Effects of Pelvic Floor Muscle Training and a Modified Lumbopelvic Belt on Pain, Kinesiophobia, and Functional Status in Pregnant Women With Symphysis Pubis Pain (Pubic Pain)

The first group will be designated as the intervention group and will receive comprehensive physiotherapy education in conjunction with the use of a modified lumbopelvic belt. As part of a structured education program, participants will receive pelvic floor muscle training and diaphragmatic breathing training, as well as guidance on protective and symptom-relieving modifications to activities of daily living and relevant ergonomic and behavioral recommendations.

intervention group and will receive comprehensive physiotherapy education in conjunction with the use of a modified lumbopelvic belt.As part of a structured education program, participants will receive pelvic floor muscle training and diaphragmatic breathing training, as well as guidance on protective and symptom-relieving modifications to activities of daily living and relevant ergonomic and behavioral recommendations.

The second group will be designated as the comparison group and will receive an educational program that includes pelvic floor muscle training, diaphragmatic breathing training, modifications to activities of daily living, and protective strategies. No belt will be used in this group.

educational program that includes pelvic floor muscle training, diaphragmatic breathing training, modifications to activities of daily living, and protective strategies

Pain intensity will be assessed using a 10-cm visual analog scale (VAS), ranging from 0 to 10. A score of 0 indicates no pain, whereas a score of 10 indicates unbearable pain. The VAS is widely used to assess pain intensity. Pain intensity will be classified as mild (1-4), moderate (5-7), or severe (8-10). Pain in the lower back, back, and pelvic girdle will be assessed separately during activity, at rest, and during sleep at night.

An algometer has long been used to measure soft-tissue pain associated with trigger points (11). An algometer will be used to assess the pressure pain threshold. The device has a blunt, non-sharp probe with a contact surface area of 1 cm². Pressure will be applied perpendicular to the midpoint of the muscle. Before the procedure, participants will be informed about the assessment and instructed to report when they first feel pain as the pressure is gradually increased. Measurements will be taken with the participant in a supine position. The pressure value at which the participant first experiences pain will be recorded as the pain threshold. Three measurements will be taken at 1-minute intervals, and the mean will be calculated (12). The assessment will be performed by applying pressure over the pubic symphysis.

The PGQ was developed by Stuge et al. (13). It is a condition-specific measure for assessing activity limitations and symptoms in individuals with pelvic girdle pain. It was developed for use in pregnant and postpartum individuals with pelvic girdle pain and can be used in both research and clinical practice. Its Turkish validity and reliability were established by Yelvar et al.

The ODI is a questionnaire developed specifically for individuals with low back pain to assess the degree of functional limitation in daily life. Its Turkish version has been tested for validity and reliability. It consists of 10 items addressing pain, personal care, lifting, standing, walking, sitting, traveling, sexual activity, and social life. Each item is scored from 0 to 5, with 0 representing the best level of function and 5 the worst

The Tampa Scale for Kinesiophobia was used to assess the severity of kinesiophobia in pregnant women. The TSK is a 17-item scale developed to measure fear of movement or reinjury. The original scale was developed by Miller, Kori, and Todd in 1991.The scale uses a four-point Likert response format: strongly disagree = 1, disagree = 2, agree = 3, and strongly agree = 4. To calculate the total score, items 4, 8, 12, and 16 are reverse-scored, and all item scores are summed. The total score ranges from 17 to 68, with higher scores indicating greater kinesiophobia.

The WHOQOL-BREF is a multidimensional self-report measure developed by the World Health Organization (WHO) to assess quality of life from a biopsychosocial perspective. A shorter version of the original WHOQOL-100, it was published in 1998. The WHOQOL-BREF consists of 26 items covering four domains of quality of life: physical health, psychological health, social relationships, and environment. Each item uses a five-point Likert scale to assess the respondent's perception of their quality of life over the previous two weeks. Scores are calculated separately for each domain and converted to a scale ranging from 0 to 100; higher scores indicate better quality of life. The WHOQOL-BREF enables comprehensive assessment of quality of life in both the general population and specific patient groups. It is widely used as a valid and reliable measure in health, psychology, rehabilitation, and public health research.