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Hameed F, Cesare A, Mariscal Del Moral N, Barton T, Chiarello C. Is Pregnancy-Related Lumbopelvic Pain Reported to Health Care Providers? J Womens Health (Larchmt) 2023; 32:1192-1199. [PMID: 37535018 DOI: 10.1089/jwh.2022.0459] [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] [Indexed: 08/04/2023] Open
Abstract
Background: Pregnancy-related lumbopelvic pain (PLPP) is a common ailment during pregnancy with physical, psychosocial, and economic consequences. Despite being common, prior literature has found that this symptom is widely underreported and therefore undertreated, especially in the United States. The objectives of this study were to determine the proportion of pregnant women who report PLPP during pregnancy to their health care providers (HCPs) and to determine what contributing factors for reporting exist. Materials and Methods: This is a cross-sectional survey design and was conducted at an academic medical center. All pregnant women attending a prenatal visit in obstetrical offices from July 2018 through March 2020 were asked to complete a questionnaire compiling demographic and socioeconomic information, answer validated survey instruments measuring physical and urinary function, and describe any pain, including intensity, frequency, and whether they told their HCPs about these symptoms and received any treatments. Results: Of the 538 respondents who had PLPP, only 43% (n = 233) reported PLPP to their provider. Of those who reported PLPP, 22% (n = 51) received treatment, of which 80% (n = 41) noted that treatment was effective. Factors that increased the likelihood of informing HCPs about PLPP were difficulty with daily mobility and a greater week of gestation. Conclusions: HCPs should inquire about PLPP throughout pregnancy. Any level of PLPP should be reported and monitored by a patient's HCP, and if it is interfering with activities of daily living, sleeping, or quality of life, it should be treated.
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Affiliation(s)
- Farah Hameed
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ariana Cesare
- Program in Physical Therapy, Columbia University Irving Medical Center, New York, New York, USA
| | - Nura Mariscal Del Moral
- Program in Physical Therapy, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Cynthia Chiarello
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Ahlqvist K, Bjelland EK, Pingel R, Schlager A, Peterson M, Olsson CB, Nilsson‐Wikmar L, Kristiansson P. Generalized joint hypermobility and the risk of pregnancy-related pelvic girdle pain: Is body mass index of importance?-A prospective cohort study. Acta Obstet Gynecol Scand 2023; 102:1259-1268. [PMID: 37614096 PMCID: PMC10540924 DOI: 10.1111/aogs.14664] [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: 03/26/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Pelvic girdle pain (PGP) affects approximately 50% of pregnant women. The mechanisms are multifactorial but not fully understood. Women with generalized joint hypermobility (GJH) may be vulnerable to load in the pelvic joints during pregnancy. Our aim was to investigate if women with GJH had an increased risk of PGP and higher pain intensity during and after pregnancy, compared with women with normal joint mobility. We also studied if body mass index (BMI) in early pregnancy influenced that risk. MATERIAL AND METHODS A prospective cohort study of 356 women, whose data were collected by self-reports and clinical examinations in early and in late pregnancy and 9 months after childbirth. GJH was present with ≥5/9 points on the Beighton score. PGP was defined by a pain drawing and ≥1 positive test. Pain intensity was measured with a visual analogue scale (0-100 mm). We adjusted for age and origin in logistic regression and ordinal logistic regression analysis. RESULTS In early pregnancy, 47.1% of the women with GJH had PGP vs 32.6% of women with normal joint mobility (adjusted odds ratio [aOR] 1.76; 95% confidence interval [CI] 0.86-3.62) and had higher odds of reporting higher pain intensity (aOR 2.04; 95% CI 1.02-4.07). The odds of PGP were highest for women with GJH and BMI ≥25 kg/m2 (aOR 6.88; 95% CI 1.34-35.27) compared with women with normal joint mobility and BMI <25 kg/m2 . The estimated associations were weaker and not statistically significant in late pregnancy or after childbirth. CONCLUSIONS Women with GJH did not have an increased risk of PGP during or after pregnancy but reported higher pain intensity in early pregnancy compared with women with normal joint mobility. Since women with combined GJH and BMI ≥25 kg/m2 had the highest odds of PGP in early pregnancy, our results may suggest that health care needs to pay attention to and develop methods to reduce the risk of PGP and delay the onset of pain during pregnancy in women with this combination.
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Affiliation(s)
- Kerstin Ahlqvist
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Elisabeth Krefting Bjelland
- Department of Rehabilitation Science and Health TechnologyOslo Metropolitan UniversityOsloNorway
- Department of Obstetrics and GynecologyAkershus University HospitalLorenskogNorway
| | - Ronnie Pingel
- Department of StatisticsUppsala UniversityUppsalaSweden
| | - Angela Schlager
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Magnus Peterson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Christina B. Olsson
- Academic Primary Healthcare CenterStockholm County CouncilHuddingeSweden
- Department of Neurobiology, Care Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddingeSweden
| | - Lena Nilsson‐Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddingeSweden
| | - Per Kristiansson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Ertmann RK, Nicolaisdottir DR, Siersma V, Overbeck G, Strøyer de Voss S, Modin FA, Lutterodt MC. Factors in early pregnancy predicting pregnancy-related pain in the second and third trimester. Acta Obstet Gynecol Scand 2023; 102:1269-1280. [PMID: 37771202 PMCID: PMC10541159 DOI: 10.1111/aogs.14670] [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: 03/23/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy. MATERIAL AND METHODS Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis. RESULTS A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores. CONCLUSIONS When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.
