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Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
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 [en]
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: urn:nbn:se:liu:diva-11156ISBN: 978-91-85715-14-5 (print)OAI: oai:DiVA.org:liu-11156DiVA: diva2:17602
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
List of papers
1. Pelvic Girdle Pain and Lumbar Pain in Pregnancy: A Cohort Study of the Consequences in terms of Health and Functioning
Open this publication in new window or tab >>Pelvic Girdle Pain and Lumbar Pain in Pregnancy: A Cohort Study of the Consequences in terms of Health and Functioning
2006 (English)In: Spine, ISSN 0362-2436, Vol. 31, no 5, E149-E155 p.Article in journal (Refereed) Published
Abstract [en]

Study Design A cohort study in pregnancy.

Objectives To differentiate between pregnancy-related pelvic girdle pain (PPGP) and lumbar pain, and to study the prevalence of each syndrome and its consequences in terms of pain, functioning, and health.

Summary of Background Data When studying prevalence, etiology, and consequences, differentiation between PPGP and lumbar pain is important, and, to our knowledge, its consequences for functioning and health during pregnancy have not previously been studied.

Methods All women answered questionnaires (demographic data, EuroQol). Women with lumbopelvic pain completed the Oswestry Disability Index, pain intensity measures, in addition to undergoing a mechanical assessment of the lumbar spine, pain provocation tests, and active straight leg raising test.

Results Of 313 women, 194 had lumbopelvic pain. The PPGP subgroup comprised 54% of those women with lumbopelvic pain, lumbar pain 17%, and combined PPGP and lumbar pain 29%. Women having both PPGP and lumbar pain reported the highest consequences in terms of health and functioning.

Conclusions Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.

Keyword
pelvic girdle pain, lumbar pain, pregnancy, health, functioning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12990 (URN)10.1097/01.brs.0000201259.63363.e1 (DOI)
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2009-05-15
2. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms
Open this publication in new window or tab >>Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms
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.

Keyword
pelvic girdle pain, lumbar pain, postpartum depressive symptoms, comorbidity, low back pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12991 (URN)10.1097/BRS.0b013e318060a673 (DOI)
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2017-12-13
3. Association between muscle function and low back pain in relation to pregnancy
Open this publication in new window or tab >>Association between muscle function and low back pain in relation to pregnancy
2008 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 4, 304-311 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy.

Design: Prospective cohort study.

Subjects: Consecutively enrolled pregnant women seen in gestational weeks 12–18 (n = 301) and 3 months postpartum (n = 262).

Methods: Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated.

Results: In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001–0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain.

Conclusion: Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.

Keyword
low back pain, pelvic girdle pain, lumbar pain, muscle function, gait, pregnancy, postpartum
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12992 (URN)10.2340/16501977-0170 (DOI)
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2017-12-13
4. Predicting persistent pregnancy-related low back pain
Open this publication in new window or tab >>Predicting persistent pregnancy-related low back pain
2008 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 33, no 12, E386-E393 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To examine the course of subtypes of low back pain (LBP) experienced [no LBP, pelvic girdle pain (PGP), lumbar pain, and combined PGP and lumbar pain (combined pain)] during gestational weeks 12 to 18 and 3 months postpartum, and to explore potential predictors for persistent PGP or combined pain postpartum.

Summary of background data: LBP is more prevalent in pregnant women (25%) than in the general population (6.3%). Persistent LBP postpartum (16%) is usually studied as a single entity. However, only one subgroup of LBP, pelvic girdle pain (PGP), is associated with pregnancy. Several studies have suggested an association between muscular dysfunction and pregnancy-related LBP, however, muscle dysfunction has not been evaluated as potential predictor of persistent LBP postpartum. Possible subgroup differences in the course and predictors of persistent LBP are unknown.

Methods: Pregnant women (n = 308) were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were evaluated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.

Results: Women with combined pain recovered to a lower degree 33% (17 of 51) than those with PGP 66% (56 of 85) or lumbar pain 72% (21 of 29). Predictors for having persistent PGP or combined pain after delivery were low endurance of back flexors, older age, combined pain in early pregnancy and work dissatisfaction (explained variance 30%).

Conclusion: Women with combined pain were identified to be a target group since they had the most unfavorable course and since the classification of combined pain was found to be a predictor for persistent pain postpartum. Identification of women at risk for persistent pain postpartum seems possible in early pregnancy and requires physical examination and self-reports. Pregnancy had low impact on the course of lumbar pain.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12993 (URN)10.1097/BRS.0b013e31817331a4 (DOI)
Available from: 2008-03-06 Created: 2008-03-06 Last updated: 2017-12-13

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