Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts

Abstract

Background Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized. Objective To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments. Design To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments. Results From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief. Conclusions The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.

Assessing (Social-Ecological) Systems Thinking by Evaluating Cognitive Maps

“…Unlike qualitative cognitive maps, FCM enables students to represent a system's dynamic behavior (i.e., function) through a simulation of causal propagations in discrete time-steps [19]. These semi-quantitative cognitive maps provide students a way to test ideas related to both structure and function and to see whether model function can be compared to empirically generated data [7,30,32,33]. Such tools also provide ways for STEM educators to assess how well students use ST and provide directed feedback for improvements, so that function and structure can be evaluated in tandem by students and teachers (Figure 1).…”

Perspectives of scholars on the nature of sustainability: a survey study

“…Although there have been calls to reconcile the relationships between epistemic orientation and research methods for some time (Bryman, 1984), to our knowledge, few studies exist which attempt to clarify these relationships empirically, rather these discussions are often more philosophical in nature (Hoshmand and Martin, 1994). In more recent discussion, Miller et al (2008) argue that recognizing epistemological pluralism, the strengths and weaknesses of different ways of generating knowledge, explicitly can facilitate collaborative and interdisciplinary scholarship leading to innovation, especially when diverse scholars from different fields are engaged in answering complex and wicked problems (Hodges et al, 2019;Cholewicki et al, 2019), like those common to many sustainability research contexts. When these findings are integrated with other survey results that indicate that researchers across sustainability contexts use a wide range of data collection and data analysis techniques, it can be concluded that sustainability as a research endeavor is associated with a diverse toolbox that generates and values multiple forms of evidence.…”

Introduction to the special issue on pelvic pain

“…Multiple researchers and clinicians regard musculoskeletal pelvic pain as lumbopelvic pain, which is considered a subgroup of nonspecific low back pain (LBP) (1,2). LBP affects people of all ages and is a leading contributor to disease burden world-wide (3) scoring highest on the list of years lived with disability (DALY's) (4).…”

“…It is astounding how vivid this very restrictive biomedical model still is among clinicians and researchers. Hodges et al, 2019 describe a collaborative model, formed by fuzzy cognitive mapping with 14 clinicians and scientists with expertise in the area of PGP (1). The most frequent category receiving emphasis was 'Biomechanics" with related "Tissue injury and pathology" in the metamodel.…”

“…The most frequent category receiving emphasis was 'Biomechanics" with related "Tissue injury and pathology" in the metamodel. Remarkably, since the category receiving highest scores regarding LBP was psychology, only 1 expert scored this in PGP (1). It might well be that PGP approaches and perspectives got stuck in time, resulting perhaps in a closed mind on what might be the cause and driver of symptoms for people afflicted with PGP?…”