Drivers, barriers, and response to care of Australian pregnant women seeking chiropractic care for low back and pelvic girdle pain: a qualitative case study.

BACKGROUND: Pregnancy-related low back and/or pelvic girdle pain is common, with a prevalence rate of up to 86% in pregnant women. Although 19.5% of Australian pregnant women visit a chiropractor for pelvic girdle pain, little is known about the experience of pregnant women who seek this care. The aim of this study was to describe and explore the experiences of Australian pregnant women who seek chiropractic care for their current pregnancy-related low back and/or pelvic girdle pain. METHODS: A qualitative case study approach with purposive sampling from 27 chiropractic practices was used. A grounded theory approach was informed by a constructivist and interpretivist stance, which provided understanding and meaning to the pregnant women's experiences. Online unstructured interviews were recorded, transcribed, and anonymised. A thematic analysis was subsequently conducted on the primary data. Codes and major themes were developed with the use of critical self- reflection (memos), survey finding triangulation and respondent validation. RESULTS: Sixteen potential respondents expressed interest in participating. After eligibility screening and data saturation, nine interviews were undertaken. Four key themes were identified: "Care drivers: what drives care seeking?", "Care barriers: what barriers are encountered?", "Chiropractic treatment: what does treatment consist of?" and "Response to care: what response was there to care?". CONCLUSION: Four key themes: care drivers, care barriers, chiropractic treatment, and response to care support an emergent substantive-level theory in women's care seeking experiences for pregnancy-related back pain and chiropractic care. This theory is that chiropractic care for pregnant women experiencing low back pain and pelvic girdle pain may improve pain and function, while reducing pregnancy-related biopsychosocial concerns. The findings may inform antenatal health providers and the chiropractic profession about pregnant women's experience seeking chiropractic care as well as directing future research.

"We are not there yet": perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia.

BACKGROUND: Pregnancy-related pelvic girdle pain (PPGP) is a common condition worldwide. Women report being unprepared about PPGP, and state they receive little recognition and support from healthcare professionals. Situated within the Common-Sense Model and Convergent Care Theory, this study sought to gain a conceptual understanding of the perceptions, beliefs and experiences of healthcare professionals who provide routine care for women with PPGP in Australia. METHODS: A qualitative research design, using individual, semi-structured interviews with purposive sampling of healthcare professionals (N=27) consisting of doctors (N=9), midwives (N=9) and physiotherapists (N=9). Most participants were female (22/27) with a range of professional experience. An interview guide consisting of open-ended questions was used with a flexible and responsive approach. Thematic analysis was performed where interview data were transcribed, coded, grouped into meaningful categories and then constructed into broad themes. RESULTS: Four themes were identified: 1. Identity and impact of PPGP; 2. What works well?; 3. What gets in the way?; and 4. Quality care: What is needed? Healthcare professionals recognised PPGP as a common and disabling condition, which created a large impact on a woman's life during pregnancy. Stepped-level care, including education and physiotherapy intervention, was seen to be helpful and led to a positive prognosis. Barriers at patient, clinician and organisation levels were identified and led to consequences for women with PPGP not receiving the care they need. CONCLUSION: This study elucidates important implications for health care delivery. Acknowledging that PPGP is a common condition causing difficulty for many women, healthcare professionals identified strong teamwork and greater clinical experience as important factors in being able to deliver appropriate healthcare. Whilst healthcare professionals reported being committed to caring for women during pregnancy, busy workloads, attitudes towards curability, and a lack of formal education were identified as barriers to care. The findings suggest timely access, clear referral pathways and an integrated approach are required for best care practice for women with PPGP. A greater emphasis on the need for multidisciplinary models of care during pregnancy is evident.

Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women With Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effect of adding core stability to usual care for pregnant women with lumbar and pelvic girdle (LPG) pain. METHODS: This was a repeated-measures design randomized controlled trial with blinded outcome assessors. Thirty-five pregnant women with LPG pain were recruited from prenatal health care providers. They were allocated to 2 study groups to receive either usual prenatal care (control group, n = 17) or usual care with core stability exercises focusing on the pelvic floor muscles and deep abdominal muscles (exercise group, n = 18) for 10 weeks. The visual analog scale, score on the Oswestry Disability Index, and the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) were evaluated with analysis of variance at pre-intervention, post-intervention, at the end of pregnancy, and 6 weeks after childbirth. RESULTS: There was a statistically significant interaction of group and time for all outcome measures except for the Social category (P = .18) in the WHOQOL-BREF questionnaire. The analysis of the group within time showed that mean scores in the exercise group were substantially improved at the post-intervention, end of pregnancy, and 6-week follow-up evaluation, except in the Environment category (end of pregnancy: P = .36; 6-week follow-up: P = .75) in the WHOQOL-BREF questionnaire. CONCLUSION: The results of this study indicate that the addition of core stability exercises was more effective than the usual care alone in pain relief, improving disability, and quality of life of pregnant women with LPG pain.

Pregnancy-related low back/pelvic girdle pain: Prevalence, severity, and risk factors in Zhengzhou, China.

BACKGROUND: Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) significantly affect the quality of life of pregnant women. Understanding their severity and risk factors may help prevent and alleviate such pain and their resulting dysfunction. OBJECTIVE: This study investigated the prevalence, severity, and biopsychosocial risk factors of pregnancy-related LBP and PGP in Zhengzhou, China. METHODS: The Numeric Pain Rating Scale (NPRS), Chinese version of the Roland-Morris Disability Questionnaire (RMDQ), and other questionnaires were self-administered by 1020 pregnant women undergoing treatment at a tertiary hospital between July and December 2019. Binary logistic regression was used to identify factors associated with pregnancy-related LBP and/or PGP. RESULTS: The prevalence of LBP and/or PGP during pregnancy was 63.0%, and most participants (80.4%) had both. The mean NPRS and RMDQ disability scores were 2.44 ± 2.10 and 6.66 ± 4.65, respectively. A higher gestational body mass index, LBP and/or PGP during menstruation, history of pregnancy-related LBP and/or PGP, and constant pressure were significantly associated with pregnancy-related LBP and/or PGP. Subjective support was a protective factor against LBP and/or PGP. CONCLUSION: The prevalence of LBP and/or PGP was high. The risk factors should be included in routine prenatal care to identify patients at risk of LBP and/or PGP.

Outcome Measurement Instruments and Evidence-based Recommendations for Measurement of the Pelvic Girdle Pain Core Outcome Set (PGP-COS): A Systematic Review and Consensus Process.

This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Studies evaluating measurement properties of instruments measuring any PGP-COS outcome in women with PGP were identified through a systematic search of MEDLINE, EMBASE and PEDro databases (inception-July 2021). The methodological quality of studies and quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. Quality criteria and the synthesized evidence were graded using the modified grading of recommendations, assessment, development, and evaluation (GRADE) approach. A consensus meeting with PGP stakeholders was then held to establish recommendations, based on the evidence, for the instruments that should be used to measure the PGP-COS. Ten instruments were identified from 17 studies. No instrument showed high quality evidence for all measurement properties and/or measured all PGP-COS outcomes. Based on current evidence and consensus, the Pelvic Girdle Questionnaire (PGQ), the Short Form-8 (SF-8) and the Fear Avoidance Beliefs Questionnaire (FABQ) are recommended for measuring the PGP-COS. Future research should establish additional measurement properties of instruments and to substantiate these recommendations.

Application of Caring Life-Course Theory to explore care needs in women with pregnancy-related pelvic girdle pain.

AIMS: To describe the care needs of women with pregnancy-related pelvic girdle pain based on the Caring Life-Course Theory. DESIGN: A descriptive qualitative research design. METHODS: Data were collected between November 2019 and February 2021 from 20 purposively selected pregnant women with pelvic girdle pain aged between 22 and 39 years in antenatal care at a tertiary hospital in Australia. Individual semi-structured interviews were recorded via a digital audio recorder and transcribed verbatim. Qualitative content analysis method was used to analyse the data. FINDINGS: Five broad themes were identified: pain is an added burden to pregnancy; knowledge is power to own what happens to me; engaging in self-help; care from others is useful; and pain deserves more attention from healthcare professionals. CONCLUSION: Caring Life-Course Theory presented a useful and applicable scaffold for describing care needs of pregnant women with pelvic girdle pain. The study revealed experiencing pelvic girdle pain led to additional care needs during pregnancy, highlighting the importance of self-management strategies and an appreciation of care from others to assist women in limiting the effects of the pain. Participants identified the need for more information and attention from healthcare professionals to be able to better manage their condition. IMPACT: This study presents a comprehensive picture of the change in care needs triggered by experiencing pelvic girdle pain during pregnancy. The findings have the potential to facilitate better care provision by considering novel methods of delivery, such as information and communication technology, whilst acknowledging the value placed on credible and trusted sources. Knowledge acquired through this study may be used by nurses and midwives, along with other healthcare professionals, to enhance the provision of comprehensive care that is acceptable to women with pelvic girdle pain during pregnancy.

Management of women with pregnancy-related pelvic girdle pain: an international Delphi study.

OBJECTIVES: Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health. DESIGN AND PARTICIPANTS: Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds. RESULTS: Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches. CONCLUSION: This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.

Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials.

BACKGROUND: Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. OBJECTIVE: This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. METHODS: This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. RESULTS: Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term. CONCLUSION: Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

The impact of a sacroiliac joint belt on function and pain using the active straight leg raise in pregnancy-related pelvic girdle pain.

INTRODUCTION: Pelvic girdle pain (PGP) is the most common musculoskeletal concern in pregnancy. The Active Straight Leg Raise (ASLR) test is diagnostic. Sacroiliac joint (SIJ) belts are included in multimodal therapy, but there is no established predictive measure to determine which pregnant women will benefit. OBJECTIVE: To determine if the ASLR score is immediately reduced by SIJ belt application and whether PGP pain and function improves after 4 weeks of belt use. DESIGN: Prospective observational cohort study. SETTING: Academic medical center. PARTICIPANTS: Pregnant women at least 18 years of age in the second or third trimester of pregnancy with posterior PGP and ASLR score of 2 to 10. INTERVENTIONS: Four-week SIJ belt use. MAIN OUTCOME MEASURES: ASLR, Numerical Rating Scale (NRS), Pelvic Girdle Questionnaire (PGQ), Perceived Global Impression of Improvement (PGII). RESULTS: Sixty-three women enrolled. On multivariable analysis, immediate belted ASLR score was -2.70 points lower than the non-belted ASLR score (P < .001). Four weeks later there was significant improvement in the ASLR score with a belt (Mdiff = -0.99; P = .001) and without a belt (Mdiff = -1.94; P < .001); the decline was more precipitous for the non-belted response (Mdiff = -0.96; P = .02). Current NRS pain scores declined from baseline by approximately -0.94 points (P < .001). This decline did not depend on ASLR scores (interaction P = .43) or wearing a belt at the time of testing (interaction P = .51). Similar conclusions held for participants' usual NRS score and average PGQ score. After 4 weeks, 82% reported improvement based on the PGII. CONCLUSIONS: SIJ belts are a safe, well-tolerated, and effective therapeutic option for pregnancy-related PGP. The ASLR score is immediately reduced following SIJ belt application but does not predict pain score 4 weeks later. SIJ belt leads to significant improvements in pain and function over time.

Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic. METHODS: We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS: Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices. CONCLUSION: Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.

Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain. METHODS: A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS: Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable. CONCLUSION: No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.

Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective.

INTRODUCTION: Clinicians need support to effectively implement a biopsychosocial approach to people with pelvic girdle pain disorders. PURPOSE: A practical clinical framework aligned with a contemporary biopsychosocial approach is provided to help guide clinician's management of pelvic girdle pain. This approach is consistent with current pain science which helps to explain potential mechanistic links with co/multi-morbid conditions related to pelvic girdle pain. Further, this approach also aligns with the Common-Sense Model of Illness and provides insight into how an individual's illness perceptions can influence their emotional and behavioural response to their pain disorder. Communication is critical to supporting recovery and facilitating behaviour change within the biopsychosocial context and in this context, the patient interview is central to exploring the multidimensional nature of a persons' presentation. Focusing the biopsychosocial framework on targeted cognitive-functional therapy as a key component of care can help an individual with pelvic girdle pain make sense of their pain, build confidence and self-efficacy and facilitate positive behaviour and lifestyle change. There is growing evidence of the efficacy for this broader integrative approach, although large scale effectiveness trials are still needed. An in-depth case study provides guidance for clinicians, showing 'how to' implement these concepts into their own practice within a coherent practical framework. IMPLICATIONS: This framework can give clinicians more confidence in understanding and managing pelvic girdle pain. The framework provides practical strategies to assist clinicians with implementation; assisting the transition from knowing to doing in an evidence-informed manner that resonates with real world practice.

Myoelectrical activity of muscles stabilizing the sacroiliac joints before and after the use of elastic tapes in women suffering from Pregnancy-related Pelvic Girdle Pain.

OBJECTIVES: The aim of this study was the analysis of activity of selected muscles stabilizing the sacroiliac joints in pregnant women suffering from pelvic pain and changes in the pattern in response to the implementation of Kinesio Taping (elastic tape). MATERIAL AND METHODS: Seventeen women with Pregnancy-related Pelvic Girdle Pain and 20 pregnant women without pain in the lumbar-pelvic complex were enrolled into the study. In patients with pelvic pain, the parameters describing the action of the muscles were assessed: before the tape was applied, immediately after application, 3 days into application and 5 days after the cessation of taping. In the control group, the test was carried out one time. The activity of the muscles was measured during extension of the hip from a four-point kneeling position. RESULTS: The gluteus maximus muscle shows higher resting activity values than in the control group, before and after application of the tape as well as five days after the removal of the tape. Before application, the gluteus maximus activates quicker than in the control group while the ipsilateral extensor spinae had a delayed activation when compared to the control group. CONCLUSIONS: The patterns of activation of tested muscles and their action potential values are different in the group of women with pelvic pain compared to the group without pelvic pain. The application of KT in the lumbar region appears to alter the activation of the GM muscle as well as improve activation of IES muscle during hip extension from the four-point-kneeling position.

[Pelvic-sacral tendon-regulation needling technique of acupuncture combined with manipulative reduction in treatment of postpartum pelvic girdle pain: a randomized controlled trial].

OBJECTIVE: To observe the effect on postpartum pelvic girdle pain treated with the combined therapy of pelvic-sacral tendon-regulation needling technique of acupuncture and manipulative reduction and the simple manipulative therapy. METHODS: A total of 80 patients with postpartum pelvic girdle pain were randomized into an observation group and a control group, 40 cases in each one. In the control group, the manipulative reduction was simply adopted. In the observation group, on the base of the treatment as the control group, the pelvic-sacral tendon-regulation needling technique of acupuncture was applied at Mingmen (GV 4), Dachangshu (BL 25), Yaoyangguan (GV 3), Ciliao (BL 32), Zhongliao (BL 33), Huantiao (GB 30) and Yanglingquan (GB 34). In either group, the treatment was given once every two days, three times a week and 3 treatments taken as one course. Totally, 3 courses of treatment were required. The clinical therapeutic effect was compared in the patients between the two groups. The changes in the scores of the pain visual analogue scale (VAS), Oswestry dysfunction index (ODI) and Japanese Orthopaedic Association (JOA), as well as the pelvic floor distress inventory-short form 20 (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7) and the sex life index (the frequency of intercourse and orgasm) were recorded in the patients of the two groups before and after treatment. RESULTS: The total effective rate was 95.0% (38/40) in the observation group, higher than 77.5% (31/40) in the control group (P<0.01). After treatment, the scores of VAS, ODI, PFDI-20 and PFIQ-7 were lower than those before treatment respectively in the patients of the two groups (P<0.01). JOA score and the sex life index were increased after treatment as compared with those before treatment in the two groups (P<0.01). The difference value of each of the above indexes in the observation group was higher than the control group (P<0.01). CONCLUSION: The combined therapy of pelvic-sacral tendon-regulation needling technique of acupuncture and manipulative reduction effectively alleviates pain and improves the muscle strength of pelvic floor muscle fibers in the patients with postpartum pelvic girdle pain. Its therapeutic effect is better than that of the simple manipulative therapy.

