| 1. |
- Elden, Helen, 1959, et al.
(författare)
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Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: A multicentre, single blind, randomised controlled trial
- 2013
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:7, s. 775-782
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared to standard treatment alone for PGP during pregnancy. Design. Randomised, multicentre, single blind, controlled trial. Setting. University hospital, a private clinic and 26 maternity care centres in Gothenburg, Sweden. Population. 123 pregnant women with PGP. Methods. Participants were randomly assigned to standard treatment (control group, n=60) or standard treatment plus craniosacral therapy (intervention group, n=63). Main Outcome Measures. Primary outcome measures: Pain intensity (Visual Analogue Scale 0-100mm) and sick leave. Secondary outcomes: function (Oswestery Disability Index), health-related quality of life (Euro-Qol), unpleasantness of pain (VAS), and assessment of the severity of PGP by an independent examiner. Results. Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. VAS median was 27 mm (95%CI 24.6-35.9) vs. 35 mm (95%CI 33.5-45.7)(p=0.017) and the function disability index was 40 (range 34-46) vs. 48 (range 40-56)(p=0.016). Conclusions. Lower morning pain intensity and lesser deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared to standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before reccomending craniosacral therapy for pelvic girdle pain.
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| 2. |
- Elden, Helen, 1959, et al.
(författare)
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Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369 women diagnosed with pelvic girdle pain during pregnancy
- 2013
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Ingår i: Advances in multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.. - 9789081601603
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Konferensbidrag (refereegranskat)abstract
- Introduction PGP have been associated with muscular dysfunction, maternal factors, and pre-pregnancy low back pain, LBP, and/or pelvic girdle pain, PGP. It has also been stated that the pain and functional disturbances in relation to PGP must be reproducible by specific clinical tests. However, physical examinations have not been performed in long-time follow-ups of women with well-defined PGP during pregnancy and knowledge of potential predictors for long-standing LBP/PGP in these women is limited. Aim To describe the long-term development of back pain in women with well-defined PGP during pregnancy and, to identify potential predictors for persistent PGP and/or LBP in a long time perspective. Materials and Methods Women with well-defined PGP according to mechanical assessment of the, lumbar spine, pelvic pain provocation tests, standard history, pain drawings and European Guidelines who completed one of three treatment studies in 2000-2002, 2006-2007 or 2009-2011 answered a questionnaire. Women reporting pain from the pelvic girdle and/or lower back were physically examined. Results Of 534 eligible women, 380 (71%) answered the questionnaire. Data from 37 (9.7%) women were excluded from analysis due to pregnancy (n=15), systemic disease (n=11), participated in two of the studies (=n5) and declined examination (n=6). Forty-five women/343 (13%) had verified back pain. Of these women, 12/343 (3.5%) had LBP; 15/343 (4.4%) had PGP and 18/343 (5.2%) had combined back- and pelvic girdle pain. During pregnancy, predictors for persisting back pain were: Having a back pain history before pregnancy (p=0.0194), high pain intensity in the morning (Visual Analogue Scale, p=0.0097), impaired function (Oswestery Disability Index p=0.0127), low health related quality of life (Euro-qol, p=0.0097), use of an elastic pelvic belt (p=0.031), difficulty to turn over in bed (p=0.001) and early debut of PGP in pregnancy (p=0.029). Relevance of the number of positive pain provocation tests during pregnancy and at follow-up will also be presented. Relevance PGP can be physically compromising during pregnancy and cause anxiousness concerning childcare after delivery and later return to work and future work planning. It is therefore important to present a reliable prognosis to these women as early as possible, preferably during pregnancy. Discussion Considering the long follow up (10 years), the dropout-ratio in this study was acceptable and the results presented were in line with earlier publications about persistent LBP and PGP in a shorter perspective. Furthermore, the women were physically examined by skilled physiotherapists to confirm the diagnoses PGP and LBP in accordance with the European Guidelines. This increases the reliability of our findings, and we therefore believe that general conclusions can be drawn. A well founded prognosis for the later development of PGP and LBP found during pregnancy thus can be presented to the pregnant women covering the time from delivery up to a decade later. Conclusion: Most women (88%) with well-defined PGP during pregnancy recovered. The long time results confirm earlier short time findings that a back pain history before pregnancy, server PGP during pregnancy and early debut of PGP in pregnancy are risk factors for persisting pain several years postpartum. Implications Identification of women at risk for longstanding back pain seems possible in early pregnancy using physical examination and self-reports.
