The Effectiveness of Non-Pharmaceutical Interventions Upon Pregnancy-Related Low Back Pain: A Systematic Review and Meta-Analysis

Ioannis Koukoulithras Sr, Alexandra Stamouli, Spyridon Kolokotsios, Minas Plexousakis Sr, Christine Mavrogiannopoulou, Ioannis Koukoulithras Sr, Alexandra Stamouli, Spyridon Kolokotsios, Minas Plexousakis Sr, Christine Mavrogiannopoulou

Abstract

Introduction: Low back pain (LBP) is a very common pathology among pregnant women and various methods are used to reduce the pain. The aim of this study is to conduct an evidence-based systematic review and meta-analysis regarding the effectiveness of the interventions used to reduce low back pain related to pregnancy. Methods and materials: The PEDro database, PubMed, and Cochrane Library were searched from January 2012 until December 2020 as well as the reference lists from identified articles. Studies of any non-pharmaceutical treatment to decrease low back pain were included but only randomized controlled trials were selected. The articles found were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) question. Details about the type of intervention, sample size, outcome measures, results, and statistical significance were extracted from the selected studies. A meta-analysis for pain intensity was conducted and the I2 index as well as x2 test were used to determine the heterogeneity between studies. A random-effects meta-analysis was carried out. The aim was to compare the effectiveness between various methods and the typical care provided on low back pain during pregnancy. Results: From all the articles found in the mentioned databases only 13 studies met the criteria. In these studies, exercise, manipulation, ear acupuncture, Kinesio tape, transcutaneous electrical nerve stimulation (TENS), and neuroemotional technique were the interventions used. In the meta-analysis, six studies with 693 participants were included. The interventions were found to have in total a statistically significant effect on low back pain in comparison with the control group that included the typical care provided to pregnant women (95%CI: 0.08 (0.02,0.31), p<0,01) and they had a high heterogeneity (considerable, Tau² = 2.70; Chi² = 64.11, I² = 91%). Exercise and TENS were determined as more effective than the other types of interventions.

Conclusions: TENS and progressive muscle relaxation exercises accompanied by music were found to be the most effective interventions. Although exercise decreased LBP it was not found to have a statistically significant result even though it seems to improve the disability and quality of life of pregnant women. Osteopathic manual treatment (OMT), Kinesio tape, and ear acupuncture affected the lumbar pain intensity but the difference compared to typical care or sham treatment was not statistically significant, while yoga did not improve pregnancy-related LBP. Further research is needed to determine the effectiveness of the interventions mentioned.

Keywords: interventions; low back pain; pain management; pregnancy; rehabilitation; systematic review and meta analysis; therapeutics.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Koukoulithras et al.

Figures

Figure 1. Preferred Reporting Items for Systematic…
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram
Figure 2. Risk-of-bias assessment of randomized controlled…
Figure 2. Risk-of-bias assessment of randomized controlled trials included in the meta-analysis.
Figure 3. Effects of intervention compared with…
Figure 3. Effects of intervention compared with typical care (UOBC) on low back pain (LBP). Outcome: Number of women with LBP after the last intervention Note: CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel method; UOBC, Usual Obstetric Care