Arcuate Pubic Ligament Injury-An Unknown Cause of Athletic Pubalgia.

A case report is presented that gives new insight into a very rare cause of athletic pubalgia. Up till now, no case has been published in literature about the relevance of an arcuate pubic ligament (APL) injury in athletic pubalgia. The APL or inferior pubic ligament is a thick triangular arch of ligamentous fibers connecting the 2 pubic bones below. The main function of the APL is to stabilize the symphysis pubis. The rupture of this ligament can lead to groin pain due to lack of stabilization of the symphysis pubis. Despite the importance of the anatomical and clinical function of the APL, very limited research is available about injuries of this ligament. This report describes a case of a traumatic left APL rupture, confirmed by magnetic resonance imaging, causing longstanding left groin pain in an amateur athlete.

Adding Chiropractic Treatment to Individual Rehabilitation for Persistent Pelvic Girdle Pain 3 to 6 Months After Delivery: A Pilot Randomized Trial.

OBJECTIVE: The purpose of this study was to investigate the feasibility of conducting a study examining the influence of individualized rehabilitation and chiropractic treatment, compared with individualized rehabilitation alone, in women with persistent dominating 1-sided pelvic girdle pain (PGP) 3 to 6 months after delivery. METHODS: Women were recruited from an outpatient clinic at Stavanger University Hospital, Norway and in a private chiropractic clinic in Stavanger. Those with persistent, dominating 1-sided PGP were included in this pilot study. Those who met inclusion criteria were randomized into 2 groups, one group received individualized rehabilitation and chiropractic treatment and the other group women received individualized rehabilitation alone. Treatment was measured for 20 weeks. RESULTS: Of 330 consenting women who were recruited who reported pelvic pain during pregnancy, 68 reported PGP or low back pain, and 63 consented to fill in a questionnaire. Forty-seven women underwent a clinical examination 3 to 6 months after delivery. During the examination, the women were diagnosed into subgroups for PGP. After exclusion of the women with low back pain only, a total of 13 women were diagnosed with dominating 1-sided PGP and thus included in this study. Six were randomized to the individualized rehabilitation and chiropractic treatment group and 5 to the individualized rehabilitation alone group. After 20 weeks of intervention, both groups reported improvement in disability and pain, but not in general health status. No serious or long-lasting adverse events were registered after treatment or training. CONCLUSION: We found that a study of this nature is feasible. However, the conditions of patient recruitment need to be considered carefully. We learned that a trial to investigate the effect of chiropractic treatment for PGP pain should include all subgroups of PGP to reach an acceptable sample size.

Outcomes and outcomes measurements used in intervention studies of pelvic girdle pain and lumbopelvic pain: a systematic review.

