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Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (Landstinget i Östergötland; Centre for Public Health Sciences; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum; Folkhälsovetenskapligt centrum)
2007 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 32, no 13, 1430-1436 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the possible association of lumbopelvic pain and postpartum depression and differences in the prevalence of depressive symptoms among women without lumbopelvic pain and women classified as having pelvic girdle pain (PGP) and/or lumbar pain.

Summary of background data: Lumbopelvic pain and depression are common pregnancy complications, but their comorbidity has rarely been evaluated and has not been studied in relation to subgroups of lumbopelvic pain.

Methods: In a cohort of consecutively enrolled pregnant women, the Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum, applying a primary screening cutoff of >=10 and a cutoff of >=13 for probable depression. Women were classified into lumbopelvic pain subgroups by means of mechanical assessment of the lumbar spine, standard history, pelvic pain provocation tests, a pain drawing, and the active straight leg raising test.

Results: The postpartum cohort (n = 267) comprised 180 (67%) women without lumbopelvic pain, 44 (16%) with PGP, 29 (11%) with lumbar pain, and 14 (5%) with combined PGP and lumbar pain. Applying a cutoff of >=10, postpartum depressive symptoms were more prevalent in women with lumbopelvic pain (27 of 87, 31%; 95% confidence interval, 26%–36%) than in women without lumbopelvic pain (17 of 180, 9%; 95% confidence interval, 5%–13%; P < 0.001). The comorbidity of lumbopelvic pain and depressive symptoms was 10%. Depressive symptoms were more prevalent in women with lumbar pain versus women without lumbopelvic pain when applying cutoffs of >=10 or >=13 (P <= 0.002); whereas for women with PGP, this comparison was significant only at the screening level of >=10 (P = 0.01).

Conclusions: Postpartum depressive symptoms were 3 times more prevalent in women having lumbopelvic pain than in those without. This comorbidity highlights the need to consider both symptoms in treatment strategies.

Place, publisher, year, edition, pages
2007. Vol. 32, no 13, 1430-1436 p.
Keyword [en]
pelvic girdle pain, lumbar pain, postpartum depressive symptoms, comorbidity, low back pain
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-12991DOI: 10.1097/BRS.0b013e318060a673OAI: oai:DiVA.org:liu-12991DiVA: diva2:17599
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2017-12-13
In thesis
1. Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
Open this publication in new window or tab >>Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of low back pain (LBP) is higher in pregnant women compared to women of the same age in a general population. Pregnancy-related LBP persists 6 years after pregnancy in 16% of women. Consequently, pregnancy represents a specific risk for LBP and persistent LBP. Pregnancy-related LBP is usually studied as a single entity, however, only one subgroup of LBP, i.e. pelvic girdle pain (PGP), seems to be associated with pregnancy. Accordingly, possible differences in subgroups of patients with LBP are unknown.

The aims of this thesis were the following: 1) to describe the prevalence of clinically classified subgroups of women with LBP in a cohort (no LBP, lumbar pain, PGP, and combined pain (PGP and lumbar pain)) during pregnancy and postpartum, and 2) to determine if there was a disparity in the course, health-related quality of life (HRQL), pain intensity, disability, depressive symptoms, or muscle function in subgroups of the cohort, and 3) to identify predictors for having persistent pregnancy-related PGP postpartum.

Consecutively-enrolled pregnant women were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. All women answered questionnaires (background data, EQ-5D). Women with LBP completed the Oswestry Disability Index and pain measures. The Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum (cut-off ≥10). Trunk muscle endurance, hip muscle strength, and gait speed were investigated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.

At the 12-18 gestational week evaluation, 118/308 (38%) women had no LBP, 33 (11%) had lumbar pain, 101 (33%) had PGP, and 56 (18%) had combined pain. Three months postpartum, 183/272 (67%) women had no LBP, 29 (11%) had lumbar pain, 46 (17%) had PGP, and 14 (5%) had combined pain. Pregnant women with combined pain were most affected in terms of HRQL, pain intensity, and disability. Depressive symptoms were three times more prevalent in women with LBP (27/87, 31%) than in women without LBP (17/180, 9%). Women with PGP and/or combined pain had lower values for trunk muscle endurance, hip extensor strength and gait speed compared to women without LBP. Postpartum, 16-20% of the women had persistent combined pain or PGP, whereas 1/29 had lumbar pain. Predictors for persistent PGP or combined pain were work dissatisfaction, older age, combined pain in early pregnancy, and low endurance of the back flexors.

In conclusion, women with combined pain were identified to be a target group since they had the lowest recovery rate and since the classification of combined pain was found to be a predictor for persistent PGP or combined pain postpartum. The hypothesis of an association between muscle dysfunction and PGP was strengthened. Based on the finding of high comorbidity of postpartum depressive symptoms and LBP, it seems important to screen for and consider treatment strategies for both symptoms.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2007
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 998
Keyword
Pelvic girdle pain, lumbar pain, pregnancy, health, functioning, postpartum depressive symptoms; low back pain; muscle function; gait; pregnancy-related; low back pain; course; predictors; recovery; persistent; muscle endurance
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-11156 (URN)978-91-85715-14-5 (ISBN)
Public defence
2007-05-25, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2009-08-22

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Gutke, AnnelieJosefsson, AnnÖberg, Birgitta

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