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Batista PA, de Oliveira C, da Costa RA, Francisco RPV, Cabar FR. Low back pain, pelvic pain, and associated factors in type 1 diabetic pregnant women. Clinics (Sao Paulo) 2024; 79:100325. [PMID: 38330787 PMCID: PMC10864871 DOI: 10.1016/j.clinsp.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). OBJECTIVE To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. METHOD An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). RESULTS The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. CONCLUSION There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.
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Affiliation(s)
- Patricia Andrade Batista
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Cláudia de Oliveira
- Department of Physical Therapy, Universidade Santa Cecília (UNISANTA), Santos, SP, Brazil
| | - Rafaela Alkmin da Costa
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Fabio Roberto Cabar
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Shanshan H, Liying C, Huihong Z, Yanting W, Tiantian L, Tong J, Jiawei Q. Prevalence of lumbopelvic pain during pregnancy: A systematic review and meta-analysis of cross-sectional studies. Acta Obstet Gynecol Scand 2024; 103:225-240. [PMID: 37997035 PMCID: PMC10823407 DOI: 10.1111/aogs.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/11/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Lumbopelvic pain (LPP) is common in pregnant women and has a significant negative effect on physical and psychological health. In this study, for the first time, we conduct a meta-analysis to estimate the overall prevalence of LPP among pregnant women and clarify the reasons for the differences in the estimated results. MATERIAL AND METHODS A systematic search of four databases (PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials) was conducted from inception until October 2022. Two reviewers conducted a methodological quality assessment. Random-effects model analysis was used to estimate the pooled prevalence and the 95% confidence interval. Chi-square tests and I2 -values were used to assess the heterogeneity. Subgroup analysis (according to the participants' continent, age, body mass index [BMI], gestational age and study risk of bias), sensitivity analysis and random-effects meta-regression were used to explore the the sources of heterogeneity. RESULTS Of the 1661 unique citations, 38 studies (21 533 pregnant participants) were included in this systematic review and meta-analysis. The overall pooled prevalence of LPP during pregnancy was 63% (95% CI: 0.57 to 0.69), with significant heterogeneity (I2 = 99.1%, P < 0.001). The prevalence differed by participants' continents, 71% (North America), 74% (South America), 63% (Asia), 64% (Europe), 59% (Africa) and 45% (Oceania). The prevalence differed by BMI, 64% (BMI <25), 64% (25 ≤ BMI ≤ 28), and 71% (BMI >28). The prevalence differed by age, 72% (age <25 years), 58% (25 ≤ age ≤ 30 years), and 69% (age >30 years). The prevalence were the same differed by study risk of bias, 63% (both low and moderate risk of bias studies). The prevalence were similar by gestational age, 62% (second trimester) and 63% (third trimester). CONCLUSIONS Lumbopelvic pain during pregnancy is common; about three-fifths of pregnant women experience LPP. More prevention and intervention research for lumbopelvic should be conducted in pregnant women with different clinical characteristics.
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Affiliation(s)
- Hong Shanshan
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Chen Liying
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Zhuang Huihong
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Wang Yanting
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Lin Tiantian
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Jin Tong
- Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Qin Jiawei
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
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Knudsen SDP, Roland CB, Alomairah SA, Jessen AD, Maindal HT, Bendix JM, Clausen TD, Løkkegaard E, Stallknecht B, Molsted S. The effect of exercise training and motivational counselling on physical activity behaviour and psychosocial factors in pregnant women: secondary analyses of the FitMum randomised controlled trial investigating prenatal physical activity. BMC Public Health 2024; 24:92. [PMID: 38178045 PMCID: PMC10768443 DOI: 10.1186/s12889-023-17525-3] [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: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A physically active lifestyle is beneficial during pregnancy. However, little is known about physical activity (PA) behaviour and psychosocial factors in women during and after pregnancy. This study examined exercise behavioural regulation, exercise self-efficacy, health-related quality of life, sickness absence and musculoskeletal pain in pregnant women offered either structured supervised exercise training, motivational counselling on PA, or standard prenatal care in the FitMum randomised controlled trial. METHODS Two hundred and eighteen healthy inactive pregnant women were randomised to structured supervised exercise training (n = 87), motivational counselling on PA (n = 86) or standard prenatal care (n = 45). The women answered the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2), the Pregnancy Exercise Self-Efficacy Scale (P-ESES-DK) and the Short Form 36 Health Survey Questionnaire (SF-36) at baseline (gestational age (GA) of max 15 weeks), GA 28 and 34 weeks, and one year after delivery. Sickness absence and low back and/or pelvic girdle pain were likewise reported in questionnaires at baseline and GA 28 weeks. RESULTS Participants offered structured supervised exercise training or motivational counselling on PA had higher autonomous motivation for exercise during pregnancy compared with participants receiving standard prenatal care (e.g., difference in intrinsic regulation at GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 0.39 [0.16; 0.64], p < 0.001). Participants offered structured supervised exercise training also had higher exercise self-efficacy during pregnancy (e.g., GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 6.97 [2.05; 12.02], p = 0.005). All participants reported high exercise self-efficacy at baseline and medium exercise self-efficacy during pregnancy and one year after delivery. No differences were found between groups in health-related quality of life, sickness absence or low back and/or pelvic girdle pain during pregnancy. No group differences were found one year after delivery. CONCLUSION Structured supervised exercise training and motivational counselling on PA had important effects on autonomous exercise motivation during pregnancy. Exercise self-efficacy was also increased with structured supervised exercise training compared to standard prenatal care. No group differences in health-related quality of life, sickness absence, or pain were found during and after pregnancy. No effects were found one year post-delivery after intervention cessation. TRIAL REGISTRATION The study was approved by the Danish National Committee on Health Research Ethics (#H-18011067) and the Danish Data Protection Agency (#P-2019-512). The study adheres to the principles of the Helsinki declaration. Written informed consent was obtained at inclusion.
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Affiliation(s)
- Signe de Place Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.
| | - Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Public Health Department, Saudi Electronic University, College of Health Sciences, Riyadh, Saudi Arabia
| | - Anne Dsane Jessen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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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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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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Innamorato MA, Cascella M, Bignami EG, Perna P, Petrucci E, Marinangeli F, Vittori A. Neurostimulation for Chronic Low Back Pain during Pregnancy: Implications for Child and Mother Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15488. [PMID: 36497567 PMCID: PMC9741143 DOI: 10.3390/ijerph192315488] [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: 09/21/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient's needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case of a 37-year-old woman with low back pain treated with neurostimulation before pregnancy. She described severe chronic low back pain unresponsive to pharmacologic treatments. We first implanted a subcutaneous stimulator into the patient, and then a definitive stimulator resulting in excellent pain control. The improvement in her quality of life allowed the woman to become pregnant. We decided to stop neurostimulation with the patient during pregnancy. The patient completed her pregnancy without complications and the baby was born healthy. During the pregnancy, the woman took only paracetamol when needed. However, this painful symptomatology, completely anecdotal, is not attributable solely to the previous spine problem but probably also to the changes occurring during pregnancy. At the end of pregnancy, the neurostimulator was reactivated without any discomfort for the patient, who is now pain free. This case report provides a first line of evidence of a possible treatment of low back pain in women intending to become pregnant, with risk-free management for both the patient and the child.
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Affiliation(s)
- Massimo Antonio Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, Via Mariano Semmola 53, 80131 Naples, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Paolo Perna
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio 48, 67100 L’Aquila, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
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Daneau C, Abboud J, Marchand AA, Houle M, Pasquier M, Ruchat SM, Descarreaux M. Mechanisms Underlying Lumbopelvic Pain During Pregnancy: A Proposed Model. FRONTIERS IN PAIN RESEARCH 2022; 2:773988. [PMID: 35295430 PMCID: PMC8915559 DOI: 10.3389/fpain.2021.773988] [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] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.
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Affiliation(s)
- Catherine Daneau
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jacques Abboud
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mariève Houle
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mégane Pasquier
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Yamada K, Kimura T, Cui M, Kubota Y, Ikehara S, Iso H. Social support, social cohesion and pain during pregnancy: The Japan Environment and Children's Study. Eur J Pain 2021; 25:872-885. [PMID: 33341980 PMCID: PMC8048612 DOI: 10.1002/ejp.1717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 12/16/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Persistent pain during pregnancy is a significant health issue, which could be correlated with psychological distress resulting from inadequate social support. This study aims to investigate whether the relationship between poor social support and antenatal pain is mediated by psychological distress. We also aimed to examine whether social cohesion moderates the influence of psychological distress on the relationship between social support and antenatal pain. METHODS We analysed 94,517 pregnancies of women from a Japanese national birth cohort completed questionnaires assessing pain, psychological distress, social support and social cohesion. Psychological distress was assessed using the Kessler Psychological Distress Scale. Two types of models were used: the mediation model to examine whether the association between social support and pain was mediated by psychological distress; the moderated mediation model to analyse whether social cohesion buffered the negative effect of inadequate social support on pain. Demographic, socioeconomic and psychological factors were controlled for in all analyses. RESULTS Psychological distress was fully mediated the association between social support and pain. Social cohesion had a focal moderation effect on the inverse association between social support and psychological distress (unstandardized regression coefficient [β] = 0.09; 95% CI, 0.07-0.11) and functioned as moderator for the indirect effect of social support on antenatal pain (index of moderated mediation = 0.006; 95% CI, 0.004-0.007). CONCLUSIONS Poor social support was related to antenatal pain through psychological distress, possibly buffered by social cohesion. During the antenatal period, social support and cohesion are important for women. SIGNIFICANCE In this study, poor social support was found to be associated with pain intensity during pregnancy, which was mediated by psychological distress and might be buffered by desirable social cohesion. This finding could potentially help healthcare providers and policy makers to understand the importance of desirable social cohesion in preventing pain among pregnant women.
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Affiliation(s)
- Keiko Yamada
- Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
- Department of PsychologyMcGill UniversityMontrealQCCanada
- Department of Anesthesiology and Pain ManagementJuntendo University Faculty of MedicineTokyoJapan
| | - Takashi Kimura
- Department of Public HealthHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Meishan Cui
- Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Diseases PreventionOsakaJapan
| | - Satoyo Ikehara
- Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Hiroyasu Iso
- Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
- Department of Public Health MedicineFaculty of Medicine, University of TsukubaTsukubaIbarakiJapan
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10
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Wuytack F, Begley C, Daly D. Risk factors for pregnancy-related pelvic girdle pain: a scoping review. BMC Pregnancy Childbirth 2020; 20:739. [PMID: 33246422 PMCID: PMC7694360 DOI: 10.1186/s12884-020-03442-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP. METHODS We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded. RESULTS We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety. CONCLUSIONS A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Cecily Begley
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
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11
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Rexelius N, Lindgren A, Torstensson T, Kristiansson P, Turkmen S. Sexuality and mood changes in women with persistent pelvic girdle pain after childbirth: a case-control study. BMC WOMENS HEALTH 2020; 20:201. [PMID: 32928204 PMCID: PMC7488986 DOI: 10.1186/s12905-020-01058-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
Background Pelvic girdle pain is a common problem during pregnancy. For most women, the symptoms cease within the first 3–6 months of giving birth, but in some women the pain persists. In this study we investigate the sexuality and frequency of depressive symptoms in women with persistent pelvic girdle pain after childbirth and in healthy women. Methods We conducted a case–control study of women with persistent pelvic girdle pain after childbirth and a control group of healthy women. The frequency of depressive symptoms and sexuality were measured using the self-rating version of the Montgomery–Asberg Depression Rating Scale and the McCoy Female Sexuality Questionnaire. Results Forty-six women with persistent pelvic girdle pain and thirty-nine healthy women were enrolled. The frequency of depressive symptoms and the total score on female sexuality did not differ between the groups. However, pain during intercourse was more frequent (P < 0.001) in women with persistent pelvic girdle pain and caused them to avoid sexual intercourse frequently (P < 0.001). In multiple linear regression a higher frequency of depressive symptoms was reversely correlated with a lower score on female sexuality (β= − 0,41, p < 0,001 95% CI -0,6 - -0,22) This association remained after adjusting for obstetric variables and individual characteristics. Conclusion Depressive symptoms and female sexuality were similar between women with persistent pelvic girdle pain after childbirth and healthy controls. However, pain during intercourse and avoidance of sexual intercourse were more frequent among women with pelvic girdle pain.
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Affiliation(s)
- Niklas Rexelius
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 90185, Umeå, Sweden. .,Department of Obstetrics and Gynecology, Sundsvall County Hospital, 851 86, Sundsvall, SE, Sweden.
| | - Anne Lindgren
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Thomas Torstensson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Sahruh Turkmen
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 90185, Umeå, Sweden
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12
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Do birthrates contribute to sickness absence differences in women? A cohort study in Catalonia, Spain, 2012-2014. PLoS One 2020; 15:e0237794. [PMID: 32845930 PMCID: PMC7449461 DOI: 10.1371/journal.pone.0237794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
Aims This study explores the differences in sickness absence trends in women according to reproductive age group and medical diagnoses. Methods Data were obtained from two administrative registries: the Continuous Working Life Sample and the Catalonian Institute of Medical Evaluations from 2012 to 2014, containing 47,879 female employees. Incidence rates and incidence risk ratios derived from Poisson and negative binomial models were calculated to compare sickness absence trends among reproductive age groups based on Catalonian birthrates: early-reproductive (25–34 years old), middle-reproductive (35–44) and late-reproductive (45–54), according to diagnostic groups, selected diseases, type of contract, occupational category, and country of origin. Results Younger women show a higher incidence of overall sickness absence compared to late-reproductive-aged women. Incidence risk ratios of sickness absence decreased significantly from early-reproductive to late-reproductive age for low back pain, hemorrhage in early pregnancy, nausea and vomiting, and abdominal and pelvic pain. Discussion The higher incidence of sickness absence due to pregnancy-related health conditions in early-reproductive women compared to other reproductive age groups, may explain the sickness absence differences by age in women. Proper management of sickness absence related to pregnancy should be a goal to reduce the sickness absence gap between younger and older women.
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13
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Risk Factors Associated with Low Back Pain among A Group of 1510 Pregnant Women. J Pers Med 2020; 10:jpm10020051. [PMID: 32549306 PMCID: PMC7354496 DOI: 10.3390/jpm10020051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Low Back Pain (LBP) is a frequent, very common, and costly health problem. LBP, which occurs during pregnancy, may become a lifelong problem. The aim of this study was to determine the risk factors associated with LBP in pregnant women. Methods: The study included 1510 pregnant women. A questionnaire assessing demography, lifestyle, prevalence, and characteristics was designed and used in the study. Pain intensity was assessed with the VAS (Visual Analogue Scale). The RMDQ (Roland Morris Disability Questionnaire) was used to assess the effect that low back pain had on the functional capacity of a pregnant woman. Middle (thoracic) and low back pain disability was measured with the help of the ODI (Oswestry Disability Index) questionnaire. Results: The study confirmed that lying/sleeping (49.6%) and sitting positions (38.7%) as well as walking (37.2%) are the most significant factors causing LBP. It was also found that women who had not engaged in physical activity were more likely to experience LBP. Conclusions: Predisposing factors for LBP in pregnancy are LBP in previous pregnancies, back pain during menstruation, a younger age and a lack of physical activity. Most women in pregnancy with LBP experienced minimal and mild disability.
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14
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Ogollah R, Bishop A, Lewis M, Grotle M, Foster NE. Responsiveness and Minimal Important Change for Pain and Disability Outcome Measures in Pregnancy-Related Low Back and Pelvic Girdle Pain. Phys Ther 2019; 99:1551-1561. [PMID: 31392990 DOI: 10.1093/ptj/pzz107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/14/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pregnancy-related low back pain and pelvic girdle pain (LBP/PGP) are common and negatively impact the lives of many pregnant women. Several patient-based outcome instruments measure treatment effect, but there is no consensus about which measure to use with women who have these pain presentations. OBJECTIVE The objective was to compare the responsiveness of 3 outcome measures in LBP/PGP: Oswestry Disability Index-version 2.0 (ODI), Pelvic Girdle Questionnaire (PGQ), and 0 to 10 numerical rating scale for pain severity (NRS); and to estimate a minimal important change (MIC) for these measures in pregnancy-related LBP/PGP. DESIGN This was a methodology study using data from a pilot randomized controlled trial. METHODS Women (N = 124) with pregnancy-related LBP/PGP were recruited to a pilot randomized controlled trial evaluating the benefit of adding acupuncture to standard care, of whom 90 completed an 8-week follow-up. Responsiveness was evaluated by examining correlation between change score and the external anchor (6-point global perceived effect scale) and by using receiver operating characteristic curve analysis. MIC was estimated using anchor-based methods. RESULTS All measures showed good responsiveness, with areas under the receiver operating characteristic curve ranging from 0.77 to 0.90. The estimated MICs were 3.1, 11.0, 9.4, 13.3, and 1.3 for the ODI, PGQ-total, PGQ-activity, PGQ-symptoms, and NRS, respectively. All the measures, apart from ODI, had MICs larger than the measurement error. LIMITATIONS The lack of an optimal "gold standard" or external criterion for assessing responsiveness and MIC was a limitation of this study. CONCLUSION All 3 outcome measures demonstrated good responsiveness. MICs were derived for each instrument. The PGQ at 8 weeks postrandomization was identified as an appropriate outcome measure for pregnancy-related LBP/PGP because it is specific to these pain presentations and assesses both activity limitations and symptoms. The NRS is an efficient, shorter alternative.
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Affiliation(s)
- Reuben Ogollah
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, D Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Annette Bishop
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Martyn Lewis
- Research Institute for Primary Care and Health Sciences.,Keele Clinical Trials Unit, Keele University
| | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,FORMI, Oslo University Hospital, Oslo, Norway
| | - Nadine E Foster
- Research Institute for Primary Care and Health Sciences.,Keele Clinical Trials Unit, Keele University
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15
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Severinsen A, Midtgaard J, Backhausen MG, Broberg L, Hegaard HK. Pregnant women’s experiences with sick leave caused by low back pain. A qualitative study. Work 2019; 64:271-281. [DOI: 10.3233/wor-192991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anette Severinsen
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Julie Midtgaard
- The University Hospitals’ Centre for Health Research (UCSF), Copenhagen University Hospital (Rigshospitalet), Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lotte Broberg
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Denmark
| | - Hanne Kristine Hegaard
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Denmark
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16
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Bergström C, Persson M, Mogren I. Psychosocial and behavioural characteristics in women with pregnancy-related lumbopelvic pain 12 years postpartum. Chiropr Man Therap 2019; 27:34. [PMID: 31417671 PMCID: PMC6691525 DOI: 10.1186/s12998-019-0257-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background There is insufficient evidence regarding psychosocial factors and its long-term association with persistent pregnancy-related lumbopelvic pain. The overall aim of this study was to investigate women with persistent pregnancy-related lumbopelvic pain 12 years postpartum based on psychosocial and behavioural characteristics using the Swedish version of the Multidimensional Pain Inventory (MPI-S) classification system. Material and methods This is a cross-sectional study based on a previous cohort. Data collection took place through a questionnaire. A total of 295 women from the initial cohort (n = 639) responded to the questionnaire giving a response rate of 47.3%. To determine the relative risk (RR) of reporting pain 12 years postpartum, a robust modified Poisson regression was used. This is the first study using the MPI-S as a predictive variable on women with persistent pregnancy-related lumbopelvic pain. Results The MPI-S classification procedure was carried out on a total of n = 226 women, where 53 women were classified as interpersonally distressed (ID), 82 as dysfunctional (DYS), and 91 as adaptive copers (AC). Women in the ID and DYS subgroups had a relative risk (RR) of reporting persistent pregnancy-related lumbopelvic pain 12 years postpartum that was more than twice as high compared to the AC subgroup (95% confidence interval (CI) in parenthesis): RR 2.57 (CI 1.76 - 3.75), p<0.0001 and RR 2.23 (CI 1.53 - 3.25), p<0.0001 respectively. Women in the DYS subgroup had more than 5 times increased risk of reporting sick leave the past 12 months compared to the AC subgroup (RR 5.44; CI 1.70 - 17.38, p=0.004). Conclusions The present study demonstrates that it is possible to classify women with persistent pregnancy-related lumbopelvic pain 12 years postpartum into relevant clinical subgroups based on psychosocial and behavioural characteristics using the MPI-S questionnaire.
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Affiliation(s)
- Cecilia Bergström
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
| | - Margareta Persson
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.,2Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | - Ingrid Mogren
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
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17
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Low back pain intensity among childbearing women and associated predictors. A cohort study. Women Birth 2019; 32:e467-e476. [DOI: 10.1016/j.wombi.2018.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/22/2022]
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18
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Abdelnaeem AO, Vining R, Rehan Youssef A. Classification of pregnancy related non-specific low back pain and pelvic girdle pain: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1637600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ahmed Omar Abdelnaeem
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States
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19
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Stafne SN, Vøllestad NK, Mørkved S, Salvesen KÅ, Stendal Robinson H. Impact of job adjustment, pain location and exercise on sick leave due to lumbopelvic pain in pregnancy: a longitudinal study. Scand J Prim Health Care 2019; 37:218-226. [PMID: 31057021 PMCID: PMC6566798 DOI: 10.1080/02813432.2019.1608058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: To identify factors associated with sick leave due to lumbopelvic pain (LPP) in pregnancy. Design: Prospective cohort study using participants from a randomized controlled trial (RCT) designed to study the effect of exercise during pregnancy on pregnancy related diseases. Setting: St. Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, April 2007 to December 2009. Subjects: Healthy pregnant women. Main outcome measures: Self-reported sick leave due to LPP in late pregnancy (gestation week 32-36). Results: In total, 532/716 (74%) women reported LPP at 32-36 weeks of pregnancy, and 197/716 (28%) reported sick leave due to LPP. Not receiving job adjustments when needed (Odds ratio, OR with 95% confidence interval, CI, was 3.0 (1.7-5.4)) and having any pain in the pelvic girdle versus no pain (OR 2.7 (1.3-5.6), OR 2.7 (1.4-5.2) and OR 2.2 (1.04-4.8)) for anterior, posterior and combined anterior and posterior pain in the pelvis respectively, were associated with sick leave due to LPP in late pregnancy. Also higher disability, sick listed due to LPP at inclusion and lower education, were significant explanatory variables. There was a trend of reduced risk for sick leave due to LPP when allocated to the exercise group in the original RCT (OR 0.7 (0.4-1.0)). Conclusion: Facilitating job adjustments when required might keep more pregnant women in employment. Furthermore, pain locations in pelvic area, disability, lower education and being sick listed due to LPP in mid pregnancy are important risk factors for sick leave in late pregnancy. Key points Current awareness: More than half of pregnant women are on sick leave during pregnancy and the most frequently reported cause is lumbopelvic pain. This paper adds: Inability to make job adjustments, pain locations in pelvic area, disability and lower education level were the most important risk factors for sick leave in late pregnancy. Facilitating early job adjustment might be a precaution to keep more pregnant women in work. Allocation to an exercise group tended to reduce the risk of sick leave in late pregnancy.Registration number: Clinical trial gov (NCT00476567).
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Affiliation(s)
- Signe N. Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;
- CONTACT Signe N. Stafne Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491Trondheim, Norway
| | - Nina K. Vøllestad
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Norway;
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;
- Research Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;
| | - Kjell Å. Salvesen
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;
- Institute of clinical and molecular medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Stendal Robinson
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Norway;
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20
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Marín-Jiménez N, Acosta-Manzano P, Borges-Cosic M, Baena-García L, Coll-Risco I, Romero-Gallardo L, Aparicio VA. Association of self-reported physical fitness with pain during pregnancy: The GESTAFIT Project. Scand J Med Sci Sports 2019; 29:1022-1030. [PMID: 30933387 DOI: 10.1111/sms.13426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 01/22/2023]
Abstract
AIMS To explore the association of self-reported physical fitness with bodily, lumbar and sciatic pain, and pain disability during pregnancy. METHODS The present study sample comprised 159 pregnant women (32.9 ± 4.7 years old). Self-reported physical fitness was assessed with the International Fitness Scale (IFIS), where higher scores indicate greater physical fitness. Bodily pain was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores indicate lower pain. Lumbar and sciatic pain were measured with a visual analogue scale (VAS). The Oswestry Disability Index (ODI) questionnaire was employed to assess the disability resulting from pain. Measures were assessed at 16th and 34th gestational weeks (g. w.). RESULTS Pregnant women showed low-moderate pain during pregnancy course. Most of them showed medium self-reported overall physical fitness. At 16th g. w., greater self-reported overall physical fitness and cardiorespiratory fitness were associated with less bodily and lumbar pain, and pain disability (all, P < 0.05). Greater muscular strength was associated with less bodily pain and pain disability (both, P < 0.05). Greater speed-agility was associated with less bodily pain (P < 0.01) and less pain disability (P < 0.05). Self-reported flexibility was not associated with any outcome (P > 0.05). At 34th g. w., greater overall physical fitness and its components were associated with less bodily and sciatic pain (all, P < 0.05). CONCLUSION Greater self-reported overall physical fitness and its components are associated with less bodily, lumbar and sciatic pain, and reduced pain disability during pregnancy. Future studies are needed to explore whether increasing physical fitness before and during pregnancy could decrease pain in this relevant stage.
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Affiliation(s)
- Nuria Marín-Jiménez
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Milkana Borges-Cosic
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Laura Baena-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Coll-Risco
- Sport and Health Research Centre, University of Granada, Granada, Spain.,Department of Physiology, Biomedical Research Centre and Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Lidia Romero-Gallardo
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Virginia A Aparicio
- Sport and Health Research Centre, University of Granada, Granada, Spain.,Department of Physiology, Biomedical Research Centre and Sport and Health Research Centre, University of Granada, Granada, Spain
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21
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Hidden association between the presence and severity of striae gravidarum and low back pain in pregnancy. Eur J Obstet Gynecol Reprod Biol 2019; 233:49-52. [DOI: 10.1016/j.ejogrb.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 12/23/2022]
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22
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Lafrenaye-Dugas AJ, Courtois F. Lombalgie chronique et difficultés sexuelles : évaluation, éducation et intervention. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Wuytack F, Gutke A, Stuge B, Mørkved S, Olsson C, Robinson HS, Vøllestad NK, Öberg B, Wikmar LN, Mena JJS, Smith V. Protocol for the development of a core outcome set for pelvic girdle pain, including methods for measuring the outcomes: the PGP-COS study. BMC Med Res Methodol 2018; 18:158. [PMID: 30509216 PMCID: PMC6276248 DOI: 10.1186/s12874-018-0624-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 11/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Pelvic Girdle Pain (PGP) is an important cause of disability and economic cost worldwide. There is a need for effective preventative and management strategies. Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult. A Core Outcome Set (COS) can address this problem by ensuring that data are relevant, useful and usable for making well-informed healthcare choices. The aim of this study is to develop a consensus-based PGP-COS, including agreement on methods (e.g. instruments) for measuring the construct outcomes in the COS for use in research and clinical practice. Furthermore, as there is uncertainty as to whether incorporating stakeholder interviews in addition to conducting a systematic review to determine an initial list of outcomes for the Delphi survey, or, whether using different rating scales in a Delphi survey impacts on the final COS, we propose to embed two methodological studies within the PGP-COS development process to address these questions. Methods The PGP-COS study will include five phases: (1) A systematic review of the literature and semi-structured interviews with 15 patients (three countries) to form the initial list of outcomes for the Delphi survey; (2) A 3-round Delphi including patients, clinicians, researchers and service providers; (3) A systematic review of methods for measuring the outcomes in the preliminary PGP-COS identified in the Delphi survey; (4) A face-to-face consensus meeting to agree on the final PGP-COS and methods for measuring the COS; (5) Global dissemination. To address the methodological questions, we will assess the number and type of outcomes, in the final PGP-COS, that were exclusively derived from the interviews. Secondly, we will randomise Delphi survey participants to either a 5-point or 9-point importance rating scale, and examine potential differences in ‘important’ ratings between the groups. Discussion There is currently no COS for measuring/monitoring PGP in trials and clinical practice. A PGP-COS will ensure that relevant outcomes are measured using appropriate measurement instruments for patients with PGP globally. Core outcome set registration This PGP-COS was registered with COMET (Core Outcome Measures for Effectiveness Trials) in January 2017 (http://www.comet-initiative.org/studies/details/958). Electronic supplementary material The online version of this article (10.1186/s12874-018-0624-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Box 455, 40530, Göteborg, Sweden
| | - Britt Stuge
- Division for Neuroscience and Musculoskeletal Medicine, Oslo University Hospital, Oslo, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, N-7489, Trondheim, Norway
| | - Christina Olsson
- Mörby Academic Primary Healthcare Centre, Golfvägen 8, 182 31, Danderyd, Sweden
| | - Hilde Stendal Robinson
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0318, Oslo, Norway
| | - Nina K Vøllestad
- Institute of Health and Society, University of Oslo, Box 1133 Blindern, N-0318, Oslo, Norway
| | - Birgitta Öberg
- Department of Medicine and Health, Linköping University, 581 85, Linköping, Sweden
| | - Lena Nilsson Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Juan Jose Saldaña Mena
- Universidad Estatal del Valle de Ecatepec, Calle León Guzmán #60 Col Valle de Anáhuac CP, 55210, Ecatepec de Morelos, Mexico
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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Lardon E, St-Laurent A, Babineau V, Descarreaux M, Ruchat SM. Lumbopelvic pain, anxiety, physical activity and mode of conception: a prospective cohort study of pregnant women. BMJ Open 2018; 8:e022508. [PMID: 30389759 PMCID: PMC6224755 DOI: 10.1136/bmjopen-2018-022508] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Pregnancy-related lumbopelvic pain (LPP) is a frequent condition known to significantly affect women in their daily life. The aetiology of pregnancy-related LPP pain is still not clearly established but the mode of conception has been suggested to contribute to LPP. Anxiety related to fertility treatments may be one of the contributing factors. The primary objectives of this study were to determine the evolution of LPP prevalence and severity, and anxiety throughout pregnancy in women who conceived spontaneously (SP) or after fertility treatments (FT). A further aim was to examine the relationship between pregnancy-related LPP severity and anxiety. The secondary objective was to determine the evolution of physical activity and their correlation with the severity of pregnancy-related LPP. DESIGN Prospective cohort study. SETTING Pregnant women were recruited through physicians' referrals, posters and newspaper advertisements in the local and surrounding communities (hospital, maternity care clinic, prenatal centres, sports centres, local university) in the city of Trois-Rivières, Canada. PARTICIPANTS 59 pregnant women (33 SP and 26 FT) were assessed during the first, second and third trimester of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Pregnancy-related LPP prevalence and severity (primary), trait and state anxiety, and physical activity levels (secondary). RESULTS There was no relationship between the mode of conception and the outcome measures. The prevalence and severity of LPP increased over the course of pregnancy (time effect, p<0.0001) whereas trait anxiety decreased from early to mid-pregnancy (time effect, p=0.03). Activity limitations increased throughout pregnancy (time effect, p<0.0001) and physical activity levels decreased (time effect, p<0.0001). The severity of LPP was positively correlated with activity limitations (r=0.51 to 0.55) but negatively with physical activity levels (r=-0.39 to -0.41). CONCLUSIONS Maternal health-related factors, such as LPP, anxiety and physical activity, are not different in women who conceived spontaneously or after fertility treatments. The more LPP was severe, the more the women were physically limited and inactive.
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Affiliation(s)
- Emeline Lardon
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Institut Franco-Européen de Chiropraxie, Paris, France
| | - Audrey St-Laurent
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Véronique Babineau
- Department of Obstetrics and Gynaecology, Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, affiliated to the University of Montreal, Trois-Rivières, Quebec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
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Vico Pardo FJ, López del Amo A, Pardo Rios M, Gijon-Nogueron G, Yuste CC. Changes in foot posture during pregnancy and their relation with musculoskeletal pain: A longitudinal cohort study. Women Birth 2018; 31:e84-e88. [DOI: 10.1016/j.wombi.2017.08.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
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Mackenzie J, Murray E, Lusher J. Women's experiences of pregnancy related pelvic girdle pain: A systematic review. Midwifery 2018; 56:102-111. [DOI: 10.1016/j.midw.2017.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/20/2017] [Accepted: 10/15/2017] [Indexed: 12/31/2022]
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Backhausen M, Damm P, Bendix J, Tabor A, Hegaard H. The prevalence of sick leave: Reasons and associated predictors - A survey among employed pregnant women. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:54-61. [PMID: 29389502 DOI: 10.1016/j.srhc.2017.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/12/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to investigate the prevalence of sick leave and self-reported reasons given for sick leave during pregnancy. Furthermore, we aimed to estimate the frequency of long-term sick leave during pregnancy in relation to pre-baseline maternal characteristics and to identify predictors of long-term sick leave. METHOD Data from 508 employed pregnant women seeking antenatal care was collected by questionnaires from August 2015 to March 2016. The questionnaires, which were filled in at 20 and 32 weeks of gestation, provided information on maternal characteristics, the number of days spent on sick leave and the associated reasons. Descriptive statistics and logistic regression analysis were applied. RESULTS The prevalence of sick leave was 56% of employed pregnant women in the first 32 weeks of gestation and more than one in four reported long-term sick leave (>20 days, continuous or intermittent). Low back pain was the reason most frequently stated. Fewer than one in ten stated that their sick leave was due to work-related conditions. Positive predictors of long-term sick leave were multiparity, pre-pregnancy low back pain and mental disease, while an advanced degree education was a negative predictor. CONCLUSIONS The prevalence of sick leave was 56% in the first 32 weeks of gestation and more than one in four women reported long-term sick leave. The majority of reasons for sick leave were pregnancy-related and low back pain was the most frequently given reason.
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Affiliation(s)
- Mette Backhausen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Gynecology and Obstetrics, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Peter Damm
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jane Bendix
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Ann Tabor
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Hanne Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Backhausen MG, Tabor A, Albert H, Rosthøj S, Damm P, Hegaard HK. The effects of an unsupervised water exercise program on low back pain and sick leave among healthy pregnant women - A randomised controlled trial. PLoS One 2017; 12:e0182114. [PMID: 28877165 PMCID: PMC5587299 DOI: 10.1371/journal.pone.0182114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 07/11/2017] [Indexed: 12/31/2022] Open
Abstract
Background Low back pain is highly prevalent among pregnant women, but evidence of an effective treatment are still lacking. Supervised exercise–either land or water based–has shown benefits for low back pain, but no trial has investigated the evidence of an unsupervised water exercise program on low back pain. We aimed to assess the effect of an unsupervised water exercise program on low back pain intensity and days spent on sick leave among healthy pregnant women. Methods In this randomised, controlled, parallel-group trial, 516 healthy pregnant women were randomly assigned to either unsupervised water exercise twice a week for a period of 12 weeks or standard prenatal care. Healthy pregnant women aged 18 years or older, with a single fetus and between 16–17 gestational weeks were eligible. The primary outcome was low back pain intensity measured by the Low Back Pain Rating scale at 32 weeks. The secondary outcomes were self-reported days spent on sick leave, disability due to low back pain (Roland Morris Disability Questionnaire) and self-rated general health (EQ-5D and EQ-VAS). Results Low back pain intensity was significantly lower in the water exercise group, with a score of 2.01 (95% CI 1.75–2.26) vs. 2.38 in the control group (95% CI 2.12–2.64) (mean difference = 0.38, 95% CI 0.02–0.74 p = 0.04). No difference was found in the number of days spent on sick leave (median 4 vs. 4, p = 0.83), disability due to low back pain nor self-rated general health. There was a trend towards more women in the water exercise group reporting no low back pain at 32 weeks (21% vs. 14%, p = 0.07). Conclusions Unsupervised water exercise results in a statistically significant lower intensity of low back pain in healthy pregnant women, but the result was most likely not clinically significant. It did not affect the number of days on sick leave, disability due to low back pain nor self-rated health. Trial registration ClinicalTrials.gov NCT02354430
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Affiliation(s)
- Mette G. Backhausen
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
- Research Unit Women`s and Children`s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- * E-mail:
| | - Ann Tabor
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne K. Hegaard
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Research Unit Women`s and Children`s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
BACKGROUND AND OBJECTIVE A comparison of sick leave in pregnancy between countries is difficult as most studies have been conducted in single countries in Scandinavia. The objective of this study was to explore patterns of and reasons for sick leave during pregnancy on a multinational level, focusing on medication use but also differences in sick leave policies. DESIGN AND SETTING Cross-sectional, web-based study in 12 European countries from October 2011 to February 2012. Data were collected via an electronic questionnaire. PARTICIPANTS Pregnant women and mothers of children under the age of 1 year. PRIMARY OUTCOME MEASURE Sick leave prevalence in pregnancy. RESULTS Of 6686 women included, 3385 (50.6%) had been on sick leave during pregnancy. The rates of sick leave varied across countries, ranging from 31.7%-34.8% in Sweden and the UK to 62.4%-71.3% in Norway, Serbia, Croatia and Poland. The most common reasons for being on sick leave were pregnancy complications (26.5%); pain in the neck, back or pelvic girdle (16.2%); and nausea and vomiting (NVP, 16.0%). Women using medications for acute illnesses were more likely to be on sick leave than their non-medicated counterparts, while an opposite trend was observed for women with chronic disorders, where non-medicated women were more likely to be on sick leave. Women from countries with 'low' sick leave policies were less likely to have extensions of sick leaves compared with women from countries with 'medium' policies (adjusted OR 0.63, 95% CI 0.49 to 0.82). CONCLUSION The rates of sick leave in pregnancy vary greatly across European countries. Women using medications were more likely to be on sick leave, especially for acute illnesses. The differences in sick leave patterns across countries only partially reflected differences in sick leave policies, which implies that sick leave in pregnancy is also affected by other national differences.
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Affiliation(s)
- Bich Thuy Truong
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Preventive Medicine and Epidemiology Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Melkersson C, Nasic S, Starzmann K, Bengtsson Boström K. Effect of Foot Manipulation on Pregnancy-Related Pelvic Girdle Pain: A Feasibility Study. J Chiropr Med 2017; 16:211-219. [PMID: 29097951 DOI: 10.1016/j.jcm.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/10/2017] [Indexed: 01/13/2023] Open
Abstract
Objective The objective of this study was to investigate if the research process to evaluate the effect of foot manipulation on pregnancy-related pelvic girdle pain (PPGP) is feasible. Methods A randomized, single-blind (patients and evaluators) pilot trial was performed to compare foot manipulation to a comparative group at 6-weekly treatment sessions at 5 physiotherapy outpatient clinics in Skaraborg primary care (Skövde, Sweden). Women at 12 to 31 weeks of pregnancy with well-defined PPGP (n = 97) and joint dysfunction or decreased range of movement in the feet were included. Women with a twin pregnancy, low back pain, rheumatoid arthritis, or other serious diseases and those who had previous foot manipulation were excluded. Visual analog scale scores were recorded before study start, before and after each treatment session, and 3 months after delivery. Results One-hundred and two women were eligible, and 97 were included (group 1: foot manipulation, n = 47; group 2: comparative treatment, n = 50); 40 and 36 in the foot manipulation and comparative treatment groups, respectively, completed the study. The foot manipulation group had a nonsignificant pain relief score compared with that of the comparative group, which had higher pain relief scores. The difference was most pronounced at the first and second treatment sessions. A power analysis showed that at least 250 individuals would be needed in each group to confirm the effect of foot manipulation. Conclusions This study showed that it is feasible to assess the effect of foot manipulation on PPGP in a multicenter physical therapy outpatient clinic setting. A new larger study should choose a different comparative method and test this hypothesis in a full-scale trial.
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Affiliation(s)
| | - Salmir Nasic
- Närhälsan, R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Karin Starzmann
- Närhälsan, R&D Centre, Skaraborg Primary Care, Skövde, Sweden
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Sibbritt D, Ladanyi S, Adams J. Healthcare practitioner utilisation for back pain, neck pain and/or pelvic pain during pregnancy: an analysis of 1835 pregnant women in Australia. Int J Clin Pract 2016; 70:825-831. [PMID: 27620139 DOI: 10.1111/ijcp.12870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Back, neck and/or pelvic pain are common symptoms experienced by pregnant women. Although pregnant women are known to use complementary and alternative medicine (CAM) frequently, no research to date has provided in-depth examination of healthcare practitioner utilisation of pregnant women who experience back, neck and/or pelvic pain. METHODS A sub-study of 1835 pregnant women from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH). Demographics, health status and healthcare utilisation measures were analysed for symptoms of back, neck and/or pelvic pain during pregnancy, using regression models. RESULTS During their pregnancy, 39.5% women experienced back pain, 12.4% experienced neck pain and 16.3% women experienced pelvic pain. Pregnant women were more likely to consult a massage therapist for their back pain (32.3%) and neck pain (39.9%), and another alternative practitioner (27.3%) or obstetrician (22.1%) for pelvic pain, while some women did not seek treatment (<30%). Women who sought help for each symptom reported significantly worse levels of mental and physical health across most SF-36 domains (P<.05). Women without health insurance, or pregnancy-related healthcare insurance were less likely to seek treatment. DISCUSSION AND CONCLUSION Pregnant women experiencing back, neck and/or pelvic pain frequently consult CAM practitioners, particularly if they have healthcare insurance. There is a need for all healthcare practitioners providing maternity care to enquire about possible back, neck and pelvic pain amongst women in their care and be cognisant of possible corresponding CAM use for such symptoms.
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Affiliation(s)
- David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Suzy Ladanyi
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
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Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord 2016; 17:276. [PMID: 27406174 PMCID: PMC4941027 DOI: 10.1186/s12891-016-1154-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/02/2016] [Indexed: 01/13/2023] Open
Abstract
Background Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women’s health and function up to 11 years after pregnancy. Methods/Design A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP. Results A total of 371/530 (70 %) women responded and 37/ 371 (10 %) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR = 1.79), history of low back pain (LBP) (OR = 2.28), positive symphysis pressure test (OR = 2.01), positive Faber (Patrick’s) test (OR = 2.22), and positive modified Trendelenburg test (OR = 2.20). Women with PGP had significantly decreased ability to perform daily activities (p < .001), lower self-efficacy (p = 0.046), decreased HRQL (p < .001), higher levels of anxiety and depression (p < .001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p = 0.032) compared to women with no PGP. Conclusions This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11 years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.
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Affiliation(s)
- Helen Elden
- Gothenburg University, Institute of Health and Caring Sciences, Sahlgrenska Academy, S-405 30, Gothenburg, Sweden.
| | - Annelie Gutke
- Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Gothenburg University, Institute of Neuroscience and Physiology, S-405 30, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital/ Molndal, S-431 80, Molndal, Gothenburg, Sweden
| | - Monika Fagevik-Olsen
- Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Gothenburg University, Institute of Neuroscience and Physiology, S-405 30, Gothenburg, Sweden.,Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, s-413 45, Gothenburg, Sweden
| | - Hans-Christian Ostgaard
- Department of Orthopaedics, Sahlgrenska Academy, Molndal Hospital, S-431 80, Molndal, Sweden
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Close C, Sinclair M, Liddle D, Mc Cullough J, Hughes C. Women's experience of low back and/or pelvic pain (LBPP) during pregnancy. Midwifery 2016; 37:1-8. [DOI: 10.1016/j.midw.2016.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/12/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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A pilot randomised controlled trial (RCT) investigating the effectiveness of reflexology for managing pregnancy low back and/or pelvic pain. Complement Ther Clin Pract 2016; 23:117-24. [DOI: 10.1016/j.ctcp.2015.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/20/2022]
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Bergström C, Persson M, Mogren I. Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiropr Man Therap 2016; 24:7. [PMID: 26885363 PMCID: PMC4754933 DOI: 10.1186/s12998-016-0088-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/08/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pregnancy related low back pain (PLBP) and pelvic girdle pain (PGP) are considered common complications of pregnancy. The long-term consequences for women with persistent PLBP/PGP postpartum are under-investigated. The main objective was to investigate the prevalence, pattern and degree of sick leave as well as healthcare utilisation and its perceived effect in women with persistent PLBP/PGP at 12 months postpartum. METHOD This is a follow-up study of a cohort involving of a sample of women, who delivered from January 1(st) 2002 to April 30(th) in 2002 at Umeå University Hospital and Sunderby Hospital, and who reported PLBP/PGP during pregnancy. A total of 639 women were followed-up by a second questionnaire (Q2) at approximately 6 months postpartum. Women with persistent PLBP/PGP at the second questionnaire (N = 200) were sent a third questionnaire (Q3) at approximately 12 months postpartum. RESULTS The final study sample consisted of 176 women reporting PLBP/PGP postpartum where N = 34 (19.3 %) reported 'no' pain, N = 115 (65.3 %) 'recurrent' pain, and N = 27 (15.3 %) 'continuous' pain. The vast majority (92.4 %) of women reported that they had neither been on sick leave nor sought any healthcare services (64.1 %) during the past 6 months at Q3. Women with 'continuous' pain at Q3 reported a higher extent of sick leave and healthcare seeking behaviour compared to women with 'recurrent' pain at Q3. Most women with persistent PLBP/PGP had been on sick leave on a full-time basis. The most commonly sought healthcare was physiotherapy, followed by consultation with a medical doctor, acupuncture and chiropractic. CONCLUSION Most women did not report any sick leave or sought any healthcare due to PLBP/PGP the past 6 months at Q3. However, women with 'continuous' PLBP/PGP 14 months postpartum did report a higher prevalence and degree of sick leave and sought healthcare to a higher extent compared to women with 'recurrent' PLBP/PGP at Q3. Women with more pronounced symptoms might constitute a specific subgroup of patients with a less favourable long-term outcome, thus PLBP/PGP needs to be addressed early in pregnancy to reduce both individual suffering and the risk of transition into chronicity.
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Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Evensen NM, Kvåle A, Brækken IH. Convergent validity of the Timed Up and Go Test and Ten-metre Timed Walk Test in pregnant women with pelvic girdle pain. ACTA ACUST UNITED AC 2016; 21:94-9. [DOI: 10.1016/j.math.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Malmqvist S, Kjaermann I, Andersen K, Økland I, Larsen JP, Brønnick K. The association between pelvic girdle pain and sick leave during pregnancy; a retrospective study of a Norwegian population. BMC Pregnancy Childbirth 2015; 15:237. [PMID: 26437972 PMCID: PMC4595083 DOI: 10.1186/s12884-015-0667-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background The incidence of pelvic girdle pain (PGP) in pregnancy is wide ranged depending on definition, the utilised diagnostic means, and the design of the studies. PGP during pregnancy has negative effects on activities of daily living and causes long sick leave, which makes it a major public health issue. Our objectives were to explore the frequency of sick leave in pregnancy due to PGP, assess the relationship between different types of pain-related activities of daily living, examine physical workload, type of work in relation to sick leave, and to explore factors that make women less likely to take sick leave for PGP. Methods All women giving birth at the maternity ward of Stavanger University Hospital, Norway, were asked to participate and complete a questionnaire on demographic features, PGP, pain-related activities of daily living, sick leave in general and for PGP, frequency of exercising before and during pregnancy. Drawings of pelvic girdle and low back area were used for the localization of pain. PGP intensity was then rated retrospectively on a numerical rating scale. Non-parametric tests, multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis. Results PGP is a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP we found that work satisfaction, problems with lifting and sleeping, and pain intensity were risk factors for sick leave. In addition, women with longer education, higher work satisfaction and fewer problems with sitting, walking and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave. Conclusions A coping factor in pregnant women with PGP was discovered, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. We recommend these issues to be further examined in a prospective longitudinal study since it may have important implications for sick leave frequency during pregnancy.
