbane, Australia
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16
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Kristiansson P, Zöller B, Dahl N, Kalliokoski P, Hallqvist J, Li X. Heredity of pregnancy-related pelvic girdle pain in Sweden. Acta Obstet Gynecol Scand 2023; 102:1250-1258. [PMID: 37470484 PMCID: PMC10540922 DOI: 10.1111/aogs.14646] [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: 02/14/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now accumulating evidence that pregnancy-related pelvic girdle pain originates from the sacroiliac joints and the pubic symphysis as well as their extra-articular ligaments. However, the heritability of the disease remains to be determined. We hypothesized that there is an increased familial risk of pregnancy-related pelvic girdle pain. MATERIAL AND METHODS A population-based national database linkage registry study of approximately 9.3 million individuals within 4.2 million families in Sweden with a recruitment period from 1997 to 2018. The Swedish Multi-generation register was used to find female pairs of twins, full siblings, half-siblings and first cousins where both in the pairs had a completed pregnancy. The outcome measure was diagnosis of pregnancy-related pelvic girdle pain (International Classification of Diseases-10 O26.7 [1997-2018]) in the first pregnancy. Data was obtained from the Swedish Hospital Discharge Register, the Swedish Outpatient Care Register, the Swedish Medical Birth Register, the Primary Healthcare Register, and Medical Treatment Register. Cox regression analysis was used to calculate adjusted estimated effect of the exposure variable familial history of pregnancy-related pelvic girdle pain on the outcome variable pregnancy-related pelvic girdle pain at first birth. RESULTS From the registers, 1 010 064 women pregnant with their first child within 795 654 families were collected. In total, 109 147 women were diagnosed with pregnancy-related pelvic girdle pain. The adjusted hazard ratio for a familial risk of pregnancy-related pelvic girdle pain was 2.09 (95% CI 1.85-2.37) among twins (monozygotic and dizygotic), 1.78 (95% CI 1.74-1.82) in full siblings, 1.16 (95% CI 1.06-1.28) in half-siblings from the mother, 1.09 (95% CI 1.024-1.16) in half-siblings from the father and 1.09 (95% CI 1.07-1.12) in first cousins. CONCLUSIONS This nationwide observational study showed a familial clustering of pregnancy-related pelvic girdle pain. The hazard ratio for the condition was associated with the degree of relatedness, suggesting that heredity factors contribute to the development of pregnancy-related pelvic girdle pain. There is no causal treatment available for pregnancy-related pelvic girdle pain and further studies are now encouraged to clarify the specific genetic factors that contribute to the disease and for future targeted interventions.
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Affiliation(s)
- Per Kristiansson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Bengt Zöller
- Center for Primary Health Care ResearchLund UniversityLundSweden
| | - Niklas Dahl
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | - Paul Kalliokoski
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Johan Hallqvist
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Xinjun Li
- Center for Primary Health Care ResearchLund UniversityLundSweden
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Sward L, Manning N, Murchison AB, Ghahremani T, McCaulley JA, Magann EF. Pelvic Girdle Pain in Pregnancy: A Review. Obstet Gynecol Surv 2023; 78:349-357. [PMID: 37322996 DOI: 10.1097/ogx.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Importance Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies. Objective The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain. Evidence Acquisition Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy. Results There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies. Conclusions Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive. Relevance Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.
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Affiliation(s)
| | - Nirvana Manning
- Associate Professor, Department Chairperson, Departments of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Amanda B Murchison
- Associate Professor, Residency Director, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Taylor Ghahremani
- Fellow, Maternal Fetal Medicine, Departments of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Everett F Magann
- Professor, MFM Fellowship Director, Departments of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
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Yamada K, Kimura T, Cui M, Tanaka E, Kubota Y, Ikehara S, Iso H. Maternal autistic traits and antenatal pain by cross-sectional analysis of the Japan Environment and Children's Study. Sci Rep 2023; 13:6068. [PMID: 37055438 PMCID: PMC10101964 DOI: 10.1038/s41598-023-32945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
The aim of cross-sectional study was to investigate whether the presence of autistic traits in pregnant women was positively associated with the prevalence and severity of antenatal pain. We analyzed 89,068 pregnant women from a Japanese national birth cohort cross-sectionally. Autistic traits were assessed using the Japanese version of the Autism-Spectrum Quotient short form (AQ-10-J). Antenatal pain was measured using the SF-8 bodily pain item (SF-8-Pain). Antenatal pain in the second to third trimester during pregnancy was categorized into three groups: without pain, mild pain, and moderate-to-severe pain. Participants were divided into eight groups by AQ-10-J score: seven consecutive scoring groups (scores 0-6), and those above the cut-off (≥ 7) for probable autistic spectrum disorders. Odds ratios (OR) for the prevalence of mild and moderate-to-severe pain were calculated for each AQ-10-J scoring group (reference: without pain group) using multinominal logistic regression analysis. Autistic traits were positively associated with mild and moderate-to-severe pain in a dose-response manner, but the association with moderate-to-severe pain was strongest. Fully-adjusted ORs (95% confidence intervals) for moderate-to-severe pain were: 1.01 (0.91-1.13) for 1 point, 1.13 (1.02-1.25) for 2 points, 1.16 (1.04-1.29) for 3 points, 1.20 (1.07-1.34) for 4 points, 1.23 (1.09-1.40) for 5 points, 1.27 (1.10-1.47) for 6 points, and 1.24 (1.05-1.46) for ≥ 7 points (AQ-10-J cut-off). We identified an association between maternal autistic traits and antenatal pain. Maternal autistic traits may need to be considered when addressing antenatal pain during healthcare for expectant mothers.
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Affiliation(s)
- Keiko Yamada
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Meishan Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eizaburo Tanaka
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Hyogo Institute for Traumatic Stress, Kobe, Hyogo, Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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Ekdahl AS, Gutke A, Olsén MF, Mannerkorpi K. Expertise and individually tailored interventions are expected by pregnant women with pelvic girdle pain who seek physical therapy: a qualitative study. Braz J Phys Ther 2023; 27:100494. [PMID: 36965211 PMCID: PMC10064431 DOI: 10.1016/j.bjpt.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Pelvic girdle pain (PGP) in pregnancy may result in activity limitations and thus a negative impact on the individual woman's everyday life. Women's expectations when they seek physical therapy because of PGP are not yet known. OBJECTIVE To explore pregnant women's lived experience of PGP and what needs and expectations they express prior to a physical therapy consultation. METHODS A qualitative study using a descriptive phenomenological method. Interviews conducted with 15 pregnant women seeking physical therapy because of PGP, recruited through purposive sampling at one primary care rehabilitation clinic. RESULTS PGP was described by four themes; An experience with larger impact on life than expected, A time for adjustments and acceptance, A feeling of insecurity and concern, A desire to move forward. PGP had a large impact on the pregnant women´s life. Thoughts of PGP as something to be endured was expressed, the women therefore accepted the situation. Finding strategies to manage everyday life was hard and when it failed, the women described despair and a need for help. They expected the physical therapist to be an expert who would see them as individuals and provide advice that could make their everyday life easier. CONCLUSION Our results reveal that pregnant women with PGP delay seeking physical therapy until their situation becomes unmanageable and they run out of strategies for self-care. The women express, in light of their individual experiences, needs and expectations for professional management and advice tailored to their individually unique situation.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Gutke
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Närhälsan Eriksberg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Haakstad LAH, Benvenuti MB, Dalhaug EM, Bø K. Lumbopelvic pain and sick leave during pregnancy: A comparison of Italy and Norway. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231218197. [PMID: 38078361 PMCID: PMC10712273 DOI: 10.1177/17455057231218197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. OBJECTIVES Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. DESIGN Cross-sectional. METHODS Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women's experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. RESULTS In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11-1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29-1.0, p = 0.06). CONCLUSION We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.
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Affiliation(s)
| | | | - Emilie Mass Dalhaug
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Nordbyhagen, Norway
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Vesting S, Gutke A, Fagevik Olsén M, Praetorius Björk M, Rembeck G, Larsson MEH. Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study. Phys Ther 2022; 103:pzac152. [PMID: 36326139 PMCID: PMC10071582 DOI: 10.1093/ptj/pzac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. METHODS Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. RESULTS Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. CONCLUSION The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. IMPACT This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.
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Affiliation(s)
- Sabine Vesting
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Praetorius Björk
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
- Department of Research, Education and Innovation, Region Västra Götaland, South Älvsborg Hospital, Borås, Sweden
| | - Gun Rembeck
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Borås, Sweden
- Region Västra Götaland, Regional Health, Borås Youth Guidance Center, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
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Assessment of In-Hospital Pain Control after Childbirth and Its Correlation with Anxiety in the Postpartum Period: A Cross-Sectional Study at a Single Center in the USA. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Anxiety is common during the antepartum, intrapartum, and postpartum period. While the relationship between obstetric pain and depression is well characterized, there are few publications examining the relationship between obstetric pain and anxiety. Our objective was to characterize the association, if any, between postpartum pain and anxiety. This was a survey-based cross-sectional study. The general anxiety disorder (GAD)-7 and American Pain Society patient outcome questionnaire (APS-POQ) were completed by 64 postpartum participants at hospital discharge. Associations between anxiety and pain control were assessed. Participants with moderate to severe scores (greater or equal to 10) on the GAD-7 had more maximum pain scores (0 to 10 scale) in the severe range (greater or equal to 7) in the first (p = 0.049) and second (p = 0.010) 24 h periods after delivery and were more likely to have spent more time in severe pain within these time frames (p = 0.007 and p = 0.010, respectively). Similar relationships were observed when classifying anxiety ordinally. In conclusion, higher postpartum pain scores were associated with greater anxiety in the postpartum period.
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23
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van Benten E, Coppieters MW, Pool JJM, Pool-Goudzwaard AL. Differences in balance control despite self-reported resolution of pregnancy-related pelvic girdle pain. A cross-sectional study. Musculoskelet Sci Pract 2022; 62:102620. [PMID: 35839702 DOI: 10.1016/j.msksp.2022.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Motor control patterns are altered when women with pregnancy-related pelvic girdle pain (PGP) experience pain. In low back pain, these adaptations can persist after recovery. OBJECTIVES This study aimed to assess balance control in postpartum women with and without a history of PGP during pregnancy. DESIGN Cross-sectional study. METHOD Eighteen postpartum women who reported to be recovered from PGP, and twelve postpartum women without a history of PGP during pregnancy performed two clinical tests: the single leg stance and active straight leg raise test. Primary outcomes were ground reaction forces measured with a force platform. RESULTS Multiple linear regression analyses showed smaller lateral displacement (β = -11cm; 95%CI: 19 to -3; p = 0.008) and lower displacement velocity of the Centre of Pressure (COP) (Ratio of Geometric Means (RGM) 0.76; 95%CI: 0.59 to 0.99; p = 0.043) during single leg stance in the participants with a history of PGP compared to participants without a history of PGP. Push-off force (β = -4.8 N; 95%CI: 22.0 to 12.5; p = 0.57) and asymmetry of push-off force (RGM 1.77; 95%CI: 0.62 to 5.04; p = 0.27) did not differ between groups. During the active straight leg raise test, no differences in lateral displacement (β = 3 cm; 95%CI: 3 to 8; p = 0.30) and COP displacement velocity (RGM 1.03; 95%CI: 0.70 to 1.52; p = 0.87) were observed. CONCLUSIONS Although the women with a history of PGP considered themselves recovered, their balance control during single leg stance was poorer compared to those without a history of PGP. No differences were found during the active straight leg raise test.
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Affiliation(s)
- Esther van Benten
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3501 AA, Utrecht, the Netherlands.
| | - Michel W Coppieters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Brisbane and Gold Coast Campus, Griffith University, 170 Kessels Road, QLD 4111, Nathan, Australia
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3501 AA, Utrecht, the Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN, Amersfoort, the Netherlands
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24
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Hameed F, Barton T, Chiarello C. Lumbopelvic Pain in Pregnancy in a Diverse Urban Patient Population: Prevalence and Risk Factors. J Womens Health (Larchmt) 2022; 31:1736-1741. [PMID: 36040347 DOI: 10.1089/jwh.2022.0077] [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: 01/14/2023] Open
Abstract
Objective: Pregnancy lumbopelvic pain (PLPP) is a common ailment during pregnancy with physical, psychosocial, and economic consequences. Prior literature has focused on majority Caucasian patient populations; none have focused on Hispanic populations, especially in the United States. The purpose of this study was to determine the proportion of pregnant people who experience PLPP in mostly Hispanic population. Materials and Methods: Cross-sectional survey Setting: Academic medical center Patients: All pregnant people attending a prenatal visit in obstetrical offices from July 2018 through March 2020 were asked to complete a questionnaire compiling demographic, socioeconomic information as well as describe any pain symptoms. Furthermore, the Pregnancy Mobility Index (PMI), Pelvic Girdle Pain Questionnaire (PGQ), and the Questionnaire for Urinary Incontinence Diagnosis (QUID) were included. Results: In a cohort (n = 851) that was 62% Hispanic, we found a 63% point-prevalence rate for PLPP. Pregnant people who reported PLPP were further along in their pregnancy, did have significantly higher scores for the PMI and PGQ, indicating a greater level of disability, and reported issues with incontinence (QUID). Results of the logistic regression found that a higher PMI score and financial instability were factors influencing PLPP. Conclusions: In a cohort of majority Hispanic people, we found that 63% of respondents had PLPP. Our study found that a higher PMI score and financial instability were factors influencing PLPP. Clinicians should be alert to pregnant people who express their difficulties with activities of daily living as they may be at risk of PLPP, and could benefit from further evaluation and treatment.
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Affiliation(s)
- Farah Hameed
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Travis Barton
- Public Sector Department, SymphonyAI, Palo Alto, California, USA
| | - Cynthia Chiarello
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
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25
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Remus A, Lempke AFD, Wuytack F, Smith V. Outcome Measurement Instruments and Evidence-based Recommendations for Measurement of the Pelvic Girdle Pain Core Outcome Set (PGP-COS): A Systematic Review and Consensus Process. THE JOURNAL OF PAIN 2022; 23:2052-2069. [PMID: 36115519 DOI: 10.1016/j.jpain.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/04/2023]
Abstract
This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Studies evaluating measurement properties of instruments measuring any PGP-COS outcome in women with PGP were identified through a systematic search of MEDLINE, EMBASE and PEDro databases (inception-July 2021). The methodological quality of studies and quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. Quality criteria and the synthesized evidence were graded using the modified grading of recommendations, assessment, development, and evaluation (GRADE) approach. A consensus meeting with PGP stakeholders was then held to establish recommendations, based on the evidence, for the instruments that should be used to measure the PGP-COS. Ten instruments were identified from 17 studies. No instrument showed high quality evidence for all measurement properties and/or measured all PGP-COS outcomes. Based on current evidence and consensus, the Pelvic Girdle Questionnaire (PGQ), the Short Form-8 (SF-8) and the Fear Avoidance Beliefs Questionnaire (FABQ) are recommended for measuring the PGP-COS. Future research should establish additional measurement properties of instruments and to substantiate these recommendations.
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Affiliation(s)
- Alexandria Remus
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Alexandra F DeJong Lempke
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - Francesca Wuytack
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Starzec-Proserpio M, Węgrzynowska M, Sys D, Kajdy A, Rongies W, Baranowska B. Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study. BMC Musculoskelet Disord 2022; 23:928. [PMID: 36266709 PMCID: PMC9585777 DOI: 10.1186/s12891-022-05864-y] [Citation(s) in RCA: 2] [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] [Received: 11/21/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland. Methods This was a prospective, observational study. In phase 1, 411 women were recruited 24–72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report. Results In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43–48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04–4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01–1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34–48.72). Conclusion Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.
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Affiliation(s)
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
| | - Anna Kajdy
- Ist Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education , ul. Żelazna 90 , 01-004 , Warsaw, Poland
| | - Witold Rongies
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, ul. Ks. Trojdena 2C, 02-109, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, ul. Żelazna 90, 01-004, Warsaw, Poland
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27
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Manzotti A, Zanini S, Colaceci S, Giovannini N, Antonioli A, Ziglioli A, Frontani F, Galeoto G. Cross-Cultural Adaptation and Validation of the Pregnancy Mobility Index for the Italian Population: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:1971. [PMID: 36292419 PMCID: PMC9601520 DOI: 10.3390/healthcare10101971] [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: 08/18/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pregnancy is a specific condition that modifies the mobility of women. In this population, it seems important to use specific tools to properly assess them. The Pregnancy Mobility Index (PMI) was created in 2006 with the aim of assessing mobility in pregnant women. The goal of this study was to translate, adapt, and evaluate the statistical properties of the questionnaire in the Italian pregnant population. METHODS The PMI underwent translation and transcultural adaptation. Reliability and concurrent validity, compared to the Oswestry Disability Index (ODI), was investigated on a sample of pregnant women. An ANOVA was performed to detect differences in the PMI score considering the Body Mass Index (BMI) and age of the sample. RESULTS The PMI was forward translated, back translated, and transculturally adapted. A consensus meeting accepted the final version of the questionnaire. The PMI was given to 93 pregnant women. PMI showed excellent reliability for every item and the total score (Cronbach's alpha of 0.945). Concurrent validity compared with ODI items 2-9 was strong considering the total score, with r = 0.726, but moderate comparing the first item of the ODI and the total score of the PMI, r = 470, and considering the total score of both questionnaires (r = 0.683). The ANOVA showed statistical difference in pregnant women with lower BMI for every subscale and total score of PMI (p = 0.009) and for outdoor mobility considering age (p = 0.019). CONCLUSIONS The PMI seems to be a valid and reliable tool to assess mobility in the pregnant population. Pregnant women with a lower BMI showed a greater mobility score in the PMI. In turn, younger pregnant women presented a lower mobility score compared to older pregnant women.
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Affiliation(s)
- Andrea Manzotti
- Division of Neonatology, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, 20154 Milan, Italy
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Sonia Zanini
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Sofia Colaceci
- Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), 00131 Rome, Italy
| | - Niccolò Giovannini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Agnese Antonioli
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Alice Ziglioli
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Francesco Frontani
- Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), 00131 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università 30, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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28
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Trajectories of Postpartum Recovery: What is Known and Not Known. Clin Obstet Gynecol 2022; 65:594-610. [PMID: 35797600 DOI: 10.1097/grf.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women's postpartum health is a public health issue that has lifelong consequences. Timely recognition and treatment of physical and mental health issues can have positive health consequences while lack of access to effective treatments or health care services can lead to long-term health problems. To advance knowledge of priority health symptoms and trajectories of postpartum recovery from women's health perspectives, we share findings from the Maternal health And Maternal Morbidity in Ireland (MAMMI) study. Data from 3047 first-time mothers recruited to a longitudinal maternal health study in Ireland from 2012 to 2017 reveal the trajectories of maternal health and health problems experienced up to 12 months postpartum. Morbidities explored include urinary incontinence, pelvic girdle pain, and sexual and mental health issues. Viewed together, and over time, the scale and persistent nature of many physical and mental health problems become apparent, yet considerable proportions of women were not asked directly about health problems by health care professionals. When women do not know what is and is not normal postpartum, they may suffer in silence and the consequence is that health problems/issues that are preventable, and treatable, are likely to become chronic. To make positive contributions to women's health, maternity care systems must be truly woman-centered and structured in ways that place emphasis on women's own health needs. In systems where women's voices and concerns are acknowledged and central, women are likely to thrive and flourish in motherhood.
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Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review. Clin Biomech (Bristol, Avon) 2022; 98:105716. [PMID: 35843136 DOI: 10.1016/j.clinbiomech.2022.105716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain. METHODS Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed. FINDING Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent. INTERPRETATION This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.
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Kablan N, Can M, Ayvacı H, Gerçek N, Eroğlu ZA, Özgit B, Tatar Y. Biomechanical and Viscoelastic Properties of the Achilles Tendon and Plantar Fascia in Pregnant Women with Pelvic Girdle Pain: A Case–Control Study. Women Health 2022; 62:476-487. [DOI: 10.1080/03630242.2022.2085843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nilüfer Kablan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İstanbul Medeniyet University, Istanbul, Turkey
| | - Merve Can
- Plato Vocational School, Department of Therapy and Rehabilitation, Istanbul Topkapı University, Istanbul, Turkey
| | - Habibe Ayvacı
- Ministry of Health, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nejla Gerçek
- Faculty of Sports Sciences, Marmara University, Istanbul, Turkey
| | - Zeynep Ayyıldız Eroğlu
- Ministry of Health, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Berk Özgit
- Ministry of Health, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yaşar Tatar
- Faculty of Sports Sciences, Marmara University, Istanbul, Turkey
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31
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Bagwell JJ, Reynolds N, Smith JA, Walaszek M, Runez H, Lam K, Peterson J, Katsavelis D. An exploratory analysis of gait biomechanics and muscle activation in pregnant females with high and low scores for low back or pelvic girdle pain during and after pregnancy. Clin Biomech (Bristol, Avon) 2022; 97:105705. [PMID: 35763890 DOI: 10.1016/j.clinbiomech.2022.105705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/16/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy. METHODS Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS <15) based on third trimester scores. Two-way mixed model ANOVAs were used to compare high and low pain groups over time. FINDINGS Nine participants met the high pain group criteria and 11 were low pain. During second trimester the high pain group compared to the low pain group demonstrated smaller peak hip flexor moments, total hip work, percent hip contribution to work, and larger percent ankle contribution to work. Pregnant females demonstrated greater hip, knee, and ankle moments, ankle work, and gluteus maximus muscle activation third trimester than second trimester. INTERPRETATION Reduced hip and greater ankle contribution to work in the high pain group during second trimester could indicate decreased hip utilization early in pregnancy and may contribute to disability as pregnancy progresses. It is also possible kinetic differences during second trimester reflect an early strategy to reduce pain by avoiding hip joint loading. Increased moments and work during third trimester indicate a clinical imperative to better prepare pregnant females to accommodate increased joint loading and muscular demand.
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Affiliation(s)
- Jennifer J Bagwell
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Nicholas Reynolds
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Michelle Walaszek
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Hannah Runez
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Kristina Lam
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Julie Peterson
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Dimitrios Katsavelis
- Department of Exercise Science, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
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Molin B, Zwedberg S, Berger AK, Sand A, Georgsson S. Disempowering women-a mixed methods study exploring informational support about pain persisting after childbirth and its consequences. BMC Pregnancy Childbirth 2022; 22:510. [PMID: 35739466 PMCID: PMC9229078 DOI: 10.1186/s12884-022-04841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one’s own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent. Methods The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data. Results The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women’s psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain. Conclusions Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.
