Telehealth: Diaphragmatic vs. Pelvic Exercise in Postpartum Pregnancy-related Pelvic Girdle Pain

Comparison of Diaphragmatic Breathing Exercise and Pelvic Stabilization Exercise in Postpartum Women With Pregnancy-related Pelvic Girdle Pain: A Real-time Telehealth-based Intervention

The goal of this interventional study is to compare investigate the short-term and long-term effects of 8-week real-time telehealth-based diaphragmatic breathing exercise and pelvic stabilization exercise on pain, disability, and quality of life in postpartum women with pregnancy-related pelvic girdle pain.

Study Overview

• Status: Recruiting
• Conditions: Pregnancy Related; Postpartum; Pelvic Girdle Pain
• Intervention / Treatment: Other: pelvic anatomy education; Other: Diaphragmatic breathing retraining; Other: Pelvic stabilization exercise

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taiwan
    • Tainan, Taiwan, Taiwan, 701
      • Recruiting
      • National Cheng Kung University
      • Contact: Tsai Yi-Ju; Phone Number: 5930 06-2353535; Email: lulilutsai@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 20-65 years
• Postpartum ≥ 3 months
• Pain located in sacroiliac joints (i.e., pain located between the posterior iliac crest and gluteal fold)
• Pregnancy-related cause of pelvic pain that pain occurs during pregnancy or after delivery (i.e., not traumatic or degenerative cause)
• At least 2 positive findings of 6 pain provocation tests for pelvic pain
• Score of Active Straight Leg Rise (ASLR) test > 0

Exclusion Criteria:

• being pregnant or actively trying to get pregnant
• having known causes of pelvic girdle pain, such as fractures and rheumatism
• having undergone lumbar, pelvic, gynecologic or obstetric surgery
• having current neurological symptoms and signs in lower extremities such as lumbar radiculopathy and myelopathy
• having cancer
• having cardiovascular disease
• being diagnosed as having a psychiatric disease
• active infection or infectious disease in the pelvis or abdomen
• having experience with structured and supervised core or trunk exercise training programs.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diaphragmatic breathing exercise group; Diaphragmatic breathing exercise through telehealth	Other: pelvic anatomy education; pelvic anatomy education; Other: Diaphragmatic breathing retraining; 8 weeks diaphragmatic breathing training
Active Comparator: Pelvic stabilization exercise group; Pelvic stabilization exercise through telehealth	Other: pelvic anatomy education; pelvic anatomy education; Other: Pelvic stabilization exercise; 8 weeks pelvic stabilization exercise training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity measure of Numeric Rating Scale (NRS)	Numeric Rating Scale (NRS) is a self-reported instrument assessing average pain intensity in currently. Possible score range from 0 (no pain) to 10 (worst possible pain).	Change from baseline to 8 weeks
Muscle function measures of lumbopelvic muscles	Ultrasonography image for muscle thickness of trunk and back muscles during rest and during active straight leg raise. Ultrasonography image for bladder displacement for pelvic floor muscles during rest,maximum contraction and during active straight leg raise	Change from baseline to 8 weeks
Diaphragm thickness	Ultrasonography image for diaphragm thickness during maximum inspiration and expiration (B mode)	Change from baseline to 8 weeks
Diaphragm mobility	Ultrasonography image for mobility during maximum inspiration and expiration (M mode)	Change from baseline to 8 weeks
Diaphragm strength	Ultrasonography image for diaphragm strength during maximal sniff and expiration (M mode). The slope achieved (mm/sec) during the diaphragmatic excursion is used to calculate the velocity of the diaphragmatic contraction	Change from baseline to 8 weeks
Mechanical Property of Thoracolumbar Fascia	The biomechanical and viscoelastic properties of the muscles will be measured using a non-invasive myometer. It automatically calculate and provide the biomechanical and viscoelastic properties of stiffness, frequency, decrement, and stress relaxation time that offer the information of tone, elasticity, stiffness and stress relaxation time of the tested tissue.	Change from baseline to 8 weeks
Functional performance of ASLR fatigue task	Participants lifted the heel of the test leg to 20 cm for as long as possible. Participants were required to maintain pressure in the cuff beneath their back as close to 40 mm Hg as possible. Visual feedback of cuff pressure was provided throughout the task, but no instruction was given on how to affect cuff pressure. Task failure was defi ned as an inability to maintain heel height 10 cm or more off the plinth and/or a change in cuff pressure of 20 mm Hg or more.	Change from baseline to 8 weeks
Functional performance of timed up and go test	Test instructions were given in Norwegian. Translated into English, the instructions were as follows: 'After "ready, set, go" stand up, walk as fast as you can until you cross the white line, turn around, and walk back to the chair and sit down again'. The white line was positioned 3m from the patient's starting position. 'After "ready, set, go" stand up, walk as fast as you can until you cross the white line, turn around, and walk back to the chair and sit down again'. The white line was positioned 3m from the patient's starting position.	Change from baseline to 8 weeks
Functional performance of 6m timed walk test	Subjects commenced the test in standing with their toes up against the tape marker. Test instructions translated into English were as follows: 'After "ready, set, go", walk as fast as you can up to the last white line without stopping or speaking along the way'. Performances were timed (to the nearest 100th of a second) between the 2m and 8m markers and later converted into speed in metres per second.	Change from baseline to 8 weeks
Disability Level: measure of pelvic girdle questionnaire(PGQ)	pelvic girdle questionnaire(PGQ) is a self-reported instrument assessing pelvic girdle pain intensity in currently. Questionnaire consisting of 20 activity items and 5 symptom items on a 4-point response scale. Possible score range from 0 (no pain) to 100 (worst possible pain).	Change from baseline to 8 weeks
Health-related Quality of Life: Short Form-36 (SF36)	SF-36 include 36 questions constructing into 8 domains (i.e., physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health). The scores of physical and mental components and total are ranged from 0 to 100, with higher scores representing better quality of life	Change from baseline to 8 weeks
Fear Avoidance Belief: Tampa Scale of Kinesiophobia	Fear of movement, fear of physical activity, and fear avoidance will be assessed using the Tampa scale of kinesiophobia (TSK). The TSK is 17-items questionnaire, where patients rate their agreement using 4-points scale. It consists of two subscales including activity avoidance to reflect the activity that may result in an increase in pain or cause injury, and somatic focus to reflect the beliefs and underlying serious conditions	Change from baseline to 8 weeks
Self-Efficacy: Pain Self-efficacy Questionnaire	The pain self-efficacy questionnaire (PSEQ) is a 10-item questionnaire, where patients rate their confidence from 0 points (not at all confident) to 6 points (completely confident). Total scores of the PSEQ is 60 points and a higher score indicates more self-efficacy	Change from baseline to 8 weeks
Parenting Stress Level: Parenting Stress Index-Short Form (PSI-SF)	The PSI-SF is a self-reported questionnaire that consists of 36 items to assess stress related to three aspects including parent-child relationship, parental distress, and difficulties in the parent-child interaction. The subscales for parental distress, parent-child dysfunctional interaction and difficult child, as well as the total stress scale are rated from 1 (strongly disagree) to 5 (strongly agree). The higher the score indicates the greater the stress.	Change from baseline to 8 weeks
Self-perceived Change: Global Rating of Change Scale (GROC)	The GROC rates perceived "overall change" on a 15-point Likert scale, with 7 (labeled "worse") on the left, +7 (labeled "better") on the right, and 0 in the middle (labeled "no change") compared to the baseline.	Change from baseline to 8 weeks

Collaborators and Investigators

• Sponsor: YI-JU TSAI

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2024
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): July 31, 2026

Study Registration Dates

• First Submitted: September 19, 2023
• First Submitted That Met QC Criteria: February 26, 2024
• First Posted (Actual): February 28, 2024

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Pain; Pelvic Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pelvic Girdle Pain
• Other Study ID Numbers: NCKU_PPGP_diaphragm

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No