scispace - formally typeset
Search or ask a question
Reference EntryDOI

Interventions for preventing and treating pelvic and back pain in pregnancy

01 Aug 2013-Cochrane Database of Systematic Reviews (John Wiley & Sons, Ltd)-Vol. 2, Iss: 8, pp 0-0
TL;DR: There was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both were better than usual care and function improved more when acupuncture was started at 26- rather than 20- weeks' gestation.
Abstract: Background More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain. Pain increases with advancing pregnancy and interferes with work, daily activities and sleep. Objectives To assess the effects of interventions for preventing and treating pelvic and back pain in pregnancy. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 July 2012), identified related studies and reviews from the Cochrane Back Review Group search strategy to July 2012, and checked reference lists from identified reviews and studies. Selection criteria Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy. Data collection and analysis Two review authors independently assessed risk of bias and extracted data. Quality of the evidence for outcomes was assessed using the five criteria outlined by the GRADE Working Group. Main results We included 26 randomised trials examining 4093 pregnant women in this updated review. Eleven trials examined LBP (N = 1312), four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). Diagnoses ranged from self-reported symptoms to the results of specific tests. All interventions were added to usual prenatal care and unless noted, were compared to usual prenatal care. For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference (SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23; two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92; one RCT, N = 241). Low-quality evidence from single trials suggested no significant difference in pain or function between two types of pelvic support belt, between osteopathic manipulation (OMT) and usual care or sham ultrasound (sham US). Very low-quality evidence suggested that a specially-designed pillow may relieve night pain better than a regular pillow. For pelvic pain, there was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both were better than usual care. Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not average pain; and evening pain relief was the same following either deep or superficial acupuncture. For lumbo-pelvic pain, there was moderate-quality evidence that an eight- to 20-week exercise program reduced the risk of women reporting lumbo-pelvic pain (RR 0.85; 95% CI 0.73 to 1.00; four RCTs, N = 1344); but a 16- to 20-week training program was no more successful than usual care at preventing pelvic pain (one RCT, N = 257). Low-quality evidence suggested that exercise significantly reduced lumbo-pelvic-related sick leave (RR 0.76; 95% CI 0.62 to 0.94, two RCTs, N = 1062), and improved function. Low-quality evidence from single trials suggested that OMT significantly reduced pain and improved function; either a multi-modal intervention that included manual therapy, exercise and education (MOM) or usual care significantly reduced disability, but only MOM improved pain and physical function; acupuncture improved pain and function more than usual care or physiotherapy; pain and function improved more when acupuncture was started at 26- rather than 20- weeks' gestation; and auricular (ear) acupuncture significantly improved these outcomes more than sham acupuncture. When reported, adverse events were minor and transient. Authors' conclusions Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or LBP. Low-quality evidence suggested that exercise significantly reduced pain and disability from LBP. There was low-quality evidence from single trials for other outcomes because of high risk of bias and sparse data; clinical heterogeneity precluded pooling. Publication bias and selective reporting cannot be ruled out. Physiotherapy, OMT, acupuncture, a multi-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone. Acupuncture was more effective than physiotherapy at relieving evening lumbo-pelvic pain and disability and improving pain and function when it was started at 26- rather than 20-weeks' gestation, although the effects were small. There was no significant difference in LBP and function for different support belts, exercise, neuro emotional technique or spinal manipulation (SMT), or in evening pelvic pain between deep and superficial acupuncture. Very low-quality evidence suggested a specially-designed pillow may reduce night-time LBP. Further research is very likely to have an important impact on our confidence in the estimates of effect and is likely to change the estimates. Future research would benefit from the introduction of an agreed classification system that can be used to categorise women according to presenting symptoms.

Summary (1 min read)

Background

  • More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain.
  • Pain increases with advancing pregnancy and interferes with work, daily activities and sleep.

Main results

  • The authors included 26 randomised trials examining 4093 pregnant women in this updated review.
  • Diagnoses ranged from self-reported symptoms to the results of specific tests.
  • All interventions were added to usual prenatal care and unless noted, were compared to usual prenatal care.
  • Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not average pain; and evening pain relief was the same following either deep or superficial acupuncture.

Authors’ conclusions

  • Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or LBP.
  • Low-quality evidence suggested that exercise significantly reduced pain and disability from LBP.
  • There was moderate-quality evidence that acupuncture reduced evening pain better than exercise; both were better than usual care (one RCT), also known as Pelvic pain.
  • 3Interventions for preventing and treating pelvic and back pain in pregnancy Copyright © 2013 The Cochrane Collaboration.
  • Further research is likely to have an important impact on their confidence in the estimate of effect and may change the estimate, also known as Moderate quality.

Did you find this useful? Give us your feedback

Content maybe subject to copyright    Report

Interventions for preventing and treating pelvic and back pain
in pregnancy (Review)
Pennick V, Liddle SD
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2013, Issue 8
http://www.thecochranelibrary.com
Interventions for preventing and treating pelvic and back pain in pregnancy (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Lt d.

T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .
6BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
17ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .
25DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
85DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.1. Comparison 1 Low-back pain: any e xercises + usual prenatal care versus usual prenatal care, Outcome 1 Pain
intensity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Analysis 1.2. Comparison 1 Low-back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 2
Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Analysis 2.1. Comparison 2 Low-back pain: water gymnastics + usual prenatal care versus usual prenatal care, Outcome 1
Number of women taking sick leave because of back pain after 32 weeks’ gestation. . . . . . . . . . . 88
Analysis 3.1. Comparison 3 Low-back pain: support belts, Outcome 1 Low-back pain, measured with VAS ; 0 to 10; 0 = no
pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Analysis 4.1. Comparison 4 Pelvic pain: deep versus superficial acupuncture, Outcome 1 Evening pain. . . . . . 90
Analysis 5.1. Comparison 5 Pelvic + low-back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome
1 Women who reported pain on Visual Analogue Scale. . . . . . . . . . . . . . . . . . . . 90
Analysis 5.2. Comparison 5 Pelvic + low-back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome
2 Women who reported LBP/PGP-related sick leave. . . . . . . . . . . . . . . . . . . . . 91
Analysis 6.1. Comparison 6 Pelvic + low-back pain: acupuncture + usual prenatal care versus usual prenatal care, Outcome
1 Number of women who reported decreased pain. . . . . . . . . . . . . . . . . . . . . . 92
Analysis 7.1. Comparison 7 Pelvic + low-back pain: acupuncture + usual prenatal care versus individualised physio + usual
prenatal care, Outcome 1 Numbers of women rating treatment as good or excellent. . . . . . . . . . 92
92APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
94FEEDBACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
95WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
96HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
97CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
97DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
97SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
98DIFFERENCES BETWEEN PROTOCO L AND REVIEW . . . . . . . . . . . . . . . . . . . . .
98INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iInterventions for preventing and treating pelvic and back pain in pregnancy (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Lt d.

[Intervention Review]
Interventions for preventing and treating pelvic and back pain
in pregnancy
Victoria Pennick
1
, Sarah D Liddle
2
1
Cochrane Editorial Unit, The Cochrane Collaboration, London, UK.
2
Institute of Nursing and Health Research, University of Ulster,
Newtownabbey, Ireland
Contact address: Victoria Pennick, Cochrane Editorial Unit, The Cochrane Collaboration, 11-13 Cavendish Square, London, W1G
0AN, UK. vpennick@cochrane.org.
Editorial group: Cochrane Pregnancy and Childbirth Group.
Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 8, 2013.
Review content assessed as up-to-date: 14 December 2012.
Citation: Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of
Systematic Reviews 2013, Issue 8. Art. No.: CD001139. DOI: 10.1002/14651858.CD001139.pub3.
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain. Pain increases
with advancing pregnancy and interferes with work, daily activities and sleep.
Objectives
To assess the effects of interventions for preventing and treating pelvic and back pain in pregnancy.
Search methods
We searched the Cochrane Pregnancy and Ch ildbirth Groups Trials Register (18 July 2012), identified related studies and reviews f r om
the Cochrane Back Review Group search strategy to July 2012, and checked reference lists from identified reviews and studies.
Selection criteria
Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy.
Data collection and analysis
Two review authors independently assessed risk of bias and extracted data. Quality of the evidence for outcomes was assessed using the
five criteria outlined by the GRADE Working Group.
Main results
We included 26 randomised trials examining 4093 pregnant women in this updated review. Eleven trials examined LBP (N = 1312),
four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). Diagnoses ranged
from self-reported symptoms to the results of specific tests. All interventions were added to usual prenatal care and unless noted, were
compared to usual prenatal care.
For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference
(SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23;
two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92;
1Interventions for preventing and treating pelvic and back pain in pregnancy (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

one RCT, N = 241). Low-quality evidence from single trials suggested no significant difference in pain or function between two types
of pelvic support belt, between osteopathic manipulation (OMT) and usual care or sham ultrasound (sham US). Very low-quality
evidence suggested that a specially-designed pillow may relieve night pain better than a regular pillow.
For pelvic pain, there was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both
were better than usual care. Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average
pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not
average pain; and evening pain relief was the same following either deep or superficial acupuncture.
For lumbo-pelvic pain, there was moderate-quality evidence that an e ight- to 20-week exercise program reduced the risk of women
reporting lumbo-pelvic pain (RR 0.85; 95% CI 0.73 to 1.00; four RCTs, N = 1344); but a 16- to 20-week training program was no
more successful than usual care at preventing pelvic pain (one RCT, N = 257). Low-quality evidence suggested that exercise significantly
reduced lumbo-pelvic-related sick leave (RR 0.76; 95% CI 0.62 to 0.94, two RCTs, N = 1062), and improved function. Low-quality
evidence from single trials suggested that OMT significantly reduced pain and improved function; either a mul ti-modal intervention
that included manual therapy, exercise and education (MOM) or usual care significantly reduced disability, but only MOM improved
pain and physical function; acupuncture improved pain and function more than usual care or physiotherapy; pain and function
improved more when acupuncture was started at 26- rather than 20- weeks gestation; and auricular (ear) acupuncture significantly
improved these outcomes more than sham acupuncture.
When reported, adverse events were minor and transient.
Authors conclusions
Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening
pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing
evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or
LBP. Low-quality evidence suggested that exercise significantly reduced pain and disability f r om LBP.
There was low-quality evidence from single trials for other outcomes because of high risk of bias and sparse data; clinical heterogeneity
precluded pooling. Publication bias and selective reporting cannot be ruled out.
Physiotherapy, OMT, acupuncture, a mul ti-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic
or back pain more than usual care alone. Acupuncture was more effective than ph ysiotherapy at relieving evening lumbo-pelvic pain
and disability and improving pain and function when it was started at 26- rather than 20-weeks gestation, although the effects were
small.
There was no significant difference in LBP and function for diffe rent support belts, exercise, neuro emotional technique or spinal
manipulation (SMT), or in evening pelvic pain between deep and superficial acupuncture.
Very low-quality evidence suggested a specially-designed pillow may reduce night-time LBP.
Further research is very likely to have an important impact on our confidence in the estimates of effect and is likely to change the
estimates. Future research would benefit from the introduction of an agreed classification system that can be used to categorise women
according to presenting symptoms.
P L A I N L A N G U A G E S U M M A R Y
Interventions for preventing and treating pelvic and back pain in pregnancy
Many women experience low-back (LBP) or pelvic pain during pregnancy. Pain usually increases as pregnancy advances, interfering
with work, daily activities, and sleep.
We included 26 randomised trials (RCTs) involving 4093 women. Eleven examined LBP (1312 women); four examined pelvic pain
(661 women); 11 examined both conditions together (lumbo-pelvic pain) (2120 women). Unless noted, interventions were added and
compared to usual prenatal care.
Moderate-quality evidence showed that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic
or lumbo-pelvic pain. Acupuncture was significantly more effective than exercise for reducing evening pelvic pain. A 16- to 20-week
2Interventions for preventing and treating pelvic and back pain in pregnancy (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

training program was no more successful than usual care in preventing pelvic or LBP. Low-quality evidence suggested that exercise
reduced pain and disability from LBP. Reported adverse effects were minor and transient. Further research is likely to change the
estimates of effect of these interventions. An agreed classification system for categorising women is overdue.
LBP: there was low-quality evidence that exercise significantly reduced pain (six RCTs) and disability (two RCTs). From single trials;
exercise in water significantly reduced LBP-related sick leave; pain and physical function were similar when wearing pelvic support bel ts
or having osteo-manipulative therapy (OMT) compared with usual care or sham ultrasound. Very low-quality evidence suggested that
a specially-designed pillow may relieve night pain better than a regular pillow.
Pelvic pain: there was moderate-quality evidence that acupuncture reduced evening pain better than exercise; both were better than
usual care (one RCT). From single trials: exercise plus a rigid belt improved average pain but not function; acupuncture was better than
sham acupuncture for evening pain and function, but not average pain. There was no difference in evening pain after either deep or
superficial acupuncture.
Lumbo-pelvic pain: there was moderate-quality evidence that an eight- to 20-week exercise program reduced the risk of lumbo-
pelvic pain; but a 16- to 20-week training program was no better than usual care for preventing pain (four RCTs). From single trials:
exercise significantly reduced lumbo-pelvic-related sick leave and improved function; OMT significantly improved pain and function; a
combination of manual therapy, exercise and education improved pain and function; acupuncture improved these outcomes more than
usual care or physiotherapy; pain and function improved more when acupuncture was started at 26- rather than 20-weeks gestation.
Ear acupuncture significantly improved these outcomes more than sham acupuncture.
3Interventions for preventing and treating pelvic and back pain in pregnancy (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Citations
More filters
Journal ArticleDOI
TL;DR: A system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all is supported, which includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships.

936 citations

Journal ArticleDOI
TL;DR: Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.
Abstract: Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose “pregnancy-related pelvic girdle pain (PPP)”, and “pregnancy-related low back pain (PLBP)”, present evidence that the two add up to “lumbopelvic pain”, and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.

513 citations

Journal ArticleDOI
TL;DR: The general nature and course of commonly experienced LBP means that there is limited scope for preventing its incidence (first-time onset), so there is considerable scope for prevention of the consequences of LBP.
Abstract: Summary of the concepts of prevention in low back pain (LBP): • The general nature and course of commonly experienced LBP means that there is limited scope for preventing its incidence (first-time onset). Prevention, in the context of this guideline, is focused primarily on reduction of the impact and consequences of LBP. • Primary causative mechanisms remain largely undetermined: risk factor modification will not necessarily achieve prevention. • There is considerable scope, in principle, for prevention of the consequences of LBP – e.g. episodes (recurrence), care seeking, disability, and workloss. • Different interventions and outcomes will be appropriate for different target populations (general population, workers, and children) yet inevitably there is overlap. • Interventions that are essentially treatments in the clinical environment, focused on management of current symptoms, are not considered as ‘prevention’ for the purposes of this guideline: they are covered in the accompanying clinical guidelines

464 citations

Journal ArticleDOI
31 Mar 2005-BMJ
TL;DR: Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group, and Acupuncture was superior to stabilising exercises in this study.
Abstract: Objectives To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy Design Randomised single blind controlled trial Settings East Hospital, Gothenburg, and 27 maternity care centres in Sweden Participants 386 pregnant women with pelvic girdle pain Interventions Treatment for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilising exercises (n = 131) Main outcome measures Primary outcome measure was pain (visual analogue scale); secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner before and after treatment Results After treatment the stabilising exercise group had less pain than the standard group in the morning (median difference = 9, 95% confidence interval 17 to 128; P = 00312) and in the evening (13, 27 to 175; P = 00245) The acupuncture group, in turn, had less pain in the evening than the stabilising exercise group (-14, -181 to -33; P = 00130) Furthermore, the acupuncture group had less pain than the standard treatment group in the morning (12, 59 to 173; P < 0001) and in the evening (27, 133 to 295; P < 0001) Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group Conclusion Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy Acupuncture was superior to stabilising exercises in this study

197 citations

Journal ArticleDOI
TL;DR: A meta-analysis of 34 RCTs of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy provided low-quality evidence that any land-based exercise significantly reduced pain.
Abstract: Background More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep. Objectives To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy. Search methods We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists. Selection criteria Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks’ gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians’ interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back pain Results from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic pain Results from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic pain Results from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two). The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain. When reported, adverse effects were minor and transient. Authors' conclusions There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit. Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out. Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

192 citations

References
More filters
Book
01 Dec 1969
TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.

115,069 citations

Book
23 Sep 2019
TL;DR: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
Abstract: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

21,235 citations

Book
01 Jan 2014
TL;DR: In this paper, the authors discuss the benefits and risks associated with physical activity and propose a general principles of exercise prescription for healthy populations with special consideration and environmental consideration, as well as a prescription for patients with chronic diseases and health conditions.
Abstract: SECTION I: HEALTH APPRAISAL AND RISK ASSESSMENT 1 Benefits and Risks Associated with Physical Activity 2 Preparticipation Health Screening SECTION II: EXERCISE TESTING 3 Preexercise Evaluation 4 Health-Related Physical Fitness Testing and Interpretation 5 Clinical Exercise Testing 6 Interpretation of Clinical Exercise Test Results SECTION III: EXERCISE PRESCRIPTION 7 General Principles of Exercise Prescription 8 Exercise Prescription for Healthy Populations With Special Considerations and Environmental Considerations 9 Exercise Prescription For Patients With Cardiovascular and Cerebrovascular Disease 10 Exercise Prescription for Populations With Other Chronic Diseases and Health Conditions 11 Behavioral Theories and Strategies for Promoting Exercise SECTION IV: APPENDICES Appendix A Common Medications Appendix B Medical Emergency Management Appendix C Electrocardiogram Interpretation Appendix D American College of Sports Medicine Certifications Appendix E Contributing Authors to the Previous Two Editions

10,477 citations

Journal ArticleDOI
TL;DR: The 2010 version of the CONSORT Statement is described, which updates the previous reporting guideline based on new methodological evidence and accumulated experience.
Abstract: Kenneth Schulz and colleagues describe the 2010 version of the CONSORT Statement, which updates the previous reporting guideline based on new methodological evidence and accumulated experience.

5,090 citations

Book
01 Dec 2003

4,047 citations

Frequently Asked Questions (11)
Q1. What have the authors contributed in "Interventions for preventing and treating pelvic and back pain in pregnancy" ?

For example, this paper found that acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or lumbo-pelvic pain. 

Further research is very likely to have an important impact on their confidence in the estimates of effect and is likely to change the estimates. Future research would benefit from the introduction of an agreed classification system that can be used to categorise women according to presenting symptoms. Further research is likely to change the estimates of effect of these interventions. GRADE Working Group grades of evidence High quality: Further research is very unlikely to change their confidence in the estimate of effect. 

Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy. 

Low-quality evidence suggested that exercise significantly reduced lumbo-pelvic-related sick leave (RR 0.76; 95% CI 0.62 to 0.94, two RCTs, N = 1062), and improved function. 

From single trials: exercise plus a rigid belt improved average pain but not function; acupuncture was better than sham acupuncture for evening pain and function, but not average pain. 

P L A The authorN L A N G U A G E S U M M A R YInterventions for preventing and treating pelvic and back pain in pregnancyMany women experience low-back (LBP) or pelvic pain during pregnancy. 

The mean pain intensity in the intervention groups was 0.80 standard deviationslower (1.07 to 0.53 lower)SMD -0.80 (-1.07, -0.53) 543(6 studies)⊕⊕©© low1,2Disability measured by Roland Morris Disability Questionnaire and Oswestry Disability Index 

The mean disability in the intervention groups was 0.56 standard deviations lower(0.89 lower to 0.23 lower)SMD -0.56 (-0.89 to -0. 23) 146 (2 studies)⊕⊕©© low1,3*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. 

For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference (SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23; two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92;1Interventions for preventing and treating pelvic and back pain in pregnancy (Review) Copyright © 2013 The Cochrane Collaboration. 

Eleven trials examined LBP (N = 1312), four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). 

Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not average pain; and evening pain relief was the same following either deep or superficial acupuncture.