Pelvic girdle pain in pregnancy Pregnancy and Childbirth Abdominal and pelvic pain
Conditions
Interventions
Following initial assessment participants will be randomly allocated to one of two treatment groups (randomisation ratio 1:1). Patients will be asked to keep a pain score diary where they will record
Sponsors
Cork University Maternity Hospital (Ireland)
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: Pregnant women (primigravida and multigravida; no age limits) from 20-35 weeks of gestation attending Cork University Maternity Hospital (CUMH) low risk antenatal clinics who are referred to the physiotherapy department by their health care provider or following self referral with back pain or pelvic pain will be assessed for inclusion in the trial. Women referred to the physiotherapy department with symptoms of pelvic girdle pain (PGP) will be assessed on presentation by a one of six departmental physiotherapists specializing in women's health. To make the diagnosis of PGP the following tests will be performed as per the European Guidelines on the diagnosis and treatment of Pelvic Girdle Pain and a pain history taken as detailed. Sacroiliac joint assessment: 1. Posterior pelvic pain provocation test (P4) 2. Gaenslen's test 3. Compression of anterior superior iliac spines (ASIS) 4. Distraction Sacro-Iliac Joint (SIJ) pain provocation test 5. Assessment of Sulci depth in lumbar spine in neutral and extension Functional pelvic test: 6. Active straight leg raise test (ASLR) Pain history (according to the criteria of Ostgaard): 7. It is recommended that a pain history be taken with specific attention paid to pain patterns and irritability of PGP 8. There must be no nerve root syndrome 9. The severity of pain must be related to motion The diagnosis of PGP will be made if the patient has two or more of criteria 1-4 (Laslett's criteria) in combination with a negative McKenzie and negative neurological examination. Criteria 5-9 will be performed and assessed to try and improve diagnostic sensitivity and specificity as well as help exclude other pathologies that may cause pelvic and back pain.
Exclusion criteria
Exclusion criteria: 1. Women with other pain conditions, history of orthopaedic disease or surgery in the spine or pelvic girdle systemic disorders or if attending the high risk antenatal clinic in CUMH 2. Women who volunteered a history of sexual abuse at any point of the study 3. Women who do not speak English fluently 4. Women with non viable pregnancies 5. Women who have already received treatment for PGP outside of this trial 6. Pregnant women who present who will not be booking at CUMH for their pregnancy or are not resident in the South West of Ireland 7. Women with a history of severe PGP in previous pregnancies. Severe PGP will be defined as occurring less than 20 weeks gestation in a previous pregnancy or requiring crutches in a previous pregnancy or women with a history of PGP in two or more previous pregnancies.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| A reduction in the current intensity of PGP related to motion on a 100-point visual analogue scale (VAS) in the morning and in the evening recorded in the patient's diaries (0 represented no pain and 100 represented worst conceivable pain). | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Admission to hospital with PGP during the course of the current pregnancy 2. Frequency of sick leave from work due to PGP from initial diagnosis until delivery 3. Representation at the physiotherapy department during the trial period (From initial assessment and diagnosis until the last treatment session) 4. Representation at the physiotherapy department after the trial period (From last treatment session until delivery) 5. Number of patients requiring the combination of crutches and Tubigrip® (elasticated tubular support bandage) during the antenatal period 6. Number of patients induced or delivered earlier than their estimated date of delivery due to severe PGP 7. Patient satisfaction measured via the Client Satisfaction Questionnaire (CSQ-18B) following the third treatment 8. Patient specific functional scale (PSFS). This will be measured at initial assessment and following the third treatment. The PSFS will measure patient's ability to perform 3 out of the 4 following tasks. Each of the 3 tasks chosen by the patient is measured out of 10 and then an average score is taken. A drop of 2 in one of the tasks will be considered as indicating an improvement. A drop of 3 in the overall average of the 3 tasks will also be considered as indicating an improvement. The 3 tasks will be chosen from: a. Turning over in bed b. Climbing stairs c. Sitting more than 10 minutes d. Standing more than 10 minutes 9. Active straight leg raise. This will be measured at initial assessment and following the third treatment. While lying supine with a wedge placed under the women's right side, the patient will be asked to alternatively raise her legs. The patient will be asked to give a score out of 5 for the difficulty level. Scores are indicated as follows 5 = Unable to perform 4 = Very Hard 3 = Moderately Hard 2 = Somewhat Hard 1 = Minimal Difficulty 0 = No Difficulty The total score will be marked out of 10 (5 for each leg). A drop in the score of 3 will be consid | — |
Countries
Ireland
Outcome results
None listed