Background: Pelvic girdle pain is a common problem during pregnancy and postpartum with significant personal and societal impact and costs. Studies examining the effectiveness of interventions for pelvic girdle pain measure different outcomes, making it difficult to pool data in meta-analysis in a meaningful and interpretable way to increase the certainty of effect measures. A consensus-based core outcome set for pelvic girdle pain can address this issue. As a first step in developing a core outcome set, it is essential to systematically examine the outcomes measured in existing studies. Objective: The objective of this systematic review was to identify, examine and compare what outcomes are measured and reported, and how outcomes are measured, in intervention studies and systematic reviews of interventions for pelvic girdle pain and for lumbopelvic pain (which includes pelvic girdle pain). Methods: We searched PubMed, Cochrane Library, PEDro and Embase from inception to the 11th May 2018. Two reviewers independently selected studies by title/abstract and by full text screening. Disagreement was resolved through discussion. Outcomes reported and their outcome measurement instruments were extracted and recorded by two reviewers independently. We assessed the quality of reporting with two independent reviewers. The outcomes were grouped into core domains using the OMERACT filter 2.0 framework. Results: A total of 107 studies were included, including 33 studies on pelvic girdle pain and 74 studies on lumbopelvic pain. Forty-six outcomes were reported across all studies, with the highest amount (26/46) in the 'life impact' domain. 'Pain' was the most commonly reported outcome in both pelvic girdle pain and lumbopelvic pain studies. Studies used different instruments to measure the same outcomes, particularly for the outcomes pain, function, disability and quality of life. Conclusions: A wide variety of outcomes and outcome measurements are used in studies on pelvic girdle pain and lumbopelvic pain. The findings of this review will be included in a Delphi survey to reach consensus on a pelvic girdle pain - core outcome set. This core outcome set will allow for more effective comparison between future studies on pelvic girdle pain, allowing for more effective translation of findings to clinical practice. Supplementary information: Supplementary information accompanies this paper at 10.1186/s12998-019-0279-2.

Introducción: El dolor de la cintura pélvica es un problema común durante el embarazo y el posparto con un impacto personal y social significativo. Los estudios que examinan la efectividad de intervenciones para el dolor de la cintura pélvica miden diferentes resultados, lo que dificulta el agrupamiento de los datos en un metanálisis para aumentar la certeza de las medidas del efecto. Un conjunto de resultados principales basado en un consenso puede abordar este problema. Primero, para desarrollar un conjunto de resultados principales, es esencial examinar sistemáticamente los resultados utilizados en los estudios existentes. Objetivo: El objetivo de esta revisión sistemática fue identificar, examinar y comparar qué resultados se miden y reportan, y cómo se los miden, en estudios de intervención y revisiones sistemáticas de intervenciones para el dolor de la cintura pélvica y para el dolor lumbopélvico. Método: Se realizaron búsquedas en PubMed, Cochrane Library, PEDro y Embase desde el inicio hasta el 11 mayo 2018. Dos revisores seleccionaron independientemente los estudios por título/resumen y texto completo. El desacuerdo se resolvió por discusión. Los resultados reportados y sus instrumentos de medición fueron extraídos por dos revisores independiente. Se evaluó la calidad de informe con dos revisores independientes. Los resultados se agruparon en dominios principales utilizando el filtro OMERACT 2.0. Resultados: Se incluyeron 107 artículos: 33 artículos sobre el dolor de la cintura pélvica y 74 artículos sobre el dolor lumbopélvico. Se informaron 46 resultados, principalmente (26/46) en el dominio "Impacto en la vida". "El Dolor" fue el resultado más frecuente. Los estudios utilizaron diferentes instrumentos para medir los mismos resultados, particularmente para los resultados dolor, función, discapacidad y calidad de vida. Conclusiones: Se utiliza una amplia variedad de resultados y mediciones de resultados en estudios sobre el dolor de la cintura pélvica y el dolor lumbopélvico. Los resultados de esta revisión se incluirán en una encuesta Delphi, obtener para llegar a un consenso sobre un conjunto de resultados principales. Este conjunto de resultados principales permitirá una comparación más efectiva entre estudios sobre el dolor de la cintura pélvica, lo que permitirá un análisis más efectivo en la práctica clínica.