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Amayri A, Khalayli N, Haj Ali D, Kudsi M. Low back pain in a sample of Syrian pregnant women: A cross-sectional study. Health Sci Rep 2023; 6:e1389. [PMID: 37408868 PMCID: PMC10318381 DOI: 10.1002/hsr2.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Low back pain related to pregnancy occurs in 60%-70% of pregnancies, at any time during pregnancy. During pregnancy, many factors such as weight gain, and others are the causes of the back pain. In Syria, due to the circumstances of the war, many pregnant women may be exposed to increase the risk of lower back pain, so this study will determine the prevalence of lower back pain among pregnant women and its potential risk factors. We aimed to evaluate the prevalence of low back pain in pregnant women and to assess the risk factors related to it. Methods A cross-sectional, observational study was conducted between May 2020 and December 2022 at Obstetrics and Gynecology University Hospital in Damascus, Syria. Pregnant women aged over 18 years were selected from the outpatient clinic. Participants, after signing the informed consent, fill out the survey, which included the following parameters: age, weight, height, body mass index (BMI), education, parity, shoe type, weekly walking hours, occupation, low back pain, in which semester, radiation, onset, alleviating and aggravating factors, disability, and pain in previous pregnancies. We used Excel 2010, and the Statistical Package for the Social Sciences version 23.0. p < 0.05 was considered statistically significant, and we used the Chi-square test (χ 2 test), t student test to test the basal differences between groups. Results A number of 551 pregnant participants were included and low back pain prevalence was 62%. There was a statistically significant relation between low back pain and each of the following: Obesity, weekly walking hours, pain in previous pregnancies, and occupation. Conclusion Low back pain is prevalent during pregnancy and the most important risk factors include obesity and pain in previous pregnancies whereas walking and employment are protective measures to prevent low back pain.
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Affiliation(s)
- Alaa Amayri
- Department of Internal Medicine, Faculty of MedicineDamascus UniversityDamascusSyrian Arab Republic
| | - Naram Khalayli
- Department of Internal Medicine, Faculty of MedicineDamascus UniversityDamascusSyrian Arab Republic
| | - Diaa Haj Ali
- Department of Internal Medicine, Faculty of MedicineSyrian Private UniversityDamascusSyrian Arab Republic
| | - Maysoun Kudsi
- Department of Internal Medicine, Faculty of MedicineDamascus UniversityDamascusSyrian Arab Republic
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Weis CA, Padkapayeva K, Smith P, Barrett J, Landsman V. Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation. J Manipulative Physiol Ther 2023; 46:143-151. [PMID: 38530696 DOI: 10.1016/j.jmpt.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum. METHODS This was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns. RESULTS We surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum. CONCLUSION The results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.
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Affiliation(s)
- Carol Ann Weis
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | | | - Peter Smith
- Institute for Work and Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Gjellestad M, Haraldstad K, Enehaug H, Helmersen M. Women's Health and Working Life: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1080. [PMID: 36673834 PMCID: PMC9859470 DOI: 10.3390/ijerph20021080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Women's health matters for participation in working life. The objective of this study was to explore female physiology in a work-life context and to investigate possible associations between women's health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women's health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women's health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women's health and working life involve a complex connection that has the potential to develop new knowledge.
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Affiliation(s)
- Marianne Gjellestad
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, 4604 Kristiansand, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, 4604 Kristiansand, Norway
| | - Heidi Enehaug
- Work Research Institute, Center for Welfare and Labour Research, Oslo Metropolitan University, 0176 Oslo, Norway
| | - Migle Helmersen
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, 4604 Kristiansand, Norway
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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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Hameed F, Barton T, Chiarello C. Lumbopelvic Pain in Pregnancy in a Diverse Urban Patient Population: Prevalence and Risk Factors. J Womens Health (Larchmt) 2022; 31:1736-1741. [PMID: 36040347 DOI: 10.1089/jwh.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: Pregnancy lumbopelvic pain (PLPP) is a common ailment during pregnancy with physical, psychosocial, and economic consequences. Prior literature has focused on majority Caucasian patient populations; none have focused on Hispanic populations, especially in the United States. The purpose of this study was to determine the proportion of pregnant people who experience PLPP in mostly Hispanic population. Materials and Methods: Cross-sectional survey Setting: Academic medical center Patients: All pregnant people attending a prenatal visit in obstetrical offices from July 2018 through March 2020 were asked to complete a questionnaire compiling demographic, socioeconomic information as well as describe any pain symptoms. Furthermore, the Pregnancy Mobility Index (PMI), Pelvic Girdle Pain Questionnaire (PGQ), and the Questionnaire for Urinary Incontinence Diagnosis (QUID) were included. Results: In a cohort (n = 851) that was 62% Hispanic, we found a 63% point-prevalence rate for PLPP. Pregnant people who reported PLPP were further along in their pregnancy, did have significantly higher scores for the PMI and PGQ, indicating a greater level of disability, and reported issues with incontinence (QUID). Results of the logistic regression found that a higher PMI score and financial instability were factors influencing PLPP. Conclusions: In a cohort of majority Hispanic people, we found that 63% of respondents had PLPP. Our study found that a higher PMI score and financial instability were factors influencing PLPP. Clinicians should be alert to pregnant people who express their difficulties with activities of daily living as they may be at risk of PLPP, and could benefit from further evaluation and treatment.
