No / This paper presents the main findings of a systematic literature review that was undertaken to investigate whether physiotherapist-guided exercise is effective in reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven electronic databases were systematically searched. Studies that met the inclusion criteria were assessed for methodological quality and internal validity. Five primary randomized controlled trials (RCTs) and one post-partum follow-up study were included in the review. The authors of all six studies incorporated advice and physiotherapist-guided exercise, either in a group setting or as part of an individualized exercise programme, into at least one of their intervention groups, with or without the addition of a pelvic support belt, acupuncture or other physiotherapy treatment modality. Two of the primary RCTs found that exercise and advice effectively reduced pre-partum PPGP. One study concluded that exercise had no additional value beyond simply supplying a pelvic support belt and advice. The results of another trial supported the use of physiotherapist-guided stabilization exercises for the treatment of post-partum PPGP. Yet another study did not find any differences between the intervention groups involved. The works included in this review all reported that PPGP reduced over time, regardless of the intervention used to treat it, suggesting that the greatest factor influencing the resolution of PPGP is time rather than exercise. The findings do not support the routine use of physiotherapist-guided exercise in the treatment of all women with PPGP. Advice, information and a non-elastic pelvic support belt should be offered to women with pre-partum PPGP, whereas patients with persistent symptoms of post-partum PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing the pelvic area as part of a wider package of physiotherapy treatment.

No / This study aimed to address whether a water exercise programme improves pain and quality of life in pregnant patients with Pelvic Girdle Pain (PGP) compared to a land-based exercise programme and the feasibility of undertaking a large-scale research programme. Twenty-three participants with diagnosed PGP, recruited at St George’s Hospital London, were randomised into two groups (water or land exercise). Each group received, four, once-weekly exercise sessions on land or water. Exercise effects on PGP were measured using the Pelvic Girdle Pain Questionnaire (PGPQ) (primary outcome), Visual Analogue Scale (VAS), Patient Specific Functional Score (PSFS) and Active Straight Leg Raise (ASLR). Quality of life was measured using the Subjective Exercise Experience Scale (SEES). Outcomes were assessed at baseline and post four weeks exercise. Results showed there was a clinically significant improvement shown in all outcome measures in the water group, compared to the land group. A statistical difference between groups was shown for ASLR (p=0.036), Positive Well-Being (p=0.000) and Fatigue levels (p=0.011). No statistical difference was shown for PGPQ (p=0.056), PSFS (p=0.530) and Psychological Distress (p=0.712) scores. Exercise in water appears to offer a clinical benefit for patients experiencing PGP compared to a land exercise, particularly with Fatigue, Positive Well-Being and ASLR scores. Statistical differences between groups are limited by small sample size and that no power calculation was used in this study. Methodology and results provide support for a larger study on this topic to provide more definitive conclusions to support the use of water-based therapy for PGP.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21703号 / 人健博第69号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 山田 重人, 教授 古田 真里枝, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Bakgrund: Graviditetsrelaterad bäckengördelsmärta är vanligt förekommande bland kvinnor under och efter en graviditet. Detta påverkar kvinnorna negativt i stor utsträckning både fysiskt och psykiskt. Fysioterapi är en viktig och betydelsefull behandlingsform vid detta tillstånd, men evidensen kring fysioterapeutiska åtgärder är inte helt klarlagd och mer forskning behövs. Syfte: Studien syftade till att utforska och beskriva fysioterapeuterss upplevelser av och erfarenheter  frångällandeav  fysioterapeutiska åtgärder för patienter medvid graviditetsrelaterad BGS.   Metod: Studien var en kvalitativ intervjustudie som baserades på sex semi-strukturerade intervjuer. Informanterna var fysioterapeuter som arbetade med kvinnor som har graviditetsrelaterad bäckengördelsmärta. Ett bekvämlighetsurval tillämpades vid rekrytering av informanter. Data analyserades genom en kvalitativ innehållsanalys. Resultat: Fyra kategorier och tolv underkategorier identifierades i analysprocessen. De fyra kategorierna var: Ett givande och utmanande arbete där patientbemötandet har stor betydelse, Undersöknings-metodik varierar mellan fysioterapeuterna, Erfarenheter och upplevelser av behandlingsåtgärder varierar mellan fysioterapeuterna och Fysioterapi är ett viktigt och betydelsefullt arbetsområde med stort behov av utveckling., med sammanlagt tolv subkategorier. Konklusion: Fysioterapeuter som arbetar med graviditetsrelaterad bäckengördelsmärta är betydelsefulla och gör stor skillnad. Det framkom att det finns ett stort behov av utveckling inom området för att kunna förbättra och effektivisera vården. Vidare forskning behövs därför för att möjliggöra utveckling och fylla existerande kunskapsluckor. / Background: Pregnancy-related pelvic girdle pain is common among women during and after pregnancy. This affects women negatively both physically and mentally. Physiotherapy is an important and significant form of treatment for this condition, but the evidence regarding physiotherapeutic interventions is not fully clarified and more research is needed. Purpose: The purpose of this study was to describe physiotherapist’s views on and experiences from physiotherapeutic interventions for patients with pregnancy-related pelvic girdle pain. Method: The study was a qualitative interview study based on six semi-structured interviews. The informants were physiotherapists who worked with women who have pregnancy-related pelvic girdle pain. A convenience selection sampling was applied when recruiting informants. The data were analyzed through using a qualitative content analysis.  Results: Four categories and twelve subcategories were identified in the analysis process. The four categories were: A rewarding and challenging work where the encounter with the patient is of great importance, Examination methodology varies between the physiotherapists, Physiotherapists views and experience of treatment variesvaries, and Physiotherapy is an important and significant area of work with great need of development., with a total of twelve subcategories. Conclusion: Physiotherapists who work with pregnancy-related pelvic girdle pain are important and make a big difference. It emerged that there is a great need for development in the area to be able to improve and make the care more effective. Further research is therefore needed to enable development and fill existing knowledge gaps.

Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning.  Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise.  Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.

<p><strong> </strong></p><p>Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland &  Morris disability questionnaire.</p><p>Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.</p>

Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland &amp;  Morris disability questionnaire. Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-16T15:23:52Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Carlos Henrique Silva de Andrade.pdf: 3508712 bytes, checksum: 11186c86de9ddc89be78ecbbb4947877 (MD5) / Made available in DSpace on 2017-02-16T15:23:52Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Carlos Henrique Silva de Andrade.pdf: 3508712 bytes, checksum: 11186c86de9ddc89be78ecbbb4947877 (MD5) Previous issue date: 2016-04-28 / CAPES / A dor da cintura pélvica apresenta-se como uma disfunção musculoesquelética comum durante o período gestacional. Devido à imaturidade biológica que ocorre na adolescência, conjectura-se que os fatores associados ao desenvolvimento dessa dor em adolescentes gestantes sejam diferentes daqueles encontrados na mulher adulta. O objetivo deste estudo foi avaliar a associação da dor lombopélvica prévia à gestação com o desenvolvimento da dor na cintura pélvica, bem como os fatores associados ao nível de incapacidade funcional em gestantes adolescentes. Foi realizado um estudo do tipo caso-controle com adolescentes gestantes, atendidas em duas unidades de referência da região metropolitana de Recife, Pernambuco, Brasil. Foram avaliadas 404 adolescentes (73 casos e 331 controles). No grupo caso, foram incluídas gestantes com idade entre 10 e 19 anos, idade gestacional entre a 28ª e a 40ª semana de gestação e presença de dor na cintura pélvica. No grupo controle foram incluídas as gestantes com ausência de dor na cintura pélvica. Um modelo de regressão logística foi utilizado para identificar os fatores associados à ocorrência de dor da cintura pélvica. Além disso, foi realizada uma análise no grupo de casos sobre os fatores associados à incapacidade funcional. A média da intensidade da dor nas 73 adolescentes com dor na cintura pélvica foi de 58 mm (Desvio Padrão [DP]: 20,13) em uma escala de 100 mm. Em relação à localização e envolvimento das articulações pélvicas, obteve-se a seguinte distribuição: 46 (63%) síndrome sacroilíaca bilateral; 17 (23,3%) síndrome da cintura pélvica e 10 (13,7%) síndrome sacroilíaca unilateral. No modelo de regressão multivariada, permaneceram associados com a dor na cintura pélvica os seguintes fatores: transtorno mental comum (Odds Ratio [OR]: 2,27; Intervalo de Confiança 95% [IC95%]: 1,23 a 4,18), dor lombar na menstruação (OR: 2,10; IC95%: 1,16 a 3,80) e trabalho árduo (OR: 1,95; IC95%: 1,13 a 3,35). No grupo de gestantes com dor na cintura pélvica, o coeficiente de determinação encontrado no modelo ajustado indica que 22% da variabilidade total da incapacidade funcional (ODI) em gestantes adolescente são explicadas pelos fatores transtorno mental comum (SRQ20), intensidade da dor na cintura pélvica (EAV) e idade gestacional (IG), expressos na seguinte equação: ODI (predito) = -18,2 + 0,81 x SRQ20 + 0,25 x EAV + 0,73 x IG. Conclui-se, portanto, que não houve associação entre a história de dor lombopélvica prévia à gestação e a presença de dor na cintura pélvica relacionada com a gestação em adolescentes. No entanto, a dor lombar na menstruação, o trabalho árduo e o transtorno mental comum foram fatores que se mostraram associados com a dor na cintura pélvica nessa população. Também foi evidenciado que a intensidade da dor e a presença de transtorno mental comum encontram-se associados com a incapacidade funcional dessas adolescentes. / Pelvic girdle pain is a common musculoskeletal dysfunction during pregnancy. Due to biological immaturity and unfavorable psychosocial conditions, pregnancy in adolescence may be associated with pelvic girdle pain. The aim of this study was to assess the association between lumbopelvic pain before pregnancy and level of functional disability and pelvic girdle pain related to pregnancy in adolescents. A case-control study was conducted with pregnant adolescents, treated at two specialist units in the city of Recife, Pernambuco state, Brazil. A total of 404 adolescents (73 cases and 331 controls) were assessed. The case group included pregnant adolescents between the ages of 10 and 19 years, gestational age between 28 and 40 weeks and exhibiting pelvic girdle pain. The control groups consisted of pregnant adolescents with no pelvic girdle pain. A logistic regression model was used to identify the factors associated with the occurrence of pelvic pain. The measure of pain intensity in 73 adolescents with pelvic pain was 58 mm (standard deviation [SD]: 20.13) on a scale of 100 mm. In relation to location and pelvic joint involvement, the following distribution was obtained: 46 (63%) bilateral sacroiliac syndrome; 17 (23.3%) pelvic congestion syndrome and 10 (13.7%) unilateral sacroiliac syndrome. In the multivariate regression model the following variables were associated with pelvic pain in pregnant adolescents: common mental disorder (Odds Ratio [OR]: 2.27; 95% Confidence Interval [95%CI]: 1.23 to 4.18), menstrual back pain (OR: 2.10; 95%CI: 1.16 to 3.80) and strenuous work (OR: 1.95; 95%CI: 1.13 to 3.35). In the group of pregnant adolescents with pelvic girdle pain, the coefficient of determination found in the adjusted model indicates that 22% of total variability in functional disability (ODI) in pregnant adolescents is explained by the following variables: common mental disorder (SRQ20), pelvic pain intensity (EAV) and gestational age (GA), expressed in the following equation: ODI (predictive) = -18.2 + 0.81 x SRQ20 + 0.25 x EAV + 0.73 x GA. It is concluded, therefore, that there is no association between history of lumbopelvic pain prior to pregnancy and the presence of pelvic girdle pain related to pregnancy in adolescents. However, menstrual back pain, strenuous work and common mental disorder were factors associated with pelvic girdle pain in this population. It was also shown that pain intensity and common mental disorder in adolescents with pregnancy-related pelvic girdle pain are closely related to the functional disability of these women.

Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth. Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rating Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined. Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections. Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.

