Implementation of an Exercise Program in Breast Cancer Rehabilitation to Improve Shoulder Outcomes: A Pilot Study

Purpose: To examine the effects of a group exercise program on shoulder pain, disability, range of motion, and strength. Method: This was an observational study of twenty-six patients who had undergone breast cancer surgery and were receiving physiotherapy intervention. The intervention was a supervised 8-week exercise group program. The primary outcome measure was shoulder pain and disability index (SPADI). Secondary outcome measures were shoulder range of motion of flexion and abduction and strength of shoulder flexion and abduction. Results: The average age of patients referred to the group was 56-years (range of 29 to 71 years). The average time since surgery was 6-9 months (range of 2 to 16 months). The exercise group intervention resulted in small reductions in SPADI scores (pConclusion: An 8-week group exercise program can be effectively implemented in the clinic without any seen side effects. There were improvements in shoulder range of motion and strength, and a reduction in pain and disability although not clinically significant. This pilot study assists clinicians with incorporating an exercise program for patients in breast cancer rehabilitation

"This is hard to cope with" : the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy

Background: Women with pregnancy-related pelvic girdle pain (PPGP) report diminished ability to perform physical activities and experience higher rates of mood disorders, such as anxiety and depression, than pregnant women without PPGP. Despite these physical and psychological impacts, little is known about the lived experiences of PPGP amongst Australian women and the ways in which they cope. Situated within biographical disruption and social support theories, this study sought to gain a conceptual understanding of the experience and impact of PPGP on daily life, and how women cope with this condition during pregnancy. Methods: A qualitative research design, situated within a phenomenological framework, using individual, semi-structured interviews consisting of open-ended questions was used with a flexible and responsive approach. Purposive sampling of pregnant women attending a single hospital included 20 participants between 14 and 38 weeks gestation, classified with PPGP as per recommended guidelines, with a mean (SD) age of 31.37 (4.16) years. Thematic analysis was performed where interview data was transcribed, coded, grouped into meaningful categories and then constructed into broad themes. Results: Three themes were identified: 1. a transformed biography; 2. coping strategies; and 3. what women want. The pain experienced created a dramatic change in women's lives, making the pregnancy difficult to endure. Women utilised social support, such as family, to help them cope with pain, and a self-care approach to maintain a positive mindset and reduce stress. Although a few women received support from healthcare professionals, many reported a lack information on PPGP and limited societal recognition of the condition. Women wanted early education, personalised information and prompt referