Objective: develop a Clinical Prediction Rule (CPR) for identifying postpartum women with Low Back (LBP) or Pelvic Girdle Pain (PGP) who demonstrate short-term improvement with Sacroiliac Joint (SIJ) mobilization. Significance: Development of a CPR for classifying subjects a-prior would improve the clinical decision-making process and research. Methods: a prospective cohort of 69 postpartum women was conducted at the University of Pittsburgh Medical Center. Subjects were six weeks to one year postpartum and had a chief complaint of pain in the lower back, pelvic girdle, or thigh. Subjects completed several self-report measures, questionnaires and underwent a physical examination. Subjects then underwent a grade V mobilization to the SIJ. Success with treatment was determined using percent changes in disability scores after one mobilization and served as the reference standard for determining accuracy of the examination variables. Variables with univariate prediction of success and non-success were combined into multivariate CPRs. Results: Fifty-five subjects (80%) had success with the mobilization and 14 (20%) were categorized as non-success. A CPR for success with four variables (seated flexion test, prone knee bend test, negative posterior superior iliac spine symmetry test, and symptom location in the lower lumbar spine and/or SIJ areas only) was identified. The presence of 2/4 criteria (+LR=3.05) increased the probability of success with mobilization from 80% to 92%. A CPR for non-success with three variables (age > 35 years, visual analogue score-best > 3, and negative prone knee bend test) was identified. The presence of 2/3 criteria (+LR=11.79) increased the probability of non-success with the mobilization from 20% to 75%. Conclusion: In our sample, 80% of subjects were successful after one mobilization without an attempt at prediction. This success rate was higher than the success rate of the general LBP population of a previously developed CPR. There is a low risk accompanying this intervention, it does not take long and benefits would be experienced after one session. The broad inclusion criteria of women with LBP or PGP allows clinicians to include women without a traditional diagnosis. Clinicians may opt to try the mobilization; an alternate approach can be used if it fails.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07052007-164019 |
| Date | 25 September 2007 |
| Creators | Hassan, Nowall A |
| Contributors | Joan Rogers, PhD, OTR/L, Anthony Delitto, PhD, PT, FAPTA, Susan Whitney, PhD, PT, NCS, ATC, FAPTA, Michael Boninger, MD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf, video/mpeg |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07052007-164019/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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