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| 3. |
- Elden, Helen, 1959, et al.
(författare)
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Demanding and challenging: Men's experiences of living with a pregnant woman with pelvic girdle pain: An interview study
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 2:4, s. 17-29
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pelvic girdle pain (PGP) is a universally disabling condition affecting approximately 50% of pregnant women. Qualitative research describes how PGP leads to struggle in women’s daily lives, makes them question and doubt their roles and identities as professionals and mothers, and test their (marital) relationships. The purpose of this study was to describe men’s experiences of living with a pregnant woman with PGP. Methods: Participants were men whose pregnant partners participated in a project containing both qualitative and quantitative studies in 2009 to 2011. Interviews were conducted in person (n=18) or by telephone (n=8), lasting approximately 20-50 minutes. Sixteen men were interviewed during their wive’s pregnancies (M age = 30 years), eight men were re-interviewed within 12 months postpartum and two men were interviewed only postpartum (26 interviews). Results: Three major categories emerged: having no knowledge of PGP, a period of emotional and physical strain, and merging. Pregnancy in a woman with PGP caused men to alter focus from themselves to their partners and family. They expressed worry, powerlessness, inadequacy, and a need for support. They had to adapt and cope, both demanding and challenging. However, they stressed that relationships with their older children improved, and that they and their partners had succeeded in becoming a team. Conclusions: The findings indicated a need for greater focus from midwives and other health care providers on the psychological impact of PGP on the man/partner. This is important, not only for men but for their respective women as well, whereby men influence their partner’s health.
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| 4. |
- Elden, Helen, 1959, et al.
(författare)
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Effects of craniosacral therapy as experienced by pregnant women with severe pelvic girdle pain: An interview study
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 2:3, s. 140-151
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Pelvic girdle pain (PGP) affects 50% of pregnant women worldwide. PGP increases with advancing pregnancy with considerable impact on quality of life, interfering with sleep, daily activities, work, motherhood and close interpersonal relationships. The use of Complementary and Alternative Medicine (CAM) is increasingly prevalent among pregnant women, particularly for pregnancy-induced back pain. Craniosacral treatment (CST) is a CAM that has shown symptom relieving effects in pregnancy-related back pain. The purpose of this study was to describe women’s experiences of the treatment. Methods: Twenty-seven women receiving CST plus standard treatment (ST) were interviewed following 3 of 5 treatments with CST by two qualified and experienced CST practitioners. Data were analysed using qualitative content analysis. Results: The experience of CST by pregnant women diagnosed with severe PGP can be described in three categories: An unfamiliar and different treatment method; description of treatment effects, and regaining a personal and social life. Women described how CST provided them with new awareness of their widespread muscle tension. They told of how they experienced increased body awareness, distraction from pain, relaxation and calm, and feelings of security and optimism. These factors may have helped them actively improve posture and lower muscle tension thereby relieving the symptoms of PGP. Conclusions: The present study reports a contextual interpretation of previously published quantitative data, as it provides a deeper understanding of total symptom relief from PGP during pregnancy. Trial registration: The trial is registered at Current Controlled Trials ISRCTN30566933. Key words Complementary and alternative medicine, Craniosacral therapy, Pregnancy, Pelvic girdle pain, Qualitative interview study
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| 5. |
- Elden, Helen, 1959, et al.
(författare)
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Feeling old in a young body: Women’s experiences of living with severe consequences of an obstetric anal sphincter rupture: An interview study.
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 3:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Background: The incidence of obstetric anal sphincter rupture (OASR) is increasing. It may cause anal incontinence and dyspareunia, leading to reduced quality of life and wellbeing. Qualitative studies are lacking. The aim was to describe experiences of living with ongoing severe consequences of an OASR 8 weeks after childbirth. Method: Twenty women with ongoing severe consequences of an OASR 8 weeks after delivery were interviewed using qualitative content analysis. Results: The experience of complications of an OASR is described in the overall theme ”Feeling old in a young body” and four categories: The body as injured; isolation; inability to function sexually, and anxiety for the future. Participants described how the consequences of OASR totally occupied their lives, making them feel old in a young body. They told of repercussions for their physical, psychological, sexual and social lives; how it affected their roles of mothers and partners, making them fear future childbirths. Diet, use of medicines, coal filters in incontinence pads, timing of toilet visits, use of the environment and mobile phones to conceal flatus and/or feces were strategies participants described. Conclusions: This study can contribute to increased understanding of how women can be affected by an OASR, and may enable healthcare personnel and authorities to meet their needs and organize care so that adequate support is available. It would also be beneficial if the women’s physical strategies were integrated into the information provided by health caregivers involved in follow-up. However, more research in this area is warranted.
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| 6. |
- Elden, Helen, 1959, et al.
(författare)
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Life's pregnant pause of pain: Pregnant women's experiences of pelvic girdle pain related to daily life: A Swedish interview study
- 2013
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Ingår i: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives. - : Elsevier BV. - 1877-5764. ; 4:1, s. 29-34
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Pelvic girdle pain (PGP) is a universally disabling condition affecting three of 10 pregnant women. Qualitative studies on the subject are lacking. Objective: To describe pregnant women’s experiences of PGP related to everyday life. Methods: In all, 27 women with PGP participating in a randomised controlled study were interviewed during 2010 to 2011. Qualitative content analysis was used. Results: Five main categories emerged; Pelvic girdle pain affects the ability to cope with everyday life; Coping with motherhood; Relationships between partners often reached th breaking point; Questioning one´s identity as defined by profession and work and; Lessons learned from living with PGP. The categories illustrate how women’s everyday lives were interrupted. Their ability to meet their own and others´ expectations put a strain on their lives causing disappointment, sadness, and frustration. It made them question and doubt their roles and identities as mothers, partners and professionals, and kept them from looking forward to future pregnancies, in the absence of effective treatment for PGP. Knowledge gained was that women with PGP should seek help immediately, listen to their bodies and acknowledge their limitations. Conclusion: PGP severely affects pregnant women’s everyday lives. There appears to be a lack of knowledge and awareness of PGP in general, as well as among caregivers and employers of PGP that needs to be highlighted and rectified. There is also a great need to learn how to support those suffering from it. Appropriate support during this important and rare phase in a woman’s life is warranted.
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| 7. |
- Elden, Helen, 1959, et al.
(författare)
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The pelvic ring of pain: Pregnant women’s experiences of pelvic girdle pain as related to embodied experiences and experiences of the healthcare care system: A Swedish interview study
- 2013
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Ingår i: Nordisk jordmor kongress, 13-15 June 2013, Oslo.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives Pelvic girdle pain (PGP) is a universal disabling condition that affects three of 10 pregnant women. Qualitative studies on the subject are lacking .The aim with this study was to describe pregnant women’s experiences of PGP related to everyday life. Method In all, 27 women with PGP participating in a randomised controlled study were interviewed during 2010 to 2011. Content analysis was used. Results Five main categories emerged; Pelvic girdle pain affects ability to cope with everyday life; Coping with motherhood; Often personal relationships between partners reached breaking point; To question the identity defined by profession and work and; Lessons-learned from living with PGP. The categories illustrate that women’s everyday life stopped. Not being able to meet their own and others expectations putting a strain on their being and made them disappointed, sad and frustrated. It made them question and doubt their roles and identities as mothers, partners and professionals. They we’re not looking forward to another pregnancy, without any effective treatment for PGP at hand. Lessons learned were that women with PGP should seek help immediately, listen to their bodies and acknowledge their own limitations. Conclusion PGP severely affects pregnant women’s everyday life. There seems to be a lack of knowledge and awareness of PGP and how to support these women both general in society, among caregivers and employers that needs to be highlighted and rectified. Appropriate support during this important and rare phase in a woman’s life is warranted.
