Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum

Cecilia Bergström, Margareta Persson, Kari-Anne Nergård, Ingrid Mogren, Cecilia Bergström, Margareta Persson, Kari-Anne Nergård, Ingrid Mogren

Abstract

Background: Pelvic girdle pain (PGP) is not always a self-limiting condition. Women with more pronounced persistent PGP (PPGP) report poorer health status compared to women with less pronounced symptoms. The knowledge concerning the long-term consequences of PPGP is limited, thus more knowledge in this area is needed. The overall aim was to study the prevalence and predictors of PPGP 12 years after delivery.

Methods: This is a long-term follow-up study based on a previous cohort study that commenced in 2002. New questionnaire data 12 years postpartum were collected in 2014 and early 2015. The questionnaire was distributed to a total of 624 women from the initial cohort.

Results: In total, 295 women (47.3%) responded to the questionnaire where 40.3% (n = 119) reported pain to a various degree and 59% (n = 174) reported no pain. Increased duration and/or persistency of pain, self-rated health, sciatica, neck and/or thoracic spinal pain, sick leave the past 12 months, treatment sought, and prescription and/or non-prescription drugs used were all associated with an statistically significant increase in the odds of reporting pain 12 years postpartum. Widespread pain was common and median expectation of improvement score was 5 on an 11-point numeric scale (interquartile range 2-7.50). More than one of five women (21.8%) reporting pain stated that they had been on sick leave the past 12 months and nearly 11% had been granted disability pension due to PPGP. No statistically significant differences were found between respondents and non-respondents regarding most background variables.

Conclusions: This study is unique as it is one of few long-term follow-up studies following women with PPGP of more than 11 years. The results show that spontaneous recovery with no recurrences is an unlikely scenario for a subgroup of women with PPGP. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. Moreover, widespread pain is commonly associated with PPGP and may thus contribute to long-term sick leave and disability pension. A screening tool needs to be developed for the identification of women at risk of developing PPGP to enable early intervention.

Keywords: Cohort studies; Disability pension; Long-term follow-up; Persistent pelvic girdle pain; Postpartum; Predictors; Prevalence; Sick leave; Widespread pain.

Conflict of interest statement

Authors’ information

All authors read and approved this manuscript.

Ethics approval and consent to participate

The study was approved by the Ethics Committee at the Umeå University (Dnr 2014–4-32 M supplement to Dnr 2012–404-31 M) and was performed in accordance with the Declaration of Helsinki. Written consent to participate were collected from all participants in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the cohort
Fig. 2
Fig. 2
Most common healthcare sought the past 12 months at Q4
Fig. 3
Fig. 3
Reported expectation of improvement using 11-point numeric rating scale (NRS) where 0 denotes ‘no chance’ and 10 ‘very good chance’

References

    1. Bergstrom 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;14:48. doi: 10.1186/1471-2393-14-48.
    1. Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord. 2016;17:276. doi: 10.1186/s12891-016-1154-0.
    1. Gausel AM, Kjaermann I, Malmqvist S, Dalen I, Larsen JP, Okland I. Pelvic girdle pain 3-6 months after delivery in an unselected cohort of Norwegian women. Eur Spine J. 2016;25:1953–9.
    1. Mogren IM. BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. Eur Spine J. 2006;15:1093–1102. doi: 10.1007/s00586-005-0004-9.
    1. Robinson HS, Vollestad NK, Veierod MB. Clinical course of pelvic girdle pain postpartum - impact of clinical findings in late pregnancy. Man Ther. 2014;19:190–196. doi: 10.1016/j.math.2014.01.004.
    1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819. doi: 10.1007/s00586-008-0602-4.
    1. Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, Ostgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13:575–589. doi: 10.1007/s00586-003-0615-y.
    1. Wuytack F, Curtis E, Begley C. Experiences of first-time mothers with persistent pelvic girdle pain after childbirth: descriptive qualitative study. Phys Ther. 2015;95:1354–1364. doi: 10.2522/ptj.20150088.
    1. Gutke A, Lundberg M, Ostgaard HC, Oberg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20:440–448. doi: 10.1007/s00586-010-1487-6.
    1. Yazdi-Ravandi S, Taslimi Z, Jamshidian N, Saberi H, Shams J, Haghparast A. Prediction of quality of life by self-efficacy, pain intensity and pain duration in patient with pain disorders. Basic Clin Neurosci. 2013;4:117–124.
    1. Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine (Phila Pa 1976) 2007;32:1430–1436. doi: 10.1097/BRS.0b013e318060a673.
    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163–2196. doi: 10.1016/S0140-6736(12)61729-2.
    1. (SBU) Sbfmu . Metoder för behandling av långvarig smärta. En systemisk literaturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2006.
    1. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine (Phila Pa 1976) 2005;30:983–991. doi: 10.1097/01.brs.0000158957.42198.8e.
    1. Bjork S, Norinder A. The weighting exercise for the Swedish version of the EuroQol. Health Econ. 1999;8:117–126. doi: 10.1002/(SICI)1099-1050(199903)8:2<117::AID-HEC402>;2-A.
    1. Quercioli C, Messina G, Barbini E, Carriero G, Fani M, Nante N. Importance of sociodemographic and morbidity aspects in measuring health-related quality of life: performances of three tools: comparison of three questionnaire scores. Eur J Health Econ. 2009;10:389–397. doi: 10.1007/s10198-008-0139-9.
    1. Johansson E, Lindberg P. Subacute and chronic low back pain. Reliability and validity of a Swedish version of the Roland and Morris disability questionnaire. Scand J Rehabil Med. 1998;30:139–143. doi: 10.1080/003655098444066.
    1. Bergstrom G, Bodin L, Jensen IB, Linton SJ, Nygren AL. Long-term, non-specific spinal pain: reliable and valid subgroups of patients. Behav Res Ther. 2001;39:75–87. doi: 10.1016/S0005-7967(99)00175-8.
    1. Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res. 2007;31:185–199. doi: 10.1111/j.1530-0277.2006.00295.x.
    1. Noren L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11:267–271. doi: 10.1007/s00586-001-0357-7.
    1. Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand. 2001;80:505–510. doi: 10.1080/j.1600-0412.2001.080006505.x.
    1. Leboeuf-Yde C, Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K. The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden. J Manip Physiol Ther. 2005;28:472–478. doi: 10.1016/j.jmpt.2005.07.003.
    1. Dunn KM, Croft PR. The importance of symptom duration in determining prognosis. Pain. 2006;121:126–132. doi: 10.1016/j.pain.2005.12.012.
    1. Sullivan MJ, Adams H, Tripp D, Stanish WD. Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression. Pain. 2008;135:151–159. doi: 10.1016/j.pain.2007.05.021.
    1. Gheldof EL, Vinck J, Vlaeyen JW, Hidding A, Crombez G. Development of and recovery from short- and long-term low back pain in occupational settings: a prospective cohort study. Euro J Pain (London, England) 2007;11:841–854. doi: 10.1016/j.ejpain.2006.12.012.
    1. Koopmans PC, Roelen CA, Groothoff JW. Risk of future sickness absence in frequent and long-term absentees. Occup Med (Lond) 2008;58:268–274. doi: 10.1093/occmed/kqn040.
    1. Laaksonen M, He L, Pitkaniemi J. The durations of past sickness absences predict future absence episodes. J Occup Environ Med. 2013;55:87–92. doi: 10.1097/JOM.0b013e318270d724.
    1. Reis RJ, Utzet M, La Rocca PF, Nedel FB, Martin M, Navarro A. Previous sick leaves as predictor of subsequent ones. Int Arch Occup Environ Health. 2011;84:491–499. doi: 10.1007/s00420-011-0620-0.
    1. Roelen CA, Koopmans PC, Anema JR, van der Beek AJ. Recurrence of medically certified sickness absence according to diagnosis: a sickness absence register study. J Occup Rehabil. 2010;20:113–121. doi: 10.1007/s10926-009-9226-8.
    1. Roelen CA, Koopmans PC, Schreuder JA, Anema JR, van der Beek AJ. The history of registered sickness absence predicts future sickness absence. Occup Med (Lond) 2011;61:96–101. doi: 10.1093/occmed/kqq181.
    1. Laaksonen M, Martikainen P, Rahkonen O, Lahelma E. Explanations for gender differences in sickness absence: evidence from middle-aged municipal employees from Finland. Occup Environ Med. 2008;65:325–330. doi: 10.1136/oem.2007.033910.