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Affiliation(s)
- Farah Hameed
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Travis Barton
- Public Sector Department, SymphonyAI, Palo Alto, California, USA
| | - Cynthia Chiarello
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Ertmann RK, Nicolaisdottir DR, Kragstrup J, Overbeck G, Kriegbaum M, Siersma V. The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth. Acta Obstet Gynecol Scand 2022; 102:33-42. [PMID: 36300886 PMCID: PMC9780714 DOI: 10.1111/aogs.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. MATERIAL AND METHODS Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. RESULTS Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications. CONCLUSIONS Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.
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Affiliation(s)
- Ruth Kirk Ertmann
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Dagny Ros Nicolaisdottir
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Jakob Kragstrup
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Gritt Overbeck
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Volkert Siersma
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
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Andersen DR, Momsen AMH, Pedersen P, Damkjær Maimburg R. Reflections on workplace adjustments for pregnant employees: a qualitative study of the experiences of pregnant employees and their managers. BMC Pregnancy Childbirth 2022; 22:456. [PMID: 35650542 PMCID: PMC9158161 DOI: 10.1186/s12884-022-04749-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The European Union directive requires employers to assess and ensure safety measures for pregnant women in the workplace. Despite this, the rate of sick leave among pregnant Scandinavian women is relatively high. This study aims to provide insight into how pregnant employees and their managers experience and address pregnancy at the workplace, to identify preconditions for successful workplace adjustments for pregnant women. METHODS We carried out a qualitative study that involved semi-structured interviews with seventeen participants: eight pregnant women and nine managers from occupations whose employees demonstrate an increased likelihood of taking sick leave during pregnancy. The interviews were thematically coded and organized into main themes and subthemes. RESULTS Based on semi-structured interviews with the seventeen participants (eight pregnant employees and nine managers), we identified preconditions for successful workplace adjustments. According to the pregnant employees, these included, "The managers' concern, understanding, and acknowledgment," "support and acceptance from colleagues," and "pregnant employees' acceptance of their need for adjustments." According to the managers, the preconditions for successful workplace adjustments included "an open and honest dialogue" and "a systematic approach." CONCLUSION Implementing workplace adjustments for pregnant employees is a complex process that comprises various initiatives, and their success may depend on several factors. This study's findings suggest that the success of workplace interventions depends on 1) management, colleagues, and the pregnant employee recognizing and accepting pregnant women's needs, 2) an organizational culture that supports women and pregnancy without compromising the occupational health of other employees, and 3) professional guidance that supports both women and managers when dealing with pregnancy-related concerns. We suggest that this study's findings may be used to improve the implementation of workplace adjustments for pregnant women.
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Affiliation(s)
- Dorte Raaby Andersen
- grid.452352.70000 0004 8519 1132Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | | | - Pernille Pedersen
- DEFACTUM, Central Denmark Region, Marselisborg Center, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rikke Damkjær Maimburg
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark ,grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Daneau C, Marchand AA, Bussières A, O'Shaughnessy J, Ruchat SM, Descarreaux M. Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial. Pilot Feasibility Stud 2022; 8:65. [PMID: 35313988 PMCID: PMC8935756 DOI: 10.1186/s40814-022-01024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP. Methods/design Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34–36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants’ recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression. Discussion This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy. Trial registration US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01024-0.
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Affiliation(s)
- Catherine Daneau
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Andrée-Anne Marchand
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - André Bussières
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Julie O'Shaughnessy
- Department of Chiropractics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Daneau C, Houle M, Pasquier M, Ruchat SM, Descarreaux M. Association Between Pregnancy-Related Hormones and Lumbopelvic Pain Characteristics in Pregnant Women: A Scoping Review. J Manipulative Physiol Ther 2021; 44:573-583. [PMID: 34895733 DOI: 10.1016/j.jmpt.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this scoping review were (1) to document and quantify the potential associations between lumbopelvic pain characteristics and pregnancy-related hormones, and (2) to identify research approaches and assessment tools used to investigate lumbopelvic pain characteristics and pregnancy-related hormones. METHODS The literature search was conducted in 6 databases (MEDLINE, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, PsycINFO, and Cochrane) from inception up to March 2020 and completed using search terms relevant to pregnant women, pregnancy-related hormones, and lumbopelvic pain. The risk of bias was assessed using the characteristics recommended by Guyatt et al. for observational studies. RESULTS The search yielded 1015 publications from which 9 met the inclusion criteria. Relaxin was the most studied pregnancy-related hormone. An association between relaxin levels and lumbopelvic pain presence or severity was found in 4 studies, while 5 studies did not report an association between them. One study reported an association between relaxin and lumbopelvic pain presence or severity while 2 studies reported no association and were considered as having a low risk of bias. One study reported measures of estrogen and progesterone levels. It showed that progesterone levels were found to be significantly higher in pregnant women with lumbopelvic pain compared to those without, while estrogen concentrations were similar in both groups. CONCLUSION The literature showed conflicting evidence regarding the association between pregnancy-related hormones and lumbopelvic pain characteristics in pregnant women. The assessment tools used to investigate lumbopelvic pain characteristics and pregnancy-related hormones are heterogeneous across studies. Based on limited and conflicting evidence, and due to the heterogeneity of assessment tools and overall poor quality of the literature, the association between pregnancy-related hormones and lumbopelvic pain characteristics is unclear.
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Affiliation(s)
- Catherine Daneau
- Department of Anatomy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Mariève Houle
- Department of Anatomy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Mégane Pasquier
- Department of Anatomy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Stephanie-May Ruchat
- Department of Physical Sciences, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Physical Sciences, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada
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Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med 2021; 10:jcm10225397. [PMID: 34830680 PMCID: PMC8622577 DOI: 10.3390/jcm10225397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden
- Correspondence:
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden;
- Department of Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium;
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Maia LB, Amarante LG, Vitorino DFM, Mascarenhas RO, Lacerda ACR, Lourenço BM, Oliveira VC. Effectiveness of conservative therapy on pain, disability and quality of life for low back pain in pregnancy: A systematic review of randomized controlled trials. Braz J Phys Ther 2021; 25:676-687. [PMID: 34344606 PMCID: PMC8721079 DOI: 10.1016/j.bjpt.2021.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/28/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Efficacy of conservative therapy for low back pain in pregnancy (PLBP) is unclear. OBJECTIVE To investigate the efficacy of conservative therapy on pain, disability, and quality of life in PLBP. METHODS The protocol of this systematic review was prospectively registered at PROSPERO (CRD42020164640). Search strategy was conducted on six databases up to August 24 2020 without date or language restrictions. Minimal intervention (i.e., placebo, sham, waiting list or no intervention) was the comparator of interest. Selection of randomized controlled trials, data extraction and methodological quality assessment of included trials were conducted independently by two reviewers. The PEDro scale (0-10) was used to assess methodological quality. Effect sizes for specific therapies were pooled when possible, using random-effects models. The quality of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. RESULTS Ten included trials provide uncertain evidence (low to very low quality) about the effects of auriculotherapy, education, exercise, exercise plus education, oil treatment, and osteopathy in pain, disability, and quality of life at short- and long-term. At short-term, mean differences (MDs) and 95% confidence intervals (CI) on a 0-10 points pain intensity scale were: for oil treatment, 2.8 points (2.6, 3.1) (n = one trial, 114 participants); for auriculotherapy, 1.6 points (1.2, 2.0) (n = one trial, 112 participants); for exercise, 2.2 points (-1.8, 6.2) (n = three trials, 297 participants). CONCLUSION There is an urgent need for larger high-quality trials investigating effects of conservative therapy in pain, disability, and quality of life in this population.
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Affiliation(s)
- Laísa B Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Letícia G Amarante
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Débora F M Vitorino
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Rodrigo O Mascarenhas
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Ana Cristina R Lacerda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Bianca M Lourenço
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vinícius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
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Svahn Ekdahl A, Fagevik Olsén M, Jendman T, Gutke A. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial. BMJ Open 2021; 11:e046314. [PMID: 34598980 PMCID: PMC8488730 DOI: 10.1136/bmjopen-2020-046314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA). DESIGN Randomised controlled trial. SETTING AND PARTICIPANTS Pregnant women (n=113) with clinically verified PGP in gestational weeks 12-28, recruited from maternity healthcare centres, randomised (1:1) into two groups. EXCLUSION CRITERIA any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment. INTERVENTIONS The intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks. PRIMARY OUTCOME VARIABLES Disability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations. SECONDARY OUTCOME VARIABLES Functioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire). RESULTS No mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture -0.96 (95% CI -1.91 to -0.01; p=0.049), TENS -1.29 (95% CI -2.13 to -0.44; p=0.003) and concern about pain; acupuncture -1.44 (95% CI -2.31 to -0.57; p=0.0012), TENS -1.99 (95% CI -2.81 to -1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048) CONCLUSION: Treating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active. TRIAL REGISTRATION NUMBER 12726. https://www.researchweb.org/is/sverige/project/127261.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Jendman
- Physiotherapy Clinic 'I Rorelse', Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
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16
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Mascarenhas VHA, Caroci-Becker A, Riesco ML. Effectiveness of aromatherapy versus standard care on physiological and psychological symptoms in pregnant women: a systematic review protocol. JBI Evid Synth 2021; 20:658-665. [PMID: 34534171 DOI: 10.11124/jbies-20-00562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of aromatherapy versus standard care on common physiological and psychological symptoms in low-risk pregnant women. INTRODUCTION Women report common symptoms that result from anatomical and physiological changes significant for fetal development and maternal-fetal protection during pregnancy. Aromatherapy is an integrative and complementary practice of ancient origin that works through the administration of essential oils. The practice is used to promote physical and psychological well-being. INCLUSION CRITERIA This systematic review will include studies on healthy pregnant women before labor who received aromatherapy as antenatal care for common physiological and psychological symptoms. Randomized clinical trials, quasi-experimental studies, cohort, and case-control studies will be included. This review will exclude studies that focus on women in labor unless data relating to pregnant women can be separated. METHODS The searches will be carried out on the following databases: MEDLINE, Scopus, CINAHL, Web of Science, CENTRAL, PsycINFO, LILACS, BDENF, CUIDEN, and MOSAICO in Portuguese, English, and Spanish, with no time limit. The searches for unpublished studies will be carried out on the following repositories: ProQuest Dissertations and Theses, Brazilian Digital Library of Theses and Dissertations, British Library EThOS, and the Canadian Theses and Dissertation Portal. The JBI approach will be used for study selection, critical evaluation, data extraction, and synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020218730.