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Affiliation(s)
- Beata Molin
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Huddinge, Sweden. .,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
| | - Sofia Zwedberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Theme Children's & Women's Health, PA Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Georgsson
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Huddinge, Sweden.,The Swedish Red Cross University, Stockholm, Sweden
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Kablan N, Ayvacı H, Can M, Tatar Y, Kumru P, Şahin S. The effect of gestational diabetes mellitus on occurrence of the pelvic girdle pain and symptom severity in pregnant women. J OBSTET GYNAECOL 2022; 42:2058-2063. [PMID: 35695227 DOI: 10.1080/01443615.2022.2081491] [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
The primary objective of this study was to examine the effect of gestational diabetes mellitus (GDM) on pelvic girdle pain (PGP) occurrence and symptom severity. Pregnant women who were with/without GDM, 20-40 years of age, and also in the second and third trimesters of pregnancy were included in the study. PGP provocation tests were administered to 187 pregnant women to determine the presence and severity of PGP. Based on the test results, the study subjects were divided into two groups; Group 1 (GDM+, PGP+; n:32) and Group 2 (GDM-, PGP+; n:35). Both groups were asked to fill in the Pelvic Girdle Questionnaire (PGQ). The relationship between the presence of GDM and the presence of PGP was found to be significant (p = .043). It was found the groups were similar in view of pain, and also in PGQ total/subscale scores (p > .05). Although GDM has no effect on symptom severity, it has been determined that it may relate to the development of PGP. Therefore, early interventions (nutrition, exercise, belt using, etc.) are recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with a previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. Clinical Trial Number: 04769375Impact of StatementWhat is already known on this subject? Gestational diabetes mellitus and pelvic girdle pain are pathologies that develops secondary to pregnancy-related systemic and biomechanical changes.What do results on this study add? GDM may related the development of PGP.What are the implications of these findings for clinical practice and/or further research? Early interventions (nutrition, exercise, belt using, etc.) and strict control of pregnant women in view of PGP is recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. The evaluation of pregnant women for PGP before administering interventions, such as exercise and diet (both decrease the pro-inflammatory markers), following the diagnosis of GDM and the measurement of plasma anti- and pro-inflammatory marker values in the same time period will further reveal the relationship between GDM and PGP.
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Affiliation(s)
- Nilüfer Kablan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İstanbul Medeniyet University, Istanbul, Turkey
| | - Habibe Ayvacı
- Ministry of Health, Zeynep Kamil Women and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Merve Can
- Plato Vocational School, Department of Physiotherapy and Rehabilitation, Ayvansaray University, Istanbul, Turkey
| | - Yaşar Tatar
- Faculty of Sports Sciences, Marmara University, Istanbul, Turkey
| | - Pınar Kumru
- Ministry of Health, Zeynep Kamil Women and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Sadık Şahin
- Ministry of Health, Zeynep Kamil Women and Pediatric Training and Research Hospital, Istanbul, Turkey
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The Association between Postpartum Pelvic Girdle Pain and Pelvic Floor Muscle Function, Diastasis Recti and Psychological Factors-A Matched Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106236. [PMID: 35627771 PMCID: PMC9141269 DOI: 10.3390/ijerph19106236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 12/10/2022]
Abstract
There is uncertainty regarding the association between abdominal morphology, pelvic floor function, and psychological factors in women with postpartum pelvic girdle pain (PGP). The aim of this case-control study was to evaluate the differences between women with and without persistent PGP regarding pelvic floor function, diastasis recti, and psychological factors 6−24 weeks postpartum. Pelvic floor manometry, palpation examination of abdominal muscles, the International Consultation on Incontinence Questionnaire Short Form, The Depression, Anxiety and Stress Scale—21, and the Pain Catastrophizing Scale were used. The PGP group presented with lower vaginal resting pressure (p < 0.001), more tenderness (p = 0.018) and impaired voluntary activation of pelvic floor muscles (p ≤ 0.001). Women with pain also had more distortion on the level of the anterior abdominal wall (p = 0.001) and more severe diastasis recti (p = 0.046) when compared to pain-free controls. Lower vaginal resting pressure was the strongest factor explaining PGP (OR 0.702, 95%CI 0.502−0.981). There were no differences in terms of the pelvic floor strength, endurance, severity of urinary incontinence and reported distress between the groups. Women with PGP 6−24 weeks postpartum differ in pelvic floor and abdominal muscle function from the pain-free controls. Vaginal resting pressure may be an important factor in pelvic girdle pain shortly postpartum. Further studies are needed to see a trend in changes over time.
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Critchley CJC. Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester. Phys Ther 2022; 102:6536908. [PMID: 35225339 DOI: 10.1093/ptj/pzac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 01/23/2023]
Abstract
ABSTRACT The objectives of this Perspective paper are to educate physical therapists on their important role in assessing and treating common pregnancy- and delivery-related health conditions and to advocate for their routine inclusion in postpartum care during the fourth trimester. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are 2 examples of musculoskeletal disorders associated with pregnancy and childbirth that can have negative physical, social, and psychological consequences. This paper reviews evidence from 2010 through 2021 to discuss the efficacy of physical therapist intervention in the fourth trimester for PFD and DRA. The role of physical therapy in the United States is compared with its role in other developed nations, with the intent of illustrating the potential importance of physical therapy in postpartum care. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for PFD and DRA; however, physical therapists in the United States currently have a peripheral role in providing postpartum care. Lack of awareness, social stigma, and policy barriers prevent women from receiving physical therapist care. Recommendations are made regarding ways in which physical therapists can increase their involvement in the fourth trimester within their community, stimulate policy change, and promote improved postpartum care practices. IMPACT This Perspective highlights the valuable role of physical therapist assessment and treatment during the postpartum period for some common musculoskeletal conditions associated with pregnancy and delivery.
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Starzec-Proserpio M, Lipa D, Szymański J, Szymańska A, Kajdy A, Baranowska B. Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study. Phys Ther 2022; 102:6497843. [PMID: 35079827 PMCID: PMC9046967 DOI: 10.1093/ptj/pzab311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing. METHODS Women diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case-control study. RESULTS Thirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis. CONCLUSIONS Pain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery. IMPACT This study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.