    1. Kivimaki M, Forma P, Wikstrom J, Halmeenmaki T, Pentti J, Elovainio M, Vahtera J. Sickness absence as a risk marker of future disability pension: the 10-town study. J Epidemiol Community Health. 2004;58:710–711. doi: 10.1136/jech.2003.015842.
    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15:834–848. doi: 10.1007/s00586-004-0864-4.
    1. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52:424–427. doi: 10.1097/JOM.0b013e3181d44f3b.
    1. Fouquet N, Bodin J, Descatha A, Petit A, Ramond A, Ha C, Roquelaure Y. Prevalence of thoracic spine pain in a surveillance network. Occup Med (Lond) 2015;65:122–125. doi: 10.1093/occmed/kqu151.
    1. Kindler LL, Jones KD, Perrin N, Bennett RM. Risk factors predicting the development of widespread pain from chronic back or neck pain. J Pain. 2010;11:1320–1328. doi: 10.1016/j.jpain.2010.03.007.
    1. Nordeman L, Gunnarsson R, Mannerkorpi K. Prevalence and characteristics of widespread pain in female primary health care patients with chronic low back pain. Clin J Pain. 2012;28:65–72. doi: 10.1097/AJP.0b013e318223622c.
    1. Valentin GH, Pilegaard MS, Vaegter HB, Rosendal M, Ortenblad L, Vaeggemose U, Christensen R. Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies. BMJ Open. 2016;6:e007616. doi: 10.1136/bmjopen-2015-007616.
    1. Strazdins L, Bammer G. Women, work and musculoskeletal health. Soc Sci Med. 2004;58:997–1005. doi: 10.1016/S0277-9536(03)00260-0.
    1. Campbell P, Foster NE, Thomas E, Dunn KM. Prognostic indicators of low back pain in primary care: five-year prospective study. J Pain. 2013;14:873–883. doi: 10.1016/j.jpain.2013.03.013.
    1. Iles RA, Davidson M, Taylor NF, O'Halloran P. Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil. 2009;19:25–40. doi: 10.1007/s10926-008-9161-0.
    1. Kongsted A, Vach W, Axo M, Bech RN, Hestbaek L. Expectation of recovery from low back pain: a longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome. Spine (Phila Pa 1976) 2014;39:81–90. doi: 10.1097/BRS.0000000000000059.
    1. McPhillips-Tangum CA, Cherkin DC, Rhodes LA, Markham C. Reasons for repeated medical visits among patients with chronic back pain. J Gen Intern Med. 1998;13:289–295. doi: 10.1046/j.1525-1497.1998.00093.x.
    1. Wuytack F, Curtis E, Begley C. The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: a descriptive qualitative study. Midwifery. 2015;31:1104–1109. doi: 10.1016/j.midw.2015.07.009.
    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;70:1702–1716. doi: 10.1111/jan.12360.
    1. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Systematic Reviews (Online) 2015;9:CD001139.
    1. Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manip Physiol Ther. 2008;31:447–454. doi: 10.1016/j.jmpt.2008.06.009.
    1. Svedberg P, Bardage C, Sandin S, Pedersen NL. A prospective study of health, life-style and psychosocial predictors of self-rated health. Eur J Epidemiol. 2006;21:767–776. doi: 10.1007/s10654-006-9064-3.
    1. Ross C, Mirkowsky J, Goldsteen K. The impact of family on health: the decade in review. J Marriage Fam. 1990;52:1059–1078. doi: 10.2307/353319.
    1. M. L. Dantzker RDH, M. L. Dantzker. Research Methods for Criminology and Criminal Justice: Jones and Bartlett Publishers, Inc; 2011.
    1. Bowling A. Research methods in health : investigating health and health services. Buckingham. Briston: Open University Press; 1997.
    1. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I. Increasing response rates to postal questionnaires: systematic review. BMJ (Clinical Research ed) 2002;324:1183. doi: 10.1136/bmj.324.7347.1183.
    1. Nakash RA, Hutton JL, Jorstad-Stein EC, Gates S, Lamb SE. Maximising response to postal questionnaires--a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5. doi: 10.1186/1471-2288-6-5.
    1. Sahlqvist S, Song Y, Bull F, Adams E, Preston J, Ogilvie D. iConnect c. Effect of questionnaire length, personalisation and reminder type on response rate to a complex postal survey: randomised controlled trial. BMC Med Res Methodol. 2011;11:62. doi: 10.1186/1471-2288-11-62.
    1. Jepson C, Asch DA, Hershey JC, Ubel PA. In a mailed physician survey, questionnaire length had a threshold effect on response rate. J Clin Epidemiol. 2005;58:103–105. doi: 10.1016/j.jclinepi.2004.06.004.
    1. Koloski NA, Jones M, Eslick G, Talley NJ. Predictors of response rates to a long term follow-up mail out survey. PLoS One. 2013;8:e79179. doi: 10.1371/journal.pone.0079179.
    1. Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–1136. doi: 10.1016/S0895-4356(97)00126-1.
    1. Ahlberg I: Kostnader för rörelseorganens sjukdomar i Sverige år 2012. In Book Kostnader för rörelseorganens sjukdomar i Sverige år 2012 (Editor ed.^eds.), vol. 2014. City; 2014.
    1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64:2028–2037. doi: 10.1002/art.34347.
    1. Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine (Phila Pa 1976) 2006;31:E149–E155. doi: 10.1097/01.brs.0000201259.63363.e1.
    1. Robinson HS, Eskild A, Heiberg E, Eberhard-Gran M. Pelvic girdle pain in pregnancy: the impact on function. Acta Obstet Gynecol Scand. 2006;85:160–164. doi: 10.1080/00016340500410024.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren