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  • 1.
    Fagevik Olsen, Monika
    et al.
    Sahlgrens University Hospital.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Elden, Helen
    University of Gothenburg.
    Nordenman, Charlotte
    Rehabenheten, Dalsjofor.
    Fabricius, Lina
    Kinna Care Centre.
    Gravesen, Melissa
    Psykiatriska Oppenvardsmottagningen, Falkoping.
    Lind, Anette
    Gothenburg University.
    Kjellby-Wendt, Gunilla
    Sahlgrens University Hospital.
    Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain2009In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 18, no 8, p. 1121-1129Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate sensitivity and specificity of self-administrated tests aimed at pain provocation of posterior and/or anterior pelvis pain and to investigate pain intensity during and after palpation of the symphysis. A total of 175 women participated in the study, 100 pregnant women with and 25 pregnant women without lumbopelvic back pain and 50 non-pregnant women. Standard pain provocation tests were compared with self assessed tests. All women were asked to estimate pain during and after palpation of the symphysis. For posterior pelvic pain, the self-test of P4 and Bridging test had the highest sensitivity of 0.90 versus 0.97 and specificity of 0.92 and 0.87. Highest sensitivity for self-test for anterior pelvic pain was pulling a mat 0.85. Palpation of symphysis was painful and persistency of pain was the longest among women who fulfilled the criteria for symphyseal pain. There were overall significant differences between the groups concerning intensity and persistency of pain (P andlt; 0.001). Our results indicate that pregnant women can perform a screening by provocation of posterior pelvic pain by self-tests with the new P4 self-test and the Bridging test. Palpation of the symphysis is painful and should only be used as a complement to history taking, pain drawing and pulling a MAT-test.

  • 2.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy2007Doctoral 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.

    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, p. E149-E155Article 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.

    Keywords
    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, p. 1430-1436Article 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.

    Keywords
    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: 2019-06-28
    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, p. 304-311Article 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.

    Keywords
    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, p. E386-E393Article 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
  • 3.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Betten, Carola
    Primary Hlth Care, Skurup, Region Skane, Sweden.
    Degerskar, Kristina
    Primary Hlth Care, Lund, Region Skane, Sweden.
    Pousette, Sara
    Private Clin Friskispraktiken, Sweden.
    Fagevik Olsen, Monika
    University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1156-1167Article, review/survey (Refereed)
    Abstract [en]

    ObjectiveTo explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. Material and methodsData sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. ResultsFor lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. ConclusionsThe levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.

  • 4.
    Gutke, Annelie
    et al.
    Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Bullington, Jennifer
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Lund, Madeleine
    Home Care and Rehabilitation, The City of Gothenburg, Gothenburg, Sweden.
    Lundberg, Mari
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; ; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 25, p. 3054-3060Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.

    Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.

    Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.

    Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

    IMPLICATIONS FOR REHABILITATION

    Chronic pregnancy-related pelvic girdle pain

    • Pregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.

    • The participants’ narratives highlighted that the pain interfered with their sense of identity.

    • It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

  • 5.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    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.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms2007In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 32, no 13, p. 1430-1436Article in journal (Refereed)
    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.

  • 6.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kjellby-Wendt, Gunilla
    Sahlgrens University Hospital.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain2010In: MANUAL THERAPY, ISSN 1356-689X, Vol. 15, no 1, p. 13-18Article in journal (Refereed)
    Abstract [en]

    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.

  • 7.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lundberg, Mari
    Gothenburg University.
    Ostgaard, Hans Christian
    Sahlgrens University Hospital.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms2011In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 20, no 3, p. 440-448Article in journal (Refereed)
    Abstract [en]

    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.

  • 8.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Olsson, Christina B.
    Stockholm County Council, Sweden Karolinska Institute, Sweden .
    Vollestad, Nina
    Oslo University, Norway.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsson Wikmar, Lena
    Karolinska Institute, Sweden .
    Stendal Robinson, Hilde
    University of Oslo, Norway .
    ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 5, p. 468-474Article in journal (Refereed)
    Abstract [en]

    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.

  • 9.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ostgaard, Hans Christian
    Göteborg.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Letter: Untitled - Response in SPINE, vol 31, issue 20, pp 2406-24072006In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 31, no 20, p. 2406-2407Article in journal (Other academic)
    Abstract [en]

    n/a

  • 10.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Roos Hansson, Eva
    Frolunda Specialist Hospital.
    Zetherstrom, Gunilla
    Frolunda Specialist Hospital.
    Christian Ostgaard, Hans
    Sahlgrens University Hospital.
    Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs2009In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 18, no 7, p. 1008-1012Article in journal (Refereed)
    Abstract [en]

    The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

  • 11.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sjödahl, Jenny
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 10, p. 929-935Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Östgaard, Hans Christian
    Sahlgrenska University.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Association between muscle function and low back pain in relation to pregnancy2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 4, p. 304-311Article in journal (Refereed)
    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.

  • 13.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Östgaard, Hans Christian
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Pelvic Girdle Pain and Lumbar Pain in Pregnancy: A Cohort Study of the Consequences in terms of Health and Functioning2006In: Spine, ISSN 0362-2436, Vol. 31, no 5, p. E149-E155Article in journal (Refereed)
    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.

  • 14.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Östgaard, Hans Christian
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predicting persistent pregnancy-related low back pain2008In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 33, no 12, p. E386-E393Article in journal (Refereed)
    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.

  • 15.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Östgaard, Hans Christian
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Untitled - Response2006In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 31, no 20, p. 2406-2407p. 2406-2407Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 16.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Ghaffari, Ghazaleh
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study2016In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 35, p. 49-55Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. Methods: Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. Findings: No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P amp;lt; 0.01). Interpretation: We suggest that disturbed motor activation patterns influence womens ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements. (C) 2016 Elsevier Ltd. All rights reserved.

  • 17.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Predictors for disability in women with persistent postpartum pelvic girdle painManuscript (preprint) (Other academic)
    Abstract [en]

    The majority of studies on postpartum lumbopelvic pain have investigated predictors for women experiencing lumbopelvic pain during pregnancy. Since the majority of women recover within the first months of delivery it is unknown if the same predictors are valid for disability in women with persistent postpartum pelvic girdle pain (PGP). The aim of this study was to identify predictors for disability in women with persistent PGP 15 months postpartum. Factors were obtained by clinical tests and questionnaires 3 months postpartum. Outcome 15 months postpartum was disability measured with Oswestry Disability Index. A multiple linear regression analysis identified two significant two-way interaction effects that predicted for disability in women with persistent PGP at 15 months postpartum: a) age + trunk flexor endurance, b) disability + hip extensor strength.

  • 18.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictors for long-term disability in women with persistent postpartum pelvic girdle pain2013In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 7, p. 1665-1673Article in journal (Refereed)
    Abstract [en]

    Purpose

    The 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).

    Methods

    Data were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.

    Results

    A 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.

    Conclusions

    Age, 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.

  • 19.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain2009In: CLINICAL BIOMECHANICS, ISSN 0268-0033, Vol. 24, no 2, p. 183-189Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain.

    Methods: Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement.

    Findings: In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition. electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements.

    Interpretation: The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.

  • 20.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain: an experimental studyManuscript (preprint) (Other academic)
    Abstract [en]

    The hypothesis was that women with pelvic girdle pain (PGP) would lack a feedforward mechanism in the pelvic floor muscles (PFM) in relation to a functional instability problem. Eight women with PGP and 10 pain-free women were included. A clinical examination was performed to verify that participants with PGP fulfilled the diagnostic criteria used in this study. Surface electromyographic activity was recorded from the PFM and unilaterally from abdominal muscles and the rectus femoris muscle. Participants performed leg lifts (performed as Active Straight Leg Raise (ASLR) tests), first with one leg and then with the other. The lift was also performed with an extra weight strapped on one leg. Median onset of PFM activity occurred before the initiation of the lifts in both groups. One woman experienced more severe PGP/dysfunction demonstrated by a higher score on the ASLR test during the clinical examination. This woman presented onset of PFM activity after the initiation of the lifts. The findings suggest that a feed-forward response of the PFM is present during leg lifts in women with and without postpartum PGP. However, one can speculate that a lack of feed-forward in the PFM may be associated with a load transfer problem.

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