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Affiliation(s)
- Victor Hugo Alves Mascarenhas
- School of Nursing, University of São Paulo, São Paulo, Brazil School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil The Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, São Paulo, Brazil
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Aldabe D, Lawrenson P, Sullivan J, Hyland G, Bussey M, Hammer N, Bryant K, Woodley S. Management of women with pregnancy-related pelvic girdle pain: an international Delphi study. Physiotherapy 2021; 115:66-84. [DOI: 10.1016/j.physio.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
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Olsson A, Kiwanuka O, Sandblom G, Stackelberg O. Evaluation of functional outcomes following rectus diastasis repair-an up-to-date literature review. Hernia 2021; 25:905-914. [PMID: 34302558 PMCID: PMC8370918 DOI: 10.1007/s10029-021-02462-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. METHOD A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. RESULT Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. CONCLUSION The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.
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Affiliation(s)
- A Olsson
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - O Kiwanuka
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
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19
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Aure O, Kvåle A. Do pain, function, range of motion, fear and distress differ according to symptom duration and work status in patients with low back pain? A cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1801834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Alice Kvåle
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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20
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Girard MP, O'Shaughnessy J, Doucet C, Ruchat SM, Descarreaux M. Association Between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women. J Manipulative Physiol Ther 2020; 43:655-666. [PMID: 32709518 DOI: 10.1016/j.jmpt.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Lumbopelvic pain (LBPP) affects 45% to 81% of pregnant women, and 25% to 43% of these women report persistent LBPP beyond 3 months after giving birth. The objective of this study was to investigate the association of physical activity, weight status, anxiety, and evolution of LBPP symptoms in postpartum women. METHODS This was a prospective observational cohort study with 3 time-point assessments: baseline (T0), 3 months (T3), and 6 months (T6). Women with persistent LBPP 3 to 12 months after delivery were recruited. At each time point, pain disability was assessed with the Pelvic Girdle Questionnaire and the Oswestry Disability Index (ODI), physical activity with Fitbit Flex monitors, and anxiety with the French-Canadian version of the State-Trait Anxiety Inventory. Weight was recorded using a standardized method. Pain intensity (numerical rating scale, 0-100) and frequency were assessed using a standardized text message on a weekly basis throughout the study. RESULTS Thirty-two women were included (time postpartum: 6.6 ± 2.0 months; maternal age: 28.3 ± 3.8 years; body weight: 72.9 ± 19.1 kg), and 27 completed the T6 follow-up. Disability, pain intensity, and pain frequency improved at T6 (P < .001). Participants lost a mean of 1.9 ± 4.5 kg at T6, and this weight loss was correlated with reduction in LBPP intensity (r = 0.479, P = .011) and LBPP frequency (r = 0.386, P = .047), Pelvic Girdle Questionnaire score (r = 0.554, P = .003), and ODI score (r = 0.494, P = .009). Improvement in ODI score at T6 was correlated with the number of inactive minutes at T3 (r = -0.453, P = .026) and T6 (r = -0.457, P = .019), and with daily steps at T6 (r = 0.512, P = .006). CONCLUSION Weight loss is associated with positive LBPP symptom evolution beyond 3 months postpartum, and physical activity is associated with reduction in pain disability.
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Affiliation(s)
- Marie-Pier Girard
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Julie O'Shaughnessy
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Chantal Doucet
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Stephanie May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
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Ahlqvist K, Bjelland EK, Pingel R, Schlager A, Nilsson-Wikmar L, Kristiansson P. The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:474. [PMID: 32689990 PMCID: PMC7372850 DOI: 10.1186/s12891-020-03486-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Pelvic girdle pain (PGP) is common during pregnancy but the causes remain poorly understood. Generalized joint hypermobility (GJH) is an inherited trait, with joint mobility beyond normal limits and is assumed to be related with PGP. The aim of this project was to study the association between self-reported GJH and the presence of PGP during pregnancy. Methods In this cohort study, 4884 Swedish-speaking women were consecutively recruited at their first visit for registration in the national antenatal screening programme in Sweden. We used the five-part questionnaire (5PQ) to assess GJH and pain drawings to identify PGP. Our primary outcome was the presence of PGP during the entire pregnancy and secondary outcomes were PGP in each trimesters. We tested the associations with logistic regression analysis, and adjusted for age and ethnicity. Results In all, 2455 (50.3%) women responded to both questionnaires. The prevalence of self-reported GJH was 28.7%. A higher proportion of women with GJH than women without GJH reported PGP during the entire pregnancy (47.9% vs. 41.0%), particularly in trimester 1 (31.6% vs. 22.0%). Thus, women with GJH also had higher odds of PGP during the entire pregnancy (adjusted odds ratio (aOR) 1.27: 95% CI 1.11–1.47) and in trimester 1 (aOR 1.54: 95% CI 1.20–1.96), but the associations were not statistically significant in trimester 2 (aOR 1.24: 95% CI 0.82–1.88) or trimester 3 (aOR 1.20: 95% CI 0.99–1.45). The odds of PGP in pregnancy increased with increasing numbers of positive answers to the 5PQ (p for linear trend < 0.001) for the entire pregnancy and in trimester 1 (p for linear trend < 0.001), but not in trimesters 2 or 3 (p = 0.13 and p = 0.06, respectively). Conclusions Compared to women with normal joint mobility, women with GJH had higher odds of reporting PGP during pregnancy and the odds increased with number of positive responses to the 5PQ. The associations were present in trimester 1 but did not reach statistical significance in trimester 2 and 3.