References

    1. Pregnancy-related low back pain. Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, Alpantaki K. Hippokratia. 2011;15:205–210.
    1. Orthopedic considerations during pregnancy. Ritchie JR. Clin Obstet Gynecol. 2003;46:456–466.
    1. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Am J Obstet Gynecol. 2010;202:1–8.
    1. Low back pain during pregnancy in Iranian women: prevalence and risk factors. Ansari NN, Hasson S, Naghdi S, Keyhani S, Jalaie S. Physiother Theory Pract. 2010;26:40–48.
    1. The efficacy of Thai massage in relieving low back pain among pregnant women in the third trimester. Thanaporn I, Orawan L. JTTAM. 2013;11:145–151.
    1. Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey. Skaggs CD, Prather H, Gross G, George JW, Thompson PA, Nelson DM. J Manipulative Physiol Ther. 2007;30:130–134.
    1. Low back pain and pelvic girdle pain in pregnancy. Casagrande D, Gugala Z, Clark SM, Lindsey RW. J Am Acad Orthop Surg. 2015;23:539–549.
    1. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Davenport MH, Marchand AA, Mottola MF, et al. Br J Sports Med. 2019;53:90–98.
    1. Understanding and managing the back pain of pregnancy. Carlson HL, Carlson NL, Pasternak BA, Balderston KD. Curr Womens Health Rep. 2003;3:65–71.
    1. Interventions for preventing and treating pelvic and back pain in pregnancy. Pennick V, Liddle SD. Cochrane Database Syst Rev. 2013;1
    1. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Moher D, Shamseer L, Clarke M, et al. Syst Rev. 2015;4:1.
    1. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Liddle SD, Pennick V. Cochrane Database Syst Rev. 2015;2015:0.
    1. Randomized controlled trials - a matter of design. Spieth PM, Kubasch AS, Penzlin AI, Illigens BM, Barlinn K, Siepmann T. Neuropsychiatr Dis Treat. 2016;12:1341–1349.
    1. Reliability of the PEDro Scale for rating quality of randomized controlled trials. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Phys Ther. 2003;83:713–721.
    1. Higgins JP. Chichester: Wiley-Blackwell; 2008. Cochrane Handbook for Systematic Reviews of Interventions.
    1. The effects of an unsupervised water exercise program on low back pain and sick leave among healthy pregnant women - a randomised controlled trial. Backhausen MG, Tabor A, Albert H, Rosthøj S, Damm P, Hegaard HK. PLoS One. 2017;12:182114.
    1. Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial. Haakstad LA, Bø K. J Rehabil Med. 2015;47:229–234.
    1. Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial. Serpil O, Hatice B, Tulay O, Cengizhan A. J Adv Nurs. 2015;71:1926–1939.
    1. Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Eggen MH, Stuge B, Mowinckel P, Jensen KS, Hagen KB. Phys Ther. 2012;92:781–790.
    1. A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain. Peterson C, Haas M, Gregory T. Chiropr Man Therap. 2012;20:18.
    1. Efficacy of a physical training program on pregnancy related lumbopelvic pain. Fahimeh R. Int J Womens Health Repro Sci. 2018;6:161–166.
    1. Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy. Akmeşe ZB, Oran NT. J Midwifery Womens Health. 2014;59:503–509.
    1. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Keskin EA, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Gynecol Obstet Invest. 2012;74:76–83.
    1. Prevention of progressive back-specific dysfunction during pregnancy: an assessment of osteopathic manual treatment based on Cochrane Back Review Group criteria. Licciardone JC, Aryal S. J Am Osteopath Assoc. 2013;113:728–736.
    1. Pregnancy research on osteopathic manipulation optimizing treatment effects: the PROMOTE study. Hensel KL, Buchanan S, Brown SK, Rodriguez M, Cruser DA. Am J Obstet Gynecol. 2015;212:108–101.
    1. Short-term effects of kinesio taping in women with pregnancy-related low back pain: a randomized controlled clinical trial. Şeyhmus K, Mahmut A, Erbil K, et al. Med Sci Monit. 2016;18:1297–1301.
    1. Prenatal yoga for back pain, balance, and maternal wellness: a randomized, controlled pilot study. Holden S, Brad M, Junhong Z, Chloe Z, Roger D, Gloria Y. Glob Adv Health Med. 2019;8:2164956119870984.
    1. Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle: A multicenter randomized clinical trial. Vas J, Cintado MC, Aranda-Regules JM, Aguilar I, Rivas F. Acta Obstet Gynecol Scand. 2019;98:1307–1317.
    1. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Gordon G, Andrew O, Elie A, et al. J Clin Epidemiol. 2011;64:383–394.
    1. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: a systematic review and meta-analysis. Helge F, Jan-David F, Sebastian B, Gary F. J Bodyw Mov Ther. 2017;21:752–762.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren