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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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Pulsifer J, Britnell S, Sim A, Adaszynski J, Dufour S. Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. Br J Sports Med 2022; 56:1262-1265. [PMID: 35948414 DOI: 10.1136/bjsports-2022-105724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Jodie Pulsifer
- Full Circle Physiotherapy, Vancouver, British Columbia, Canada
| | | | - Adrienne Sim
- Full Circle Physiotherapy, Langley, British Columbia, Canada
| | | | - Sinead Dufour
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Beales D, Slater H, Palsson T, O'Sullivan P. Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective. Musculoskelet Sci Pract 2020; 48:102152. [PMID: 32560860 DOI: 10.1016/j.msksp.2020.102152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/08/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Clinicians need support to effectively implement a biopsychosocial approach to people with pelvic girdle pain disorders. PURPOSE A practical clinical framework aligned with a contemporary biopsychosocial approach is provided to help guide clinician's management of pelvic girdle pain. This approach is consistent with current pain science which helps to explain potential mechanistic links with co/multi-morbid conditions related to pelvic girdle pain. Further, this approach also aligns with the Common-Sense Model of Illness and provides insight into how an individual's illness perceptions can influence their emotional and behavioural response to their pain disorder. Communication is critical to supporting recovery and facilitating behaviour change within the biopsychosocial context and in this context, the patient interview is central to exploring the multidimensional nature of a persons' presentation. Focusing the biopsychosocial framework on targeted cognitive-functional therapy as a key component of care can help an individual with pelvic girdle pain make sense of their pain, build confidence and self-efficacy and facilitate positive behaviour and lifestyle change. There is growing evidence of the efficacy for this broader integrative approach, although large scale effectiveness trials are still needed. An in-depth case study provides guidance for clinicians, showing 'how to' implement these concepts into their own practice within a coherent practical framework. IMPLICATIONS This framework can give clinicians more confidence in understanding and managing pelvic girdle pain. The framework provides practical strategies to assist clinicians with implementation; assisting the transition from knowing to doing in an evidence-informed manner that resonates with real world practice.
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Affiliation(s)
- Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Thorvaldur Palsson
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, 9220, Aalborg, Denmark
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6845, Australia
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