Investigating the Efficacy of an 18-Week Postpartum Rehabilitation and Physical Development Intervention on Occupational Physical Performance and Musculoskeletal Health in UK Servicewomen: Protocol for an Independent Group Study Design

Kirsty Jayne Elliott-Sale, Emma Louise Bostock, Thea Jackson, Sophie Louise Wardle, Thomas James O'Leary, Julie Patricia Greeves, Craig Sale, Kirsty Jayne Elliott-Sale, Emma Louise Bostock, Thea Jackson, Sophie Louise Wardle, Thomas James O'Leary, Julie Patricia Greeves, Craig Sale

Abstract

Background: Postpartum women are at an increased risk of pelvic floor dysfunction, musculoskeletal injury, and poor psychological health and have reduced physical fitness compared to before pregnancy. There is no formal, evidence-based rehabilitation and physical development program for returning UK servicewomen to work following childbirth.

Objective: This study aims to examine the efficacy of a rehabilitation and physical development intervention for returning postpartum UK servicewomen to occupational fitness.

Methods: Eligible servicewomen will be assigned to a training or control group in a nonrandomized controlled trial 6 weeks after childbirth. Group allocation will be based on the location of standard pregnancy and postpartum care. The control group will receive standard care, with no prescribed intervention. The training group will start an 18-week core and pelvic health rehabilitation program 6 weeks post partum and a 12-week resistance and high-intensity interval training program 12 weeks post partum. All participants will attend 4 testing sessions at 6, 12, 18, and 24 weeks post partum for the assessment of occupational physical performance, pelvic health, psychological well-being, quality of life, and musculoskeletal health outcomes. Occupational physical performance tests will include vertical jump, mid-thigh pull, seated medicine ball throw, and a timed 2-km run. Pelvic health tests will include the Pelvic Organ Prolapse Quantification system, the PERFECT (power, endurance, repetitions, fast, every contraction timed) scheme for pelvic floor strength, musculoskeletal physiotherapy assessment, the Pelvic Floor Distress Inventory-20 questionnaire, and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms. Psychological well-being and quality of life tests will include the World Health Organization Quality of Life questionnaire and the Edinburgh Postnatal Depression Scale. Musculoskeletal health outcomes will include body composition; whole-body areal bone mineral density; tibial volumetric bone mineral density, geometry, and microarchitecture; patella tendon properties; muscle architecture; muscle protein and collagen turnover; and muscle mass and muscle breakdown. Data will be analyzed using linear mixed-effects models, with participants included as random effects, and group and time as fixed effects to assess within- and between-group differences over time.

Results: This study received ethical approval in April 2019 and recruitment started in July 2019. The study was paused in March 2020 owing to the COVID-19 pandemic. Recruitment restarted in May 2021. The results are expected in September 2022.

Conclusions: This study will inform the best practice for the safe and optimal return of postpartum servicewomen to physically and mentally demanding jobs.

Trial registration: ClinicalTrials.gov NCT04332757; https://ichgcp.net/clinical-trials-registry/NCT04332757.

International registered report identifier (irrid): DERR1-10.2196/32315.

Keywords: exercise; intervention; musculoskeletal; pelvic health; performance; postnatal; servicewomen; well-being.

Conflict of interest statement

Conflicts of Interest: SLW is employed by the UK Ministry of Defence as a defence scientist and is a project officer on this trial. TJOL is employed by the UK Ministry of Defence as a defence scientist. KJES and CS are co-grant holders and co-principal investigators in this trial. JPG is employed by the UK Ministry of Defence as a principal scientist and defence principal investigator on this trial.

©Kirsty Jayne Elliott-Sale, Emma Louise Bostock, Thea Jackson, Sophie Louise Wardle, Thomas James O'Leary, Julie Patricia Greeves, Craig Sale. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 01.06.2022.

Figures

Figure 1
Figure 1
Study schematic.
Figure 2
Figure 2
Testing procedures. EPDS: Edinburgh Postnatal Depression Scale; ICIQ-VS: International Consultation on Incontinence Questionnaire–Vaginal Symptoms; PFDI-20: Pelvic Floor Distress Inventory–20; WHOQOL-BREF: World Health Organization Quality of Life.
Figure 3
Figure 3
Physical development training mesocycles and training blocks. RM: repetition maximum.
Figure 4
Figure 4
Procedures for muscle protein and collagen turnover using deuterium oxide (D2O).
Figure 5
Figure 5
Procedures for muscle mass analyses using D3-creatine (D3Cr).
Figure 6
Figure 6
Procedures for muscle protein breakdown using D3-3-methyl-histidine (D3-3MH).

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