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Affiliation(s)
- Stefan Malmqvist
- Department of Health Studies, University of Stavanger, Stavanger, Norway. .,Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
| | | | - Knut Andersen
- Department of Health Studies, University of Stavanger, Stavanger, Norway. .,Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
| | - Inger Økland
- Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway.
| | - Jan Petter Larsen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
| | - Kolbjørn Brønnick
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
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Influence des facteurs professionnels sur l’absentéisme de la femme enceinte dans la région du centre tunisien. ARCH MAL PROF ENVIRO 2015. [DOI: 10.1016/j.admp.2015.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev 2015; 2015:CD001139. [PMID: 26422811 PMCID: PMC7053516 DOI: 10.1002/14651858.cd001139.pub4] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep. OBJECTIVES To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists. SELECTION CRITERIA Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks' gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians' interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back painResults from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic painResults from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic painResults from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient. AUTHORS' CONCLUSIONS There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.
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Affiliation(s)
- Sarah D Liddle
- Ulster UniversityInstitute of Nursing and Health ResearchShore RoadNewtownabbeyCo AntrimIrelandBT37 0QB
| | - Victoria Pennick
- CochraneCochrane Editorial Unit11‐13 Cavendish SquareLondonUKW1G 0AN
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Alsaad AMS, Fox C, Koren G. Toxicology and teratology of the active ingredients of professional therapy MuscleCare products during pregnancy and lactation: a systematic review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:40. [PMID: 25879694 PMCID: PMC4356057 DOI: 10.1186/s12906-015-0585-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/24/2015] [Indexed: 12/01/2022]
Abstract
Background The rates of muscle aches, sprains, and inflammation are significantly increased during pregnancy. However, women are afraid to use systemic analgesics due to perceptions of fetal risks. Thus, topical products are important alternatives to consider for those women. Of interest, Professional Therapy MuscleCare (PTMC) has shown to be effective in alleviating the myofascial pain as reported in a randomized, placebo-controlled double-blinded comparative clinical study of five topical analgesics. However, to date, there is no complete review or long-term safety studies on the safety of these products during pregnancy and lactation. Thus, the aim of this article was to review toxicological, developmental, and reproductive effects associated with the use of PTMC products. Methods We performed a systematic review on safety of PTMC from all toxicological articles investigating the effects of PTMC’s ingredients. This search was conducted through medical and toxicological databases including, Web of Science, EMBASE, Medline, and Micromedix. Both reported and theoretical adverse effects were extensively reviewed. Results Of the 1500 publications reviewed, 100 papers were retrieved and included in the review. Although some ingredients in PTMC products might cause adverse reproductive effects at high systemic doses, these doses are hundreds to thousands fold greater than those systemically available from topical use at the recommended maximum dose (i.e. 10 g/day). Conclusions This study provides evidence that, when used as indicated, PTMC is apparently safe for pregnant women and their unborn babies as well as for breastfed infants.
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Backhausen MG, Katballe M, Hansson H, Tabor A, Damm P, Hegaard HK. A standardised individual unsupervised water exercise intervention for healthy pregnant women. A qualitative feasibility study. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:176-81. [PMID: 25433827 DOI: 10.1016/j.srhc.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Low back pain during pregnancy is common and associated with sick leave. Studies suggest that exercise may reduce low back pain during pregnancy. Before carrying out a randomised controlled trail with individual water exercise as intervention a qualitative feasibility study was done. OBJECTIVE To explore women's views and experiences of the acceptability and benefits of and possible barriers to the standardised individual unsupervised water exercise intervention. MATERIALS AND METHODS Eleven women were interviewed after participating in a water exercise intervention. Content analysis was used. RESULTS Four main categories emerged: motivation to participate, attitudes towards the exercise programme, perception of benefits, and acceptability of supportive components. The women had a desire to stay physically active during pregnancy and found water exercise a suitable, type of exercise to perform during pregnancy. The intervention was experienced to have benefits on both their physical health and their mental well-being. Crowded swimming pools were perceived as the greatest barrier. CONCLUSION It is feasible to perform a RCT using the described intervention. The intervention was accepted by the participants because it supported their desire to be physically active during pregnancy. The main barrier was crowded swimming pools and this issue must be addressed in a future RCT.
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Affiliation(s)
- Mette G Backhausen
- Department of Obstetrics, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Department of Gynecology and Obstetrics, Roskilde University Hospital, Køgevej, 4000 Roskilde, Denmark.
| | - Malene Katballe
- Department of Obstetrics, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Helena Hansson
- Department of Obstetrics, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, Denmark
| | - Peter Damm
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, Denmark; Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne K Hegaard
- Department of Obstetrics, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, Denmark
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Bhardwaj A, Nagandla K. Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management. Postgrad Med J 2014; 90:450-60. [DOI: 10.1136/postgradmedj-2013-132377] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gijon-Nogueron GA, Gavilan-Diaz M, Valle-Funes V, Jimenez-Cebrian AM, Cervera-Marin JA, Morales-Asencio JM. Anthropometric foot changes during pregnancy: a pilot study. J Am Podiatr Med Assoc 2014; 103:314-21. [PMID: 23878384 DOI: 10.7547/1030314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Women's feet change during pregnancy owing to hormonal and anatomical changes, thus having a strong influence on the decrease in their quality of life during pregnancy. This preliminary study aimed to value the anthropometric and positional changes that affect their feet. METHODS Ten pregnant women were measured during their gestational period to analyze the anthropometric changes in their feet from the 12th week of pregnancy. We examined the changes that occured in foot length, forefoot width, arch of the foot height, and the fixed position of the foot by using the Foot Posture Index, and we analyzed three intervals corresponding to pregnancy weeks 12, 24, and 34. RESULTS The most significant finding, with a reliability rate of 95%, is the decrease in internal arch height, which descends 0.65 mm (0.0394 inches) on average at the final stage of the pregnancy period. This change happened in 18 of the feet analyzed, tending toward pronation according to the measure provided by the Foot Posture Index, with a change of 3.78 points on this scale. CONCLUSIONS The foot of the pregnant woman tends to flatten during gestational weeks 12 to 34, taking a more pronated posture, and the anthropometric changes in late pregnancy result in increases in foot length and forefoot width, changes that seem to be moderate.
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Affiliation(s)
- Gabriel A Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Science, University of Málaga, Málaga, Spain.
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Bergström C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy - pain status, self-rated health and family situation. BMC Pregnancy Childbirth 2014; 14:48. [PMID: 24460727 PMCID: PMC3937130 DOI: 10.1186/1471-2393-14-48] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 01/22/2014] [Indexed: 01/13/2023] Open
Abstract
Background Pelvic girdle pain (PGP) in pregnancy is distinct from pregnancy-related low back pain (PLBP). However, women with combined PLBP and PGP report more serious consequences in terms of health and function. PGP has been estimated to affect about half of pregnant women, where 25% experience serious pain and 8% experience severe disability. To date there are relatively few studies regarding persistent PLBP/PGP postpartum of more than 3 months, thus the main objective was to identify the prevalence of persistent PLBP and PGP as well as the differences over time in regard to pain status, self-rated health (SRH) and family situation at 12 months postpartum. Methods The study is a 12 month follow-up of a cohort of pregnant women developing PLBP and PGP during pregnancy, and who experienced persistent pain at 6 month follow-up after pregnancy. Women reporting PLBP/PGP (n = 639) during pregnancy were followed up with a second questionnaire at approximately six month after delivery. Women reporting recurrent or persistent LBP/PGP at the second questionnaire (n = 200) were sent a third questionnaire at 12 month postpartum. Results A total of 176 women responded to the questionnaire. Thirty-four women (19.3%) reported remission of LBP/PGP, whereas 65.3% (n = 115) and 15.3% (n = 27), reported recurrent LBP/PGP or continuous LBP/PGP, respectively. The time between base line and the 12 months follow-up was in actuality 14 months. Women with previous LBP before pregnancy had an increased odds ratio (OR) of reporting ‘recurrent pain’ (OR = 2.47) or ‘continuous pain’ (OR = 3.35) postpartum compared to women who reported ‘no pain’ at the follow-up. Women with ‘continuous pain’ reported statistically significant higher level of pain at all measure points (0, 6 and 12 months postpartum). Non-responders were found to report a statistically significant less positive scoring regarding relationship satisfaction compared to responders. Conclusions The results from this study demonstrate that persistent PLBP/PGP is a major individual and public health issue among women 14 months postpartum, negatively affecting their self-reported health. However, the perceived relationship satisfaction seems to be stable between the groups.