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Affiliation(s)
| | - Daria Lipa
- St. Sophia Specialist Hospital, Warsaw, Poland
| | - Jacek Szymański
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agata Szymańska
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Femino JD, Nelson SC, Agulnik M, Zuckerman LM. All-Internal Limb Lengthening with Simultaneous Corrective Osteotomy After Internal Hemipelvectomy: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00029. [PMID: 36099533 DOI: 10.2106/jbjs.cc.22.00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 27-year-old woman with a Grade II chondrosarcoma in the right acetabulum underwent a Type II internal hemipelvectomy with an ischiofemoral fusion. She developed a 7.0-cm functional limb-length discrepancy with adduction of the hip at rest. Four years after surgery, she underwent a corrective osteotomy and limb lengthening with a magnetic lengthening nail. Eleven years after tumor resection and a successful pregnancy, she had symmetric leg lengths and ambulated without an assistive device. CONCLUSIONS A magnetic lengthening nail is a viable option for correcting limb-length discrepancies after hemipelvectomy. If necessary, a simultaneous corrective proximal femoral osteotomy can be performed.
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Affiliation(s)
- Joseph D Femino
- Division of Orthopaedic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California
- Department of Surgery, Hopital Adventiste d'Haiti, Port-au-Prince, Haiti
| | - Mark Agulnik
- Department of Medical Oncology and Therapeutics, City of Hope National Medical Center, Duarte, California
| | - Lee M Zuckerman
- Division of Orthopaedic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California
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Daneau C, Marchand AA, Bussières A, O'Shaughnessy J, Ruchat SM, Descarreaux M. Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial. Pilot Feasibility Stud 2022; 8:65. [PMID: 35313988 PMCID: PMC8935756 DOI: 10.1186/s40814-022-01024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP. Methods/design Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34–36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants’ recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression. Discussion This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy. Trial registration US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01024-0.
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Affiliation(s)
- Catherine Daneau
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Andrée-Anne Marchand
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - André Bussières
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Julie O'Shaughnessy
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Kishikawa Y, Tanaka S, Iwanaga K, Nakagawa I, Shiotsuka T, Tsuda N, Kobachi Y, Hirano K, Murakami Y. Effects of pain-related catastrophic thinking, anxiety, and depression on pain intensity and quality of life in patients with knee and low back pain. J Phys Ther Sci 2022; 34:625-629. [PMID: 36118662 PMCID: PMC9444518 DOI: 10.1589/jpts.34.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We aimed to examine the effects of pain-related catastrophic thoughts and
anxiety/depression on pain intensity and quality of life (QOL), and how these effects
(relationships) vary with pain location, in outpatients with chronic pain. [Participants
and Methods] We recruited 14 participants with low back pain (2 males and 12 females) and
14 with knee joint pain (3 males and 11 females). We used the following evaluation tools:
the visual analog scale (to evaluate pain intensity), pain catastrophizing scale (in which
scores are categorized into helplessness, rumination, and magnification), Hospital Anxiety
and Depression Scale (for psychodynamic evaluation), and a questionnaire for QOL
evaluation. [Results] There was no difference in pain intensity between the groups. The
“low back pain” group showed a positive correlation between pain intensity and anxiety,
while the “knee pain” group showed a positive correlation between pain intensity and
helplessness. The “low back pain” group showed a negative correlation between health in
QOL assessment items and helplessness, and between health and magnification. However, in
the “knee pain” group, there was a negative correlation between health and rumination,
between health and anxiety, and between positive mental attitude and magnification.
[Conclusion] Mental status varied depending on the pain location, regardless of the
intensity of the pain. This suggests that a psychological approach dependent on pain
location is needed during physical therapy.
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Affiliation(s)
- Yuki Kishikawa
- Department of Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Nishikyushu University: 4490-9 Osaki, Kanzaki, Saga 842-8585, Japan
| | - Shinichi Tanaka
- Department of Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Nishikyushu University: 4490-9 Osaki, Kanzaki, Saga 842-8585, Japan
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Xiong PT, Poehlmann J, Stowe Z, Antony KM. Anxiety, Depression, and Pain in the Perinatal Period: A Review for Obstetric Care Providers. Obstet Gynecol Surv 2021; 76:692-713. [PMID: 34854926 DOI: 10.1097/ogx.0000000000000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain. Objective This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered. Evidence Acquisition Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year. Results A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references. Conclusions and Relevance The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain.
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Affiliation(s)
- Pa Ta Xiong
- Medical Student, School of Medicine and Public Health
| | - John Poehlmann
- Resident Physician, Department of Obstetrics and Gynecology, University of Wisconsin-Madison
| | - Zachary Stowe
- Professor, Department of Psychiatry, University of Wisconsin-Madison, Wisconsin Psychiatric Institute and Clinics
| | - Kathleen M Antony
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI
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Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med 2021; 10:jcm10225397. [PMID: 34830680 PMCID: PMC8622577 DOI: 10.3390/jcm10225397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden
- Correspondence:
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden;
- Department of Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium;
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Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, De Stefano F, Kondilis A. Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. Cureus 2021; 13:e18619. [PMID: 34786225 PMCID: PMC8580107 DOI: 10.7759/cureus.18619] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/14/2022] Open
Abstract
Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term “pregnancy-related sacroiliac joint pain.” All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Manraj Sekhon
- William Beaumont School of Medicine, Oakland University, Rochester, USA
| | - Thao Doan
- School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Brianne Bowers
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, USA
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Santiago de Querétaro, MEX
| | | | - Frank De Stefano
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, USA
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Elden H, Olsen MF, Hussein NF, Axelsson LW, Sengpiel V, Ullman M. Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up. BMC Pregnancy Childbirth 2021; 21:776. [PMID: 34784887 PMCID: PMC8594151 DOI: 10.1186/s12884-021-04023-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. METHODS This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. RESULTS 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). CONCLUSIONS In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.
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Affiliation(s)
- Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden. .,Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopedics, Gothenburg, Sweden.
| | - Monika Fagevik Olsen
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Occupational Therapy and Physical Therapy, Gothenburg, Sweden
| | - Nasrin Farah Hussein
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Lisa Wibeck Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Verena Sengpiel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | - Michael Ullman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Catala P, Suso-Ribera C, Marin D, Bedmar D, Peñacoba C. A longitudinal study exploring the evolution of pain during pregnancy and after delivery: does worry matter? Arch Womens Ment Health 2021; 24:759-766. [PMID: 33837828 DOI: 10.1007/s00737-021-01127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study is to evaluate the evolution of pain through pregnancy until after delivery, as well as to explore the mediating role of pregnancy worries in this evolution of pain. We conducted a longitudinal cohort study. The convenience sample was evaluated on four separate occasions: in the first trimester of pregnancy (pain), during the third trimester (pain and worry), during labor (pain), and after birth (< 24 h; pain). The final sample included 120 pregnant women with a mean age of 31.29 years (SD = 4.9; range = [22, 42 years]). The results evidenced changes in pain over time (F = 13.31, p < .001). Pain severity increased in the third trimester compared to the first trimester (t = - 4.60; 95% CI = [- 1.31, - 0.52]; p < .001), while pain during the third trimester and pain after delivery were comparable (t = - 0.94; 95% CI = [- 1.02, 0.36]; p = .35). Pain during labor was uncorrelated with all other pain measures, so it was not included in the model. The results of the mediation analyses indicated a total effect of pain during pregnancy (first and third trimester) and worry on pain severity after delivery (B = 0.35; SE = 0.14; t = 2.43; 95% CI = [0.06, 0.65]; p = .017). Pregnancy worries (B = 0.14; SE = 0.07; 95% CI = [0.06, 0.29]), but not pain during the third trimester (B = 0.03; SE = 0.12; 95% CI = [- 0.17, 0.31]) mediated the relationship between pain during the first trimester and pain after delivery. These results support the need to reduce worry in pregnant mothers, especially when pain during the first trimester is high, to reduce the risk of pain after delivery.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Dolores Marin
- Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Obstetrics Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Dolores Bedmar
- Pain Unit, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
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Svahn Ekdahl A, Fagevik Olsén M, Jendman T, Gutke A. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial. BMJ Open 2021; 11:e046314. [PMID: 34598980 PMCID: PMC8488730 DOI: 10.1136/bmjopen-2020-046314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA). DESIGN Randomised controlled trial. SETTING AND PARTICIPANTS Pregnant women (n=113) with clinically verified PGP in gestational weeks 12-28, recruited from maternity healthcare centres, randomised (1:1) into two groups. EXCLUSION CRITERIA any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment. INTERVENTIONS The intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks. PRIMARY OUTCOME VARIABLES Disability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations. SECONDARY OUTCOME VARIABLES Functioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire). RESULTS No mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture -0.96 (95% CI -1.91 to -0.01; p=0.049), TENS -1.29 (95% CI -2.13 to -0.44; p=0.003) and concern about pain; acupuncture -1.44 (95% CI -2.31 to -0.57; p=0.0012), TENS -1.99 (95% CI -2.81 to -1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048) CONCLUSION: Treating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active. TRIAL REGISTRATION NUMBER 12726. https://www.researchweb.org/is/sverige/project/127261.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Jendman
- Physiotherapy Clinic 'I Rorelse', Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
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Aldabe D, Lawrenson P, Sullivan J, Hyland G, Bussey M, Hammer N, Bryant K, Woodley S. Management of women with pregnancy-related pelvic girdle pain: an international Delphi study. Physiotherapy 2021; 115:66-84. [DOI: 10.1016/j.physio.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
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Fruscalzo A, Cocco P, Londero AP, Gantert M. Low Back Pain during Pregnancy and Delivery Outcomes. Z Geburtshilfe Neonatol 2021; 226:104-111. [PMID: 34433210 DOI: 10.1055/a-1553-4856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women's well-being and delivery outcomes. MATERIAL AND METHODS Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded. RESULTS A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10-30) and 6/10 points (IQR=5-8) on a visual analog scale in the 3rd trimester (p<0.05). The extent of functional impairment also progressively increased up to 39/100 points (IQR=25-55, p<0.05). Women affected by LBP during pregnancy had a higher cesarean section rate during labor than women without LBP (11.9% vs. 28.9%, p<0.05). The risk was also significant in the multivariate analysis (OR=4.0, 95%CI=1.1-15.0, p<0.05). There was no difference in the rate of operative vaginal births or in the other outcomes considered. CONCLUSIONS LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.
