Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial

Catherine Daneau, Andrée-Anne Marchand, André Bussières, Julie O'Shaughnessy, Stephanie-May Ruchat, Martin Descarreaux, Catherine Daneau, Andrée-Anne Marchand, André Bussières, Julie O'Shaughnessy, Stephanie-May Ruchat, Martin Descarreaux

Abstract

Background: About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP.

Methods/design: Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34-36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants' recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression.

Discussion: This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy.

Trial registration: US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021.

Keywords: Lumbopelvic pain; Motor control exercise; Pregnancy; Prevention; Treatment.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

References

    1. Bergström C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy–pain status, self-rated health and family situation. BMC Pregnancy Childbirth. 2014;14(1):48.
    1. Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard H-C. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord. 2016;17(1):276.
    1. Skaggs CD, Prather H, Gross G, George JW, Thompson PA, Nelson DM. Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey. J Manip Physiol Ther. 2007;30(2):130–134.
    1. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract. 2010;10(1):60–71.
    1. Wu W, Meijer OG, Uegaki K, Mens J, Van Dieen J, Wuisman P, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575–589.
    1. Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794–819.
    1. Aldabe D, Ribeiro DC, Milosavljevic S, Bussey MD. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012;21(9):1769–1776.
    1. Greenwood CJ, Stainton MC. Back pain/discomfort in pregnancy: invisible and forgotten. J Perinat Educ. 2001;10(1):1.
    1. Franklin ME, Conner-Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. 1998;28(3):133–138.
    1. Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Furuse M. Anatomical configuration of the spinal column in the supine position. II. Comparison of pregnant and non-pregnant women. Br J Anaesth. 1995;75(1):6–8.
    1. Yousef AM, Hanfy HM, Elshamy FF, Awad MA, Kandil IM. Postural Changes during Normal Pregnancy. J Am Sci. 2011;7(6):1013–8.
    1. Dumas G, Reid J, Wolfe L, Griffin M, McGrath M. Exercise, posture, and back pain during pregnancy: Part 1. Exercise and posture. Clin Biomech. 1995;10(2):98–103.
    1. Rodacki CL, Fowler NE, Rodacki AL, Birch K. Stature loss and recovery in pregnant women with and without low back pain. Arch Phys Med Rehabil. 2003;84(4):507–512.
    1. Sihvonen T, Huttunen M, Makkonen M, Airaksinen O. Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy. Arch Phys Med Rehabil. 1998;79(10):1210–1212.
    1. Bastiaanssen JM, de Bie RA, Bastiaenen CH, Essed GG, van den Brandt PA. A historical perspective on pregnancy-related low back and/or pelvic girdle pain. Eur J Obstet Gynecol Reprod Biol. 2005;120(1):3–14.
    1. Gutke A, Betten C, Degerskär K, Pousette S, Olsén MF. Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand. 2015;94(11):1156–1167.
    1. Elden H, Lundgren I, Robertson E. Life’s pregnant pause of pain: pregnant women’s experiences of pelvic girdle pain related to daily life: a Swedish interview study. Sex Reprod Healthc. 2013;4(1):29–34.
    1. Engeset J, Stuge B, Fegran L. Pelvic girdle pain affects the whole life—a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Res Notes. 2014;7(1):686.
    1. Owe KM, Nystad W, Bø K. Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study. Scand J Med Sci Sports. 2009;19(5):637–645.
    1. Mottola MF, Davenport MH, Ruchat S-M, Davies GA, Poitras VJ, Gray CE, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339–46.
    1. Mottola MF, Davenport MH, Ruchat S-M, Davies GA, Poitras V, Gray C, et al. N° 367-2019 lignes directrices canadiennes sur l'activité physique durant la grossesse. J Obstet Gynaecol Can. 2018;40(11):1538–48.
    1. Davenport MH, Ruchat S-M, Poitras VJ, Garcia AJ, Gray CE, Barrowman N, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367–1375.
    1. Ruchat S-M, Mottola MF, Skow RJ, Nagpal TS, Meah VL, James M, et al. Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1347–1356.
    1. Sinclair M, Close C, McCullough J, Hughes C, Liddle S. How do women manage pregnancy-related low back and/or pelvic pain? Descriptive findings from an online survey. Evid Based Midwifery. 2014;12(3):76–82.
