The impact of a sacroiliac joint belt on function and pain using the active straight leg raise in pregnancy-related pelvic girdle pain

INTRODUCTION

Pelvic girdle pain (PGP) is the most common musculoskeletal concern in pregnancy. The Active Straight Leg Raise (ASLR) test is diagnostic. Sacroiliac joint (SIJ) belts are included in multimodal therapy, but there is no established predictive measure to determine which pregnant women will benefit.

OBJECTIVE

To determine if the ASLR score is immediately reduced by SIJ belt application and whether PGP pain and function improves after 4 weeks of belt use.

DESIGN

Prospective observational cohort study.

SETTING

Academic medical center.

PARTICIPANTS

Pregnant women at least 18 years of age in the second or third trimester of pregnancy with posterior PGP and ASLR score of 2 to 10.

INTERVENTIONS

Four-week SIJ belt use.

MAIN OUTCOME MEASURES

ASLR, Numerical Rating Scale (NRS), Pelvic Girdle Questionnaire (PGQ), Perceived Global Impression of Improvement (PGII).

RESULTS

Sixty-three women enrolled. On multivariable analysis, immediate belted ASLR score was -2.70 points lower than the non-belted ASLR score (P < .001). Four weeks later there was significant improvement in the ASLR score with a belt (M_diff  = -0.99; P = .001) and without a belt (M_diff  = -1.94; P < .001); the decline was more precipitous for the non-belted response (M_diff  = -0.96; P = .02). Current NRS pain scores declined from baseline by approximately -0.94 points (P < .001). This decline did not depend on ASLR scores (interaction P = .43) or wearing a belt at the time of testing (interaction P = .51). Similar conclusions held for participants' usual NRS score and average PGQ score. After 4 weeks, 82% reported improvement based on the PGII.

CONCLUSIONS

SIJ belts are a safe, well-tolerated, and effective therapeutic option for pregnancy-related PGP. The ASLR score is immediately reduced following SIJ belt application but does not predict pain score 4 weeks later. SIJ belt leads to significant improvements in pain and function over time.

Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation

Systems analysis of the systemic arterial (SAPW), cerebrospinal fluid (CSFPW), and sagittal sinus (SSPW) pulse waves was carried out in 13 dogs during hypercapnia (5% CO2), intracranial normotension (inhalation of 100% O2), and intracranial hypertension (inhalation of 100% O2 plus an intraventricular infusion). Power amplitude and phase spectra were determined for each wave, and the power amplitude and phase transfer functions calculated between the cerebrospinal fluid (CSF) pressure and systemic arterial pressures, and between the sagittal sinus pressure and CSF pressure. The study indicates that the CSFPW and SSPW were virtually identical when impedance between the cerebral veins and sagittal sinus was minimal, which argues that the CSF pulse was derived from the cerebral venous bed. During inhalation of 100% O2, transmission of the SAPW across the precapillary resistance vessels into the cerebral venous pulse (as represented by the CSFPW) was nonlinear, while transmission across the lateral lacunae into the sagittal sinus was linear. During intracranial hypertension, wave transmission across the precapillary resistance vessels was linear, and across the lateral lacunae was nonlinear. During hypercapnia, wave transmission across the precapillary resistance vessels and the lateral lacunae was linear. When the wave transmission was nonlinear, there was also suppression in transmission of the lower harmonics, particularly the fundamental frequency, and a more positive phase transfer function, suggesting an inertial effect or decrease in acceleration of the pulse. Conversion from a nonlinear to linear transmission across the precapillary resistance vessels is evidence of loss of vasomotor tone, and is accompanied by rounding of the CSFPW. A vascular model which encompasses the above data and is based on flow in collapsible tubes and changes in vasomotor tone is posited to explain control of pulsatile flow and pulse waveform changes in the cerebrovascular bed. The model helps to clarify the strong interrelationship between intracranial pressure, cerebral blood flow, and cerebral autoregulation.

Computed tomography in astrocytomas. A statistical analysis of the parameters of malignancy and the positive contrast-enhanced CT scan

Four histopathological indices of malignancy--cellularity, pleomorphism, vascularity, and necrosis--were correlated with the positive-contrast CT scan in 84 patients with pathologically proved astrocytoma. Vascularity and necrosis correlated best with the scan in supratentorial tumors, while vascularity and cellularity correlated significantly with the scan in cerebellar astrocytomas. These findings indicate that the degree of malignancy of a supratentorial astrocytoma can be inferred from the contrast-enhanced scan, but that this is not generally possible with posterior fossa tumors.