Bakgrund: Bäckensmärta är en vanlig problematik under graviditet och postpartum. Uppkomsten av problematiken beror på de olika förändringar kvinnans kropp genomgår under graviditeten. Det finns ett antal olika tester som en fysioterapeut kan utföra för att diagnostisera smärtan, såsom P4-test, Patrick´s, FABER, Gaenslens´s test, distraktions test, sidliggande kompression, sacrum tryck och modifierad Trendelenburg´s test. Sedan finns det olika behandlingsalternativ såsom akupunktur, TENS, manipulationer, mobilisering, bäckenbälte och olika träningsformer men det finns inte en stark evidens kring alla dessa. Den kunskap som lärs ut under grundutbildningen ger inte mycket redskap för hur en fysioterapeut ska arbeta med graviditetsrelaterad bäckensmärta. Syfte: Syftet med studien är att beskriva kunskaper och erfarenheter från fysioterapeuter inom kvinnohälsa med kompetens att behandla patienter med graviditetsrelaterad bäckensmärta under graviditet och postpartum Metod: En kvalitativ intervjustudie där fyra fysioterapeuter som arbetar inom kvinnohälsa intervjuades. Insamlad data analyserades enligt kvalitativ innehållsanalys. Resultat: Dataanalysen resulterade i fyra kategorier, grundutbildningen ger basal kunskap, vidareutbildningar fördjupar kunskapen, beprövad erfarenhet prioriteras i mötet med patienten, fysioterapeutens undersökning och behandling av bäckensmärta. Konklusion: Grundutbildningen i fysioterapi upplevdes ge basala kunskaper men sakna djupare kunskap angående kvinnohälsa och graviditetsrelaterad bäckensmärta. Vidareutbildningar inom kvinnohälsa var till stor nytta för att ge god vård åt patienter med bäckensmärta under och efter graviditet. Det upplevdes viktigt att beakta patientens helhetssituation, utifrån ett biopsykosocialt förhållningssätt, ta en noggrann anamnes och kunna bemöta patienten empatiskt. Fysioterapeuterna upplevde det viktigt att ge råd om att tänka på att sköta om sin hälsa och få egen tid. Den fysioterapeutiska undersökningen av graviditetsrelaterad bäckensmärta bör innehålla ett P4-test, ASLR, modifierat trendelenburg och palpation runt bäckenet. I behandlingen bör patienten få ett individuellt träningsprogram med bålstabiliserande övningar för att stärka glutealmuskulaturen. Akupunktur kan vara relevant som smärtstillande behandling. / Background: Pelvic pain is a common problem during pregnancy and postpartum. The emergence of the problem is due to the various changes the woman's body undergoes during pregnancy. There are a number of different tests that a physiotherapist can perform to diagnose the pain, such as the P4 test, Patrick's, FABER's, Gaenslen's test, distraction test, lateral compression, sacrum pressure and modified Trendelenburg's test. Then there are various treatment options such as acupuncture, TENS, manipulations, mobilization, pelvic girdle belt and various forms of exercise, but there are not strong evidence around all of these. The knowledge taught during basic education does not provide much tools for how a physiotherapist should work with pregnancy-related pelvic pain. Aim: The aim of this study was to describe the knowledge and experience of physiotherapists in women's health with competence to treat patients with pregnancy-related pelvic girdle pain during pregnancy and postpartum. Method: A qualitative interview study where four physiotherapists working in women's health were interviewed. Collected data was analyzed according to qualitative content analysis. Results: The data analysis resulted in four categories, the basic training provides basic knowledge, further education deepens the knowledge, proven experience is prioritized in meeting with the patient, the physiotherapist's examination and treatment of pelvic pain. Conclusion: The basic education in physiotherapy was perceived to provide basic knowledge but lack deeper knowledge regarding women's health and pregnancy-related pelvic pain. Further education in women's health was of great benefit in providing good care to patients with pelvic pain during and after pregnancy. It is important to consider the patient's overall situation, based on a biopsychosocial approach, take a careful history and be able to treat the patient empathetically. The physiotherapists felt it was important to give advice on thinking about taking care of oneself and having personal time. The physiotherapeutic examination of pregnancy-related pelvic pain should include a P4 test, ASLR, modified Trendelenburg and palpation around the pelvis. The patient should receive an individual training program with posterior stabilizing exercises to strengthen the gluteal muscles. Acupuncture can be relevant as a pain-relieving treatment.