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Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
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Abstract
BACKGROUND More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain. Pain increases with advancing pregnancy and interferes with work, daily activities and sleep. OBJECTIVES To assess the effects of interventions for preventing and treating pelvic and back pain in pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 July 2012), identified related studies and reviews from the Cochrane Back Review Group search strategy to July 2012, and checked reference lists from identified reviews and studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. Quality of the evidence for outcomes was assessed using the five criteria outlined by the GRADE Working Group. MAIN RESULTS We included 26 randomised trials examining 4093 pregnant women in this updated review. Eleven trials examined LBP (N = 1312), four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). Diagnoses ranged from self-reported symptoms to the results of specific tests. All interventions were added to usual prenatal care and unless noted, were compared to usual prenatal care. For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference (SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23; two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92; one RCT, N = 241). Low-quality evidence from single trials suggested no significant difference in pain or function between two types of pelvic support belt, between osteopathic manipulation (OMT) and usual care or sham ultrasound (sham US). Very low-quality evidence suggested that a specially-designed pillow may relieve night pain better than a regular pillow. For pelvic pain, there was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both were better than usual care. Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not average pain; and evening pain relief was the same following either deep or superficial acupuncture. For lumbo-pelvic pain, there was moderate-quality evidence that an eight- to 20-week exercise program reduced the risk of women reporting lumbo-pelvic pain (RR 0.85; 95% CI 0.73 to 1.00; four RCTs, N = 1344); but a 16- to 20-week training program was no more successful than usual care at preventing pelvic pain (one RCT, N = 257). Low-quality evidence suggested that exercise significantly reduced lumbo-pelvic-related sick leave (RR 0.76; 95% CI 0.62 to 0.94, two RCTs, N = 1062), and improved function. Low-quality evidence from single trials suggested that OMT significantly reduced pain and improved function; either a multi-modal intervention that included manual therapy, exercise and education (MOM) or usual care significantly reduced disability, but only MOM improved pain and physical function; acupuncture improved pain and function more than usual care or physiotherapy; pain and function improved more when acupuncture was started at 26- rather than 20- weeks' gestation; and auricular (ear) acupuncture significantly improved these outcomes more than sham acupuncture.When reported, adverse events were minor and transient. AUTHORS' CONCLUSIONS Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or LBP. Low-quality evidence suggested that exercise significantly reduced pain and disability from LBP.There was low-quality evidence from single trials for other outcomes because of high risk of bias and sparse data; clinical heterogeneity precluded pooling. Publication bias and selective reporting cannot be ruled out.Physiotherapy, OMT, acupuncture, a multi-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone. Acupuncture was more effective than physiotherapy at relieving evening lumbo-pelvic pain and disability and improving pain and function when it was started at 26- rather than 20-weeks' gestation, although the effects were small.There was no significant difference in LBP and function for different support belts, exercise, neuro emotional technique or spinal manipulation (SMT), or in evening pelvic pain between deep and superficial acupuncture.Very low-quality evidence suggested a specially-designed pillow may reduce night-time LBP.Further research is very likely to have an important impact on our confidence in the estimates of effect and is likely to change the estimates. Future research would benefit from the introduction of an agreed classification system that can be used to categorise women according to presenting symptoms.
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Affiliation(s)
- Victoria Pennick
- Cochrane Editorial Unit, The Cochrane Collaboration, 11-13 Cavendish Square, London, UK, W1G 0AN
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Persson M, Winkvist A, Dahlgren L, Mogren I. "Struggling with daily life and enduring pain": a qualitative study of the experiences of pregnant women living with pelvic girdle pain. BMC Pregnancy Childbirth 2013; 13:111. [PMID: 23668823 PMCID: PMC3661342 DOI: 10.1186/1471-2393-13-111] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 05/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy. Methods A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach. Results The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented. Conclusions PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.
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Affiliation(s)
- Margareta Persson
- Dalarna University, School of Health and Social studies, Falun, SE-791 88, Sweden.
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Dørheim SK, Bjorvatn B, Eberhard-Gran M. Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG 2012; 120:521-30. [DOI: 10.1111/1471-0528.12035] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Affiliation(s)
- SK Dørheim
- MoodNet Research Group; Division of Psychiatry; Stavanger University Hospital; Stavanger; Norway
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Peterson CD, Haas M, Gregory WT. A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain. Chiropr Man Therap 2012; 20:18. [PMID: 22694756 PMCID: PMC3542201 DOI: 10.1186/2045-709x-20-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/24/2012] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED BACKGROUND This pilot randomized controlled trial evaluated the feasibility of conducting a full scale study and compared the efficacy of exercise, spinal manipulation, and a mind-body therapy called Neuro Emotional Technique for the treatment of pregnancy-related low back pain, a common morbidity of pregnancy. METHODS Healthy pregnant women with low back pain of insidious onset were eligible to enroll in the study at any point in their pregnancy. Once enrolled, they remained in the study until they had their babies. Women were randomly allocated into one of three treatment groups using opaque envelopes. The treatment schedule paralleled the prenatal care schedule and women received individualized intervention. Our null hypothesis was that spinal manipulation and Neuro Emotional Technique would perform no better than exercise in enhancing function and decreasing pain. Our primary outcome measure was the Roland Morris Disability Questionnaire and our secondary outcome measure was the Numeric Pain Rating Scale. Intention to treat analysis was conducted. For the primary analysis, regression was conducted to compare groups on the outcome measure scores. In a secondary responder analysis, difference in proportions of participants in attaining 30% and 50% improvement were calculated. Feasibility factors for conducting a future larger trial were also evaluated such as recruitment, compliance to study protocols, cost, and adverse events. RESULTS Fifty-seven participants were randomized into the exercise (n = 22), spinal manipulation (n = 15), and Neuro Emotional Technique (n = 20) treatment arms. At least 50% of participants in each treatment group experienced clinically meaningful improvement in symptoms for the Roland Morris Disability Questionnaire. At least 50% of the exercise and spinal manipulation participants also experienced clinically meaningful improvement for the Numeric Pain Rating Scale. There were no clinically meaningful or statistically significant differences between groups in any analysis. CONCLUSIONS This pilot study demonstrated feasibility for recruitment, compliance, safety, and affordability for conducting a larger study in the future. Spinal manipulation and exercise generally performed slightly better than did Neuro Emotional Technique for improving function and decreasing pain, but the study was not powered to detect the between-group differences as statistically significant. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT00937365).
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Affiliation(s)
| | - Mitchell Haas
- Division of Research, University of Western States, Portland, OR, USA
| | - W Thomas Gregory
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
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Pregnancy-related lumbopelvic pain: listening to Australian women. Nurs Res Pract 2012; 2012:387428. [PMID: 22685643 PMCID: PMC3366229 DOI: 10.1155/2012/387428] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/04/2012] [Accepted: 03/09/2012] [Indexed: 11/25/2022] Open
Abstract
Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. Sample population: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy.
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Prevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population. J Manipulative Physiol Ther 2012; 35:272-8. [DOI: 10.1016/j.jmpt.2012.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 11/30/2011] [Accepted: 01/13/2012] [Indexed: 11/19/2022]
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