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Affiliation(s)
- Kerstin Ahlqvist
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.
| | - Elisabeth Krefting Bjelland
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Angela Schlager
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.,Academic Primary Healthcare Centre, Stockholm County Council, Huddinge, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden
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Meucci RD, Perceval AH, Lima DRD, Cousin E, Marmitt LP, Pizzato P, Silva PAD, Jesien S, Cesar JA. Occurrence of combined pain in the lumbar spine, pelvic girdle and pubic symphysis among pregnant women in the extreme south of Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200037. [PMID: 32491051 DOI: 10.1590/1980-549720200037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and characterize the occurrence of low back pain (LBP), posterior pelvic girdle pain (PPGP) and pubic symphysis pain (PSP) among pregnant women resident in Rio Grande, RS. METHODS This was a cross-sectional study of all postpartum women who gave birth in 2016. Two pictures were used to investigate the presence of LBP, PPGP and PSP, both isolated and combined. Multinomial logistic regression was used to evaluate the factors associated with each symptom. RESULTS LBP was reported by 42.2%, PSP by 4.9%, and PPGP by 2%, while LBP + PSP was reported by 9%, LBP and PPGP by 2.8% and PPGP + PSP by 1.1%, and pain in all three regions was reported by 3.9% of the sample. The more advanced the age of the pregnant women, the risk for LBP and of LBP combined with one of the pelvic girdle regions was reduced, while the risk for PPGP + PSP was increased. Depression during pregnancy increased the risk for all symptom combinations. CONCLUSION This study provided a detailed description of the occurrence of the evaluated outcomes and its associated factors. Studies like this are rare in Brazil, especially a census with low rates of losses and refusals. The high prevalence of the evaluated symptoms suggests that it should be investigated routinely in prenatal care, taking into account the age of the pregnant women, depressive symptoms and those experiencing combined or intense pain.
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Affiliation(s)
- Rodrigo Dalke Meucci
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Aline Henriques Perceval
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Daniele Ramos de Lima
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Ewerton Cousin
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luana Patrícia Marmitt
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Paula Pizzato
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Priscila Arruda da Silva
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Stephanie Jesien
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Juraci Almeida Cesar
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
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Tuna F, Akleylek C, Özdemir H, Demirbağ Kabayel D. Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients. Gynecol Endocrinol 2020; 36:238-242. [PMID: 31385717 DOI: 10.1080/09513590.2019.1648417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pregnancy-associated osteoporosis (PAO) is a rare but painful disease. The current study aimed to investigate the demographic and clinical features, risk factors, treatment options, and outcomes of Turkish patients with PAO. In our retrospective, cross-sectional, and descriptive study the time to PAO diagnosis was 3.6 months. Pain and loss of height were detected in 78.6% and 28.6% of patients, respectively. As such, 60.6% of patients reported fractures at the thoracic area, 30.3% at the lumbar area, and 9.1% at the sacral area. While 14.3% of patients had optimal vitamin D status during pregnancy, 64.3% had vitamin D deficiency, and 21.4% had vitamin D insufficiency. Of the patients, 21.4% received anticoagulant therapy during their pregnancy. Dual X-ray absorptiometry scans revealed that osteoporosis was predominantly in the trabecular bone (L1-L4 Z-score -2.9, Femur Z score -2.19). Management options included supplements of calcium with vitamin D (93%), weaning the baby (79%), specific treatments for osteoporosis (64%), use of a supportive corset (50%), and exercise (21%), respectively. In addition, after delivery, 35.7% of patients were administered denosumab, 21.4% bisphosphonate, and 7.1% were given teriparatide. Data of the clinical features, treatments, and outcomes of PAO may contribute to early detection and management.
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Affiliation(s)
- Filiz Tuna
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Cansu Akleylek
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Hande Özdemir
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Derya Demirbağ Kabayel
- Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne, Turkey
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Lutterodt MC, Kähler P, Kragstrup J, Nicolaisdottir DR, Siersma V, Ertmann RK. Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice. BJGP Open 2019; 3:bjgpopen19X101674. [PMID: 31719117 PMCID: PMC6995862 DOI: 10.3399/bjgpopen19x101674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Women often wish to discuss their pregnancy symptoms with their GP. However, the two parties' understanding of symptoms may not be aligned. AIM To examine to what degree a specific pregnancy-related symptom worried women in the first trimester and analyse the characteristics of the most worried women. DESIGN & SETTING A cross-sectional study was performed in general practice in Denmark from 1 March 2015-15 August 2016. METHOD Women attending the first prenatal care visit completed a questionnaire about pregnancy-related physical symptoms and worries. Women were recruited from 125 GP practices and 294 GPs participated in the study. Further data were obtained from their pregnancy health record. Multivariable logistic regression analysis was used to assess the associations between the women's worries and the severity of the symptoms, which were adjusted for age and parity. RESULTS A total of 1508 women, aged 16-45 years, were included and 1455 completed the questionnaire. Nausea, vomiting, pelvic cavity pain, and back pain were the most common symptoms, and 88% reported having two or more symptoms simultaneously. Among the 1278 women reporting nausea, only 21% were worried, while 88% of the 252 women reporting vaginal bleeding were worried. Primigravidae (those pregnant for the first time) were significantly more worried about vomiting and nausea than multigravidae (those who have experienced pregnancy previously). Those aged >35 years were more worried about pelvic girdle pain and pelvic cavity pain than younger women. CONCLUSION Pregnancy-related physical symptoms are frequent in the first trimester. The severity of worries depends on the symptom. Vaginal bleeding and pain give rise to the majority of severe worries, especially among young women.
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Affiliation(s)
- Melissa C Lutterodt
- GP, The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Kähler
- The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- GP, The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny R Nicolaisdottir
- The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ruth K Ertmann
- GP, The Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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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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Christensen L, Vøllestad NK, Veierød MB, Stuge B, Cabri J, Robinson HS. The Timed Up & Go test in pregnant women with pelvic girdle pain compared to asymptomatic pregnant and non-pregnant women. Musculoskelet Sci Pract 2019; 43:110-116. [PMID: 31076336 DOI: 10.1016/j.msksp.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP). OBJECTIVES This cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG. METHODS In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables. RESULTS The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002). CONCLUSION Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP.
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Affiliation(s)
- Lene Christensen
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway, Forskningsveien 3A, Harald Schjelderups hus, 0373 Oslo, Norway.
| | - Nina K Vøllestad
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway, Forskningsveien 3A, Harald Schjelderups hus, 0373 Oslo, Norway.
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Dept. of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway, Sognsvannsveien 9, Domus Medica, 0372 Oslo, Norway.
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Jan Cabri
- Dept. of Physical Performance, Norwegian School of Sport Sciences, Norway, Sognsveien 220, 0863 Oslo, Norway.
| | - Hilde Stendal Robinson
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway, Forskningsveien 3A, Harald Schjelderups hus, 0373 Oslo, Norway.
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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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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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Gutke A, Stuge B, Elden H, Sandell C, Asplin G, Fagevik Olsén M. The Swedish version of the pelvic girdle questionnaire, cross-cultural adaptation and validation. Disabil Rehabil 2019; 42:1013-1020. [PMID: 30707631 DOI: 10.1080/09638288.2018.1515991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: The aims of this study were to translate and culturally adapt The Pelvic Girdle Questionnaire to Swedish, and to evaluate the construct and discriminative validity.Materials and methods: A translation and cultural adaptation process was performed according to international guidelines. Pilot tests were conducted among 16 women during pregnancy and post-partum. Analysis of the construct and discriminative validity of the Swedish version of the Pelvic Girdle Questionnaire was performed in a sample of 177 pregnant women suffering from pain in the lumbo-pelvic area. Participants completed the Pelvic Girdle Questionnaire along with Oswestry Disability Index, numeric rating scales for pain intensity and for pelvic girdle pain concerns.Results: The Swedish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alphas between 0.82 and 0.96, good convergent validity with high correlations with the Oswestry Disability Index and the pain intensity numeric rating scale, whereas moderate correlation was shown between the concerns numeric rating scale and the other instruments as hypothesized. Receiver operating characteristic curves showed good discriminatory capacity for women in need of treatment.Conclusions: The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability. It has good construct and discriminative validity for measurements of consequences of pregnancy-related pelvic girdle pain among Swedish speaking women.IMPLICATIONS FOR REHABILITATIONPregnancy-related pelvic girdle pain may be disabling and long-lasting, however treatable when identified.The Pelvic Girdle Questionnaire is the only condition-specific, reliability tested and validated questionnaire for pelvic girdle pain.The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability, good construct validity for pelvic girdle pain among Swedish speaking women, and shows good discriminative capacity for women in need of treatment.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helen Elden
- Institute of Health and Caring Sciences, Sahlgrenska, Academy, Gothenburg University, Gothenburg, Sweden
| | - Christofer Sandell
- Physiotherapy Department, Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Gillian Asplin
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, Sahlgrenska University Hospital, Molndal, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Starzec M, Truszczyńska-Baszak A, Stuge B, Tarnowski A, Rongies W. Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the Polish Population. J Manipulative Physiol Ther 2018; 41:698-703. [PMID: 30594333 DOI: 10.1016/j.jmpt.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to translate and culturally adapt the Pelvic Girdle Questionnaire (PGQ) into Polish to allow pelvic girdle pain (PGP) assessment in Polish women. METHODS The translation process comprised 4 stages: forward translation, backward translation, committee review, and pretest. We then conducted a pilot study of the final version of the questionnaire in 49 women (mean age: 31.2 years, standard deviation: 3.74 years) who had PGP when pregnant or within a year postpartum. RESULTS The internal consistency of the newly created questionnaire assessed with Cronbach's α was 0.916. CONCLUSION The internal consistency of the process of translation and cross-cultural adaptation of the Polish version of the PGQ was satisfactory. The Polish version of the PGQ may be used both in clinical practice and for research among Polish women with PGP.
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Affiliation(s)
- Małgorzata Starzec
- Department of Rehabilitation, Physiotherapy Division, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
| | | | - Britt Stuge
- Division of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | | | - Witold Rongies
- Department of Rehabilitation, Physiotherapy Division, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Duarte VM, Meucci RD, Cesar JA. Dor lombar intensa em gestantes do extremo Sul do Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:2487-2494. [DOI: 10.1590/1413-81232018238.22562016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/23/2016] [Indexed: 08/30/2023] Open
Abstract
Resumo O objetivo deste artigo é medir a prevalência e identificar fatores associados à dor lombar intensa (DL intensa) entre parturientes do município de Rio Grande, RS, Brasil, em 2013. Questionário padronizado aplicado por entrevistadoras previamente treinadas em até 48 horas após o parto. Realizou-se análise multivariável utilizando regressão de Poisson tendo a razão de prevalência como medida de efeito. Dentre as 2685 parturientes incluídas no estudo, 51,2% referiram dor lombar gestacional e 27,3% tinham DL intensa, com maior probabilidade de ocorrência entre adolescentes, mulheres com sobrepeso/obesidade, ex-fumantes e naquelas que praticaram atividade física na gestação. Entre as parturientes que tiveram DL intensa, 29,2%, 37,3% e 33,3% tiveram que deixar de fazer as lidas da casa, faltar ao trabalho e procurar um médico devido à DL, respectivamente. É elevada a prevalência de dor lombar intensa no período gestacional e preocupante seu impacto sobre as atividades da vida diária e utilização de serviços de saúde. Recomenda-se investigação clínica e manejo da dor lombar durante a gestação nas consultas de rotina do pré-natal.