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Affiliation(s)
- Arrigo Fruscalzo
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
| | - Paolo Cocco
- Pediatric Surgery, University of Naples Federico II School of Medicine and Surgery, Napoli, Italy and Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Ambrogio P Londero
- Clinic of Gynecology and Obstetrics, University Hospital of Udine, Udine, Italy
| | - Markus Gantert
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
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Filipec M, Matijević R. Expert advice about therapeutic exercise in the management of sacroiliac dysfunction in pregnancy: Secondary analysis of a randomized trial. Eur J Obstet Gynecol Reprod Biol 2021; 265:18-24. [PMID: 34411904 DOI: 10.1016/j.ejogrb.2021.08.011] [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: 04/29/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess primiparous and multiparous women, and singleton and multiple pregnancies in a recently published randomized trial. STUDY DESIGN Secondary analysis of a randomized clinical trial was performed. In total, 500 women with sacroiliac dysfunction diagnosed in pregnancy were randomized into a study group (who received expert advice about therapeutic exercise) and a control group (who continued with their normal lifestyle habits). The outcome measures assessed were: pain intensity [visual analogue scale (VAS)] and degree of functional disability (Quebec scale) at enrolment and after 3 and 6 weeks. Primiparous and multiparous women, and singleton and multiple pregnancies in the study and control groups were analysed separately. RESULTS Sacroiliac dysfunction was more common in primiparous women compared with multiparous women (84.70% vs 77.16%), and in multiple pregnancies compared with singleton pregnancies (86.53% vs 80.07%). For all four subgroups analysed in this secondary analysis, the reduction in pain intensity (p = 0.001) and the degree of functional disability (p = 0.001) were better in the study group compared with the control group. Better results for the two outcome measures were found when comparing primiparous and multiparous women in the study group at follow-up, but the difference in functional disability disappeared 6 weeks after enrolment (p = 0.383). There was no difference in the two outcome measures between singleton and multiple pregnancies 3 and 6 weeks after enrolment (p = 0.061, p = 0.489 and p = 0.741, p = 0.353, respectively). CONCLUSION Expert advice about therapeutic exercise is effective for the reduction of symptoms of sacroiliac dysfunction in all four subgroups (primiparous and multiparous women, singleton and multiple pregnancies). Earlier reduction of pain intensity and degree of functional disability were obtained in primiparous women compared with multiparous women in the study group.
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Affiliation(s)
- Manuela Filipec
- Department of Physical Medicine and Rehabilitation, Clinical Hospital 'Sveti Duh', Zagreb, Croatia; Department of Physiotherapy, University North, Varazdin, Croatia.
| | - Ratko Matijević
- Department of Obstetrics and Gynaecology, University of Zagreb, Zagreb, Croatia; School of Medicine, Merkur University Hospital, Zagreb, Croatia
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Mathur VA, Nyman T, Nanavaty N, George N, Brooker RJ. Trajectories of pain during pregnancy predict symptoms of postpartum depression. Pain Rep 2021; 6:e933. [PMID: 34104839 PMCID: PMC8177876 DOI: 10.1097/pr9.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/24/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Postpartum depression imparts a significant and long-lasting burden on maternal and child health. Successful prevention or early detection of postpartum depression will rely on the identification of early risk factors. Pain during pregnancy (before childbirth) is a key potential predictor of postpartum depression risk. However, longitudinal studies characterizing pregnancy pain, its normal trajectory over time, and its prospective relations with symptoms of postpartum depression are lacking. METHODS We used data from a longitudinal study of maternal emotion that included assessments of pain and depressive symptoms at 3 time points-during the second and third trimester of pregnancy and at 4 months postpartum. Structural equation modelling was used to estimate longitudinal patterns of change in maternal pain over time. Latent growth curve parameters were tested as predictors of symptoms of postpartum depression. RESULTS Ninety-three healthy pregnant women enrolled in this study. Although the sample comprised women with relatively low-risk pregnancies, more than 90% of participants experienced pregnancy pain. Greater linear increases and less negative quadratic change in maternal pain over time were associated with greater levels of postpartum depression, even when controlling for prenatal depressive symptoms. Interpreting both parameters together, pain that increased in late pregnancy, when normative patterns had either levelled off or begun to decline, was associated with greater levels of postpartum depression. CONCLUSION A developmental trajectory of pain experience that did not subside after childbirth was associated with greater postpartum depressive symptoms, suggesting that atypical trajectories of pain may be a risk factor for postpartum depression.
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Affiliation(s)
- Vani A. Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Tristin Nyman
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Nevita George
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Rebecca J. Brooker
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
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Horibe K, Isa T, Matsuda N, Murata S, Tsuboi Y, Okumura M, Kawaharada R, Kogaki M, Uchida K, Nakatsuka K, Ono R. Association between sleep disturbance and low back and pelvic pain in 4-month postpartum women: A cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2983-2988. [PMID: 33977349 DOI: 10.1007/s00586-021-06847-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 02/20/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Persistent low back and pelvic pain (LBPP) is a postpartum-specific health problem. Sleep disturbances' association with persistent LBPP is not yet clear. We aimed to examine the cross-sectional association between sleep disturbance and persistent LBPP at 4 months postpartum. METHODS We enrolled 120 women with LBPP during pregnancy (mean age, 31.8; standard deviation, 4.9 years). The primary outcome was persistent LBPP. We assessed LBPP severity at 4 months postpartum using the Numerical Rating Scale (NRS), where women with an NRS score of ≥ 4 at 4 months postpartum were allocated to the persistent LBPP group. We assessed sleep disturbance at 4 months postpartum using the Japanese version of the Pittsburgh Sleep Quality Index with a total score of ≥ 6 indicating sleep disturbance. Moreover, we performed univariate and multiple logistic regression analyses to examine the cross-sectional association of sleep disturbance with persistent LBPP. The relevant confounding variables were age, body mass index, parity, and history of LBPP before pregnancy. RESULTS Among the 120 women, 45 women had persistent LBPP (37.5%) with 32 (71.1%) of them reporting sleep disturbance. There was a significant association of sleep disturbance with persistent LBPP (odds ratio [OR], 2.81; 95% confidence interval [95% CI], 1.28-6.19), which remained after adjustments for confounding variables (OR, 2.98; 95% CI, 1.31-6.75). CONCLUSION Our findings indicate that sleep disturbance is associated with persistent LBPP at 4 months postpartum; therefore, it should be taken into consideration in postpartum women with persistent LBPP.
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Affiliation(s)
- Kana Horibe
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Tsunenori Isa
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Naoka Matsuda
- Division of Rehabilitation Medicine, Kobe Mariners Hospital, Kobe, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Yamato Tsuboi
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Maho Okumura
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Rika Kawaharada
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Masahumi Kogaki
- Takumi Day-Care Facility in Children, Nishinomiya, Hyogo, Japan
| | - Kazuaki Uchida
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Kiyomasa Nakatsuka
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, Japan.
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