Pelvic girdle pain, clinical tests and disability in late pregnancy

Robinson, Hilde Stendal; Mengshoel, Anne Marit; Bjelland, Elisabeth Krefting; Vøllestad, Nina Køpke

doi:10.1016/j.math.2010.01.006

Cited by 95 publications

(100 citation statements)

References 40 publications

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“…This subgroup has been associated with greater functional disability, more frequent sick leave, and significantly worse prognosis than pain in one or two pelvic locations. 2,3,28 Furthermore, it has previously been shown that the number of pain sites has a strong predictor utility. 9 This strengthens our classification of severity level during pregnancy, which was based on pain intensity, pain location, and the number of pain sites.…”

Section: Discussionmentioning

confidence: 99%

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

Bjelland

Stuge

Engdahl

et al. 2012

BJOG

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Objective To study the prognosis for pelvic girdle pain, and to explore the association between presence of emotional distress during pregnancy and pelvic girdle syndrome 6 months after delivery.Design Longitudinal population study. Main outcome measure Pelvic girdle syndrome 6 months after delivery, defined as pain in the anterior pelvis and on both sides in the posterior pelvis.Results Six months after delivery, 78.0% of the women had recovered, 18.5% reported persistent pain in one or two pelvic locations, 3.0% reported pelvic girdle syndrome and 0.5% reported severe pelvic girdle syndrome. The recovery rates decreased with increasing levels of pain severity in pregnancy. Being emotionally distressed at two time points during pregnancy was associated with the presence of pelvic girdle syndrome (adjusted OR 1.5, 95% CI 1.2-1.9) and severe pelvic girdle syndrome (adjusted OR 1.9, 95% CI 1.1-3.1), after adjustment for pain severity in pregnancy, other medical conditions, body mass index, age at menarche, previous low back pain, and smoking during pregnancy.Conclusions In this follow-up of women with pelvic girdle pain in pregnancy, the recovery rates after delivery were high. Our findings suggest that the presence of emotional distress during pregnancy is independently associated with the persistence of pelvic girdle pain after delivery.Keywords Emotional distress, pelvic girdle pain, pregnancy, prognostic factors, prospective cohort, the Norwegian Mother and Child Cohort Study.Please cite this paper as: Bjelland E, Stuge B, Engdahl B, Eberhard-Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study . BJOG 2013;120:32-40.

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Section: Discussionmentioning

confidence: 99%

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

Bjelland

Stuge

Engdahl

et al. 2012

BJOG

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“…Cohort studies 15,16 suggest that predictors of poor recovery from symptoms post partum include older age, work dissatisfaction and the presence of combined low back pain and PGP in comparison with pain in either location alone. There is some evidence that women with combined pubic symphysis pain and bilateral posterior PGP in pregnancy have a slower recovery than those women with fewer pain locations 12,16 and that women with a high number of other bodily pain sites are more likely to have high pain intensity scores and postpartum non-recovery. 17 Guidelines 3 suggest risk factors for PGP include a previous history of low back pain and previous trauma to the pelvis.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial

Foster

Bishop

Bartlam

et al. 2016

Health Technol Assess

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BackgroundMany pregnant women experience low back pain. Acupuncture appears to be a safe, promising intervention but evidence is needed about its clinical effectiveness and cost-effectiveness.ObjectivesTo assess the feasibility of a future large randomised controlled trial (RCT) testing the additional benefit of adding acupuncture to standard care (SC) for pregnancy-related back pain.DesignPhase 1: a questionnaire survey described current care for pregnancy-related back pain. Focus groups and interviews with midwives, physiotherapists and pregnant women explored acceptability and feasibility of acupuncture and the proposed RCT. Phase 2: a single-centre pilot RCT. Participants were identified using six methods and randomised to SC, SC plus true acupuncture or SC plus non-penetrating acupuncture.ParticipantsPhase 1: 1093 physiotherapists were surveyed and 15 midwives, 21 physiotherapists and 17 pregnant women participated in five focus groups and 20 individual interviews. Phase 2: 125 women with pregnancy-related back pain participated.InterventionsSC: a self-management booklet and onward referral for one-to-one physiotherapy (two to four sessions) for those who needed it. SC plus true acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising true (penetrating) acupuncture, advice and exercise. SC plus non-penetrating acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising non-penetrating acupuncture, advice and exercise.Main outcome measuresPilot RCT outcomes included recruitment rates, treatment fidelity, follow-up rate, patient-reported pain and function, quality of life and health-care resource use. Birth and neonatal outcomes were also assessed. Staff overseeing outcome data collection were blind to treatment allocation.ResultsPhase 1: 629 (57.5%) physiotherapists responded to the survey, 499 were experienced in treating pregnancy-related back pain and reported 16 advice and 18 treatment options. Typical treatment comprised two to four individual sessions of advice and exercise over 6 weeks. Acupuncture was reported by 24%. Interviews highlighted the impact of back pain and paucity of effective interventions. Women and midwives strongly supported a RCT and expressed few concerns. Physiotherapists’ concerns about acupuncture in pregnancy informed a training programme prior to the pilot RCT. Phase 2: We recruited 125 of 280 potentially eligible women (45%) in 6 months and randomised 41 to SC and 42 each to the SC plus true acupuncture and SC plus non-penetrating acupuncture arms. Analysis was conducted with 124 participants (41, 42 and 41, respectively) as one participant was randomised in error. Three of six recruitment methods were the most successful. In total, 10% of women (n = 4) randomised to SC alone accessed one-to-one physiotherapy and received an average of two treatments. The average number of treatments was six for both SC plus true acupuncture and SC plus non-penetrating acupuncture. Treatments were in line with protocols. Eight-week follow-up was 74%. Patient-reported outcomes (pain, function and quality of life) favoured the addition of acupuncture. There was no evidence of serious adverse events on mothers or birth and neonatal outcomes. The Pelvic Girdle Questionnaire was found to be an appropriate outcome measure for a future trial.ConclusionsA future main RCT is feasible and would be welcomed by women and clinicians. Longer-term follow-up and further follow-up efforts are recommended for a main trial.Trial registrationCurrent Controlled Trials ISRCTN49955124.FundingThis project was funded by the National Institute of Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 33. See the NIHR Journals Library website for further project information.

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“…It is a musculoskeletal pain located within the pelvic area between the posterior iliac crest and gluteal folds, with or without leg pain [8] . Prevalence estimates for PGP range widely from 20% overall [8] 35-50% in early pregnancy and 60%-70% in late pregnancy [9,10] . For 25 to 30% of pregnant women the problem becomes severe [1,2,11] .…”

Section: Introductionmentioning

confidence: 99%

The pelvic ring of pain: Pregnant women’s experiences of severe pelvic girdle pain: An interview study

Elden

Lundgren²,

Robertson³

2014

Clinical Nursing Studies

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Background: Pelvic girdle pain (PGP) is a universal problem affecting approximately 50% of all pregnant women. For 25 to 30% of pregnant women the problem becomes severe. Methods:In-depth interviews were carried out with 27 pregnant women with severe PGP in 2009-2010. Qualitative content analysis was used.Results: The women's experiences are summarized in four categories: A strange body; the body on guard; relation and support from health care and, acceptance of PGP.Conclusions: PGP completely preoccupied women with severe PGP. It influenced their self-evident trust in their bodies as well as their capabilities to guide and control them. The fear of triggering pain and unpleasant sensations made them avoid movement. They experienced anxiety and worry of not being able to manage their pregnancy and childbirth, and bind to their unborn child. They felt worse that their complaints are trivialized, and not taken seriously in health care. To be able to cope with PGP, they had to accept it and realize that they have to be aware and accept their bodies' limitations. This means working with their bodies and not against them. PGP made the women look upon life more seriously and changed their self-perception. Increased awareness and knowledge are needed among healthcare to enable them to meet these women's needs and provide them with adequate support. Information about PGP could be sent home with the woman at the first visit to the midwife. This would probably prevent or reduce the worry that can arise in women suffering severe PGP.

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Pelvic girdle pain, clinical tests and disability in late pregnancy

Cited by 95 publications

References 40 publications

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial

The pelvic ring of pain: Pregnant women’s experiences of severe pelvic girdle pain: An interview study

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