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| 8. |
- Elden, Helen, 1959, et al.
(författare)
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The pelvic ring of pain: Pregnant women’s experiences of severe pelvic girdle pain: An interview study
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 2:2, s. 30-41
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 9. |
- Elden, Helen, 1959, et al.
(författare)
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The pregnant pause of pain: Pregnant women’s experiences of pelvic girdle pain as related to daily life: A Swedish interview study
- 2013
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Ingår i: BfIn (Barnafödande i Norden). March 2013, Gothenborg. ..
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Konferensbidrag (refereegranskat)abstract
- Introduction Pelvic girdle pain (PGP) is a universally disabling condition affecting three of 10 pregnant women. Qualitative studies on the subject are lacking. Objective To describe pregnant women’s experiences of PGP as related to daily life. Methods In all, 27 women with PGP participating in a randomised controlled study were interviewed during 2010–2011. Qualitative content analysis was used. Results Five main categories emerged: PGP affects the ability to cope with everyday life; Coping with motherhood; Relationships between partners often reached the breaking point; Questioning one’s identity as defined by profession and work, and Lessons learned from living with PGP. The categories illustrate how women’s everyday lives were interrupted. Their inability to meet their own and others’ expectations put a strain on their lives causing disappointment, sadness and frustration. It made them question and doubt their roles and identities as mothers, partners and professionals, and kept them from looking forward to future pregnancies, in the absence of effective treatment for PGP. Knowledge gained was that women with PGP should seek help immediately, listen to their bodies, and acknowledge their limitations. Conclusion PGP severely affects pregnant women’s everyday lives. There appears to be a lack of knowledge and awareness in general, as well as among caregivers and employers of PGP that needs to be highlighted and rectified. There is also a great need to learn how to support those suffering from it. Appropriate support during this important and rare phase in a woman’s life is highly warranted.
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| 10. |
- Elden, Helen, 1959, et al.
(författare)
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Treatment Modalities for Pelvic Girdle Pain in Pregnant Women
- 2014
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Ingår i: Journal of Acupuncture and Meridian Studies. - : Medical Association of Pharmacopuncture Institute. - 2005-2901.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Background: Pelvic girdle pain (PGP) affects 30 percent of pregnant women. It severely affects pregnant women’s daily lives and causes high costs for society. Methods: Two randomized controlled trials (RCT) compared the efficacies of (1) standard treatment (S) plus acupuncture (ACU), S þ stabilizing exercises (SE), and S alone (nZ386) and (2) penetrating acupuncture (PACU) and non-penetrating sham acupuncture (NPACU) as an adjunct to S in pregnant women (nZ115) with well-defined PGP. Results: ACU, as well as SE, constituted efficient complements to S for PGP during pregnancy. ACU had no observable severe adverse influences on the pregnancy, the mother, the delivery or the fetus/neonate. Regression of PGP after delivery was excellent. Both PACU and NPACU led to clinically relevant decreases in pain. Compared to the NPACU group, the PACU group had superior ability in 7 of 13 daily activities. Conclusion: ACU and SE as adjuncts to standard treatment are effective for treating PGP during pregnancy. Acupuncture is not accompanied by any severe adverse influences on the pregnant women or the fetus/neonate. Regression of PGP occurs in the great majority of women after delivery. PACU had no additional effect on PGP reduction compared to NPACU, but it improved the ability to perform daily activities, keeping more women in regular work. Keywords: pelvic girdle pain; acupuncture; stabilizing exercises; adverse events; regression
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