| 1. |
- 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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| 2. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Evaluation of self-administered tests for pelvic girdle pain in pregnancy
- 2014
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background Different tests are used in order to classify women with pelvic girdle pain (PGP). One limitation of the tests is that they need to be performed by an examiner. Self-administered tests have previously been described and evaluated by women who performed the tests directly before the examiner performed the original tests. Thus, an evaluation of the self-administered tests performed in a more natural setting, such as the women’s home is needed. The purpose of this study was to investigate the agreement between self-administered tests performed at home and tests performed by an examiner on women with suspected PGP. Additionally to compare the classification made by an examiner and classification based on results of the self-administered tests and questionnaire. Methods One hundred and twenty three pregnant women with suspected PGP participated. Before the appointment at the clinic the women performed the self-administered tests and filled in a questionnaire. During the appointment one specialized physiotherapist performed the tests. Result of the two different sets of tests and the classifications made by the examiner and the self-administered tests including questionnaires were compared concerning percentage of agreement (POA), sensitivity and positive predicted value (PPV). Results The P4 and the bridging test had the highest POA (≥74.8%), sensitivity (≥75.5%) and PPV (≥91.2%) for posterior PGP. For anterior PGP the MAT test had highest POA (76.4%), and PPV (69.5%), and the modified Trendelenburg test the highest sensitivity (93.0%). Agreement between the two classifications was 87%. A significantly higher number of positive P4 and bridging tests (p<0.01) and a significantly lower number of positive Trendelenburg tests, Active Straight Leg raise and Straight Leg Raise (p<0.05) were recorded by the examiner compared to the self-administered ones. Conclusions Our results indicate that self-administered test and questionnaires are possible to use for testing and classification of women with suspected PGP.
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| 3. |
- Gutke, Annelie, et al.
(författare)
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ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 46:5, s. 468-474
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.
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| 4. |
- Gutke, Annelie, et al.
(författare)
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Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms
- 2011
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Ingår i: EUROPEAN SPINE JOURNAL. - : Springer Science Business Media. - 0940-6719 .- 1432-0932. ; 20:3, s. 440-448
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Tidskriftsartikel (refereegranskat)abstract
- The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.
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| 5. |
- Gutke, Annelie, et al.
(författare)
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Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy : a randomized, controlled clinical trial
- 2010
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 42:10, s. 929-935
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain (PGP). Design: A prospective, randomized, single-blinded, clinically controlled study. Subjects: Eighty-eight women with PGP were recruited 3 months after delivery. Methods: The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had one telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function. Results: No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared to baseline although the majority still experienced PGP. Conclusion: Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Regardless of treatment with specific stabilizing exercises or not, the majority still experiences some back pain almost a year after pregnancy.
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| 6. |
- Gutke, Annelie, et al.
(författare)
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The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain
- 2010
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Ingår i: MANUAL THERAPY. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 15:1, s. 13-18
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Tidskriftsartikel (refereegranskat)abstract
- Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslens test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60-0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lUrnbopelvic pain into lumbar pain and PGP in pregnant women.
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| 7. |
- Sjödahl, Jenny, et al.
(författare)
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Predictors for long-term disability in women with persistent postpartum pelvic girdle pain
- 2013
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Ingår i: European spine journal. - : Springer Verlag (Germany). - 0940-6719 .- 1432-0932. ; 22:7, s. 1665-1673
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP).MethodsData were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.ResultsA multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength.ConclusionsAge, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.
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| 8. |
- Sjödahl, Jenny, 1979-
(författare)
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Pregnancy-related pelvic girdle pain and its relation to muscle function
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.
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