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Girard MP, O’Shaughnessy J, Doucet C, Lardon E, Stuge B, Ruchat SM, Descarreaux M. Validation of the French-Canadian Pelvic Girdle Questionnaire. J Manipulative Physiol Ther 2018; 41:234-241. [DOI: 10.1016/j.jmpt.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 01/03/2023]
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Paula LFD, Silva RGC, Andres LF, Korelo RIG. Association between kinesiologic dysfunctions, lumbar disability and lumbopelvic pain in pregnancy. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.003.ao05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Low back pain in pregnancy is highly prevalent and multifactorial. However, it is still nuclear if the back pain is associated with functional kinetic changes that occur during pregnancy. Objective: To evaluate the occurrence of low back pain in pregnancy and to investigate the association of low back pain disability with intensity, pain origin and kinesilogic dysfunction (range of motion of the lumbar spine, lumbar flexibility and trunk mobility). Methods: Women (n = 32) with gestational age equal or less than 20 weeks, assisted in one health centers on the coast of Paraná. Obstetric and historical lumbopelvic of pain, musculoskeletal discomfort, intensity lumbopelvic pain, low back disability, the source of pain through specific clinical trials, joint range of motion of the lumbar spine, the lumbar flexibility and general mobility of the trunk were evaluated. Results: The lumbar region was the most reported and higher frequency (p = 0.000) for the occurrence of musculoskeletal discomforts. The prevalence of lumbopelvic pain was 93.8%. Most reported the first episode after the 14th week of pregnancy (90%), on a daily frequency (63.3%), high intensity (50%), limiting the activities of daily living (50%) and generating low back disability (moderate to severe in 56.9%). Lumbar disability levels were significantly correlated to gestational age (r = 0.353), pain intensity (r = 0.402), positive results in clinical trials (except for the Lasègue test), range of motion for flexion (r = -0.280) and lumbar extension (r = -0.301), lumbar flexibility (r = -0.371) and general mobility trunk (r = 0.503). Conclusion: The greater gestational age, the greater intensity of pain, positivity in clinical trials, decreased range of motion, flexibility and lumbar trunk mobility constitute major lumbar disability.
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Gutke A, Bullington J, Lund M, Lundberg M. Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth. Disabil Rehabil 2017; 40:3054-3060. [DOI: 10.1080/09638288.2017.1368724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer Bullington
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Madeleine Lund
- Home Care and Rehabilitation, The City of Gothenburg, Gothenburg, Sweden
| | - Mari Lundberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Eser F, Nebioğlu S, Aliyeva A, Kılıçarslan A, Atalay CR, Özcanlı G, Erten Ş, Uysal F. Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life. Eur J Rheumatol 2017; 5:37-39. [PMID: 29657873 DOI: 10.5152/eurjrheum.2017.16088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/27/2017] [Indexed: 01/22/2023] Open
Abstract
Objectives To investigate the prevalence of neuropathic pain in pregnant women and to state its influence on the functional status and health-related quality of life (HRQoL) in terms of physical, social, and emotional functioning. Methods A total of 90 pregnant women with lumbopelvic pain (LPP) and non-pregnant and healthy controls were included. The presence of neuropathic pain was determined using the Leeds assessment of neuropathic symptoms and signs (LANNS) questionnaire. The HRQoL was assessed using the Nottingham Health Profile (NHP), and the functional status was evaluated using the Oswestry Disability Index (ODI). The severity of pain was measured using a visual analog scale. Results The LANNS score was ≥12 in 34 pregnant women (37.8%). The prevalence of neuropathic pain was higher in pregnant women with LPP (odds ratio=6.22; 95% confidence interval=2.68-14.44) (p<0.001) than in controls. The LANNS score was found to be correlated with the physical mobility subgroup in the NHP at high levels (p=0.002, r=0.32) and with the ODI and pain subgroup in the NHP at moderate levels (p=0.013, r=0.26 and p=0.038, r=0.22, respectively). Conclusion The present study is the first to demonstrate that neuropathic pain is associated with pregnancy-related LPP and strongly correlated with functional impairment and deterioration in the HRQoL. A better understanding of neuropathic pain mechanisms in pregnancy-related LPP will help us find more effective treatment strategies.
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Affiliation(s)
- Filiz Eser
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Saniye Nebioğlu
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Aygün Aliyeva
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Kılıçarslan
- Department of Physical Treatment and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Cemal Reşat Atalay
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Gizem Özcanlı
- Department of Obstetrics and Gynecology, Ankara Numune Training and Research Hospital Ankara, Turkey
| | - Şükran Erten
- Department of Rheumatology, Yıldırım Beyazıt University Atatürk Training and Research Hospital, Ankara, Turkey
| | - Funda Uysal
- Department of Physical Treatment and Rehabilitation, Yenimahalle Training and Research Hospital, Ankara, Turkey
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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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Chang HY, Jensen MP, Lai YH. How do pregnant women manage lumbopelvic pain? Pain management and their perceived effectiveness. J Clin Nurs 2015; 24:1338-46. [DOI: 10.1111/jocn.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Hao-Yuan Chang
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine; University of Washington; Seattle WA USA
| | - Yeur-Hur Lai
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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