    1. Wang SM, DeZinno P, Fermo L, William K, Caldwell-Andrews AA, Bravemen F, et al. Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med. 2005;11(3):459–464.
    1. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2013;(8):CD001139.
    1. Close C, Sinclair M, Liddle SD, Madden E, McCullough JE, Hughes C. A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy. J Adv Nurs. 2014;70(8):1702–1716.
    1. Davenport MH, McCurdy AP, Mottola MF, Skow RJ, Meah VL, Poitras VJ, et al. Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1376–1385.
    1. Gutke A, Olsson CB, Völlestad N, Öberg B, Wikmar LN, Robinson HS. Association between lumbopelvic pain, disability and sick leave during pregnancy–a comparison of three Scandinavian cohorts. J Rehabil Med. 2014;46(5):468–474.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207.
    1. Sivayogam A, Banerjee A. Diagnostic performance of clinical tests for sacroiliac joint pain. Phys Ther Rev. 2011;16(6):462–467.
    1. Lardon E, St-Laurent A, Babineau V, Descarreaux M, Ruchat S-M. Lumbopelvic pain, anxiety, physical activity and mode of conception: a prospective cohort study of pregnant women. BMJ Open. 2018;8(11):e022508.
    1. Ensemble soyons unique. Le rapport annuel de gestion 2016-2017 du CIUSSS MCQ. Accessible à .
    1. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31(2):180–191.
    1. (INSPQ) INdSPdQ. From Tiny Tot to Toddler : A pratical guide for parents from pregnancy to age two 2019 [Available from: .
    1. Magee DJ, Zachazewski JE, Quillen WS, Manske RC. Pathology and intervention in musculoskeletal rehabilitation. Elsevier Health Sciences; 2015.
    1. Kahyaoglu Sut H, Balkanli KP. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35(3):417–422.
    1. Gauthier J, Bouchard S. Adaptation canadienne-française de la forme révisée du State–Trait Anxiety Inventory de Spielberger. Can J Behav Sci. 1993;25(4):559.
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short-form mcgill pain questionnaire (sf-mpq), chronic pain grade scale (cpgs), short form-36 bodily pain scale (sf-36 bps), and measure of intermittent and constant osteoarthritis pain (icoap) Arthritis Care Res. 2011;63(S11):S240–SS52.
    1. Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):593–607.
    1. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117–126.
    1. Hägg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J. 2003;12(1):12–20.
    1. Girard M-P, Marchand A-A, Stuge B, Ruchat S-M, Descarreaux M. Cross-cultural adaptation of the Pelvic Girdle Questionnaire for the French-Canadian population. J Manip Physiol Ther. 2016;39(7):494–499.
    1. Ogollah R, Bishop A, Lewis M, Grotle M, Foster NE. Responsiveness and Minimal Important Change for Pain and Disability Outcome Measures in Pregnancy-Related Low Back and Pelvic Girdle Pain. Phys Ther. 2019;99(11):1551–1561.
    1. Chandonnet N, Saey D, Alméras N, Marc I. French Pregnancy Physical Activity Questionnaire compared with an accelerometer cut point to classify physical activity among pregnant obese women. PLoS One. 2012;7(6):e38818.
    1. Miller RP, Kori SH, Todd DD. The Tampa Scale: a measure of kinesiophobia. Clin J Pain. 1991;7(1):51.
    1. French DJ, Roach PJ, Mayes S. Peur du mouvement chez des accidentés du travail: L'Échelle de Kinésiophobie de Tampa (EKT) Can J Behav Sci. 2002;34(1):28.
    1. Bourque P, Beaudette D. Étude psychometrique du questionnaire de dépression de Beck auprès d'un échantillon d'étudiants universitaires francophones. Can J Behav Sci. 1982;14(3):211.
    1. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166(7):493–505.
    1. Lin C-WC, Haas M, Maher CG, Machado LA, van Tulder MW. Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. Eur Spine J. 2011;20(7):1024–1038.
    1. Davenport MH, Marchand A-A, Mottola MF, Poitras VJ, Gray CE, Garcia AJ, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;56(3):297–306.
    1. Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine. 2004;29(4):351–359.
    1. Fontana Carvalho AP, Dufresne SS, Rogerio de Oliveira M, Couto Furlanetto K, Dubois M, Dallaire M, et al. Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain. Eur J Phys Rehabil Med. 2020;56(3):297–306.
    1. ACSM . ACSM's resources for the personal trainer. 3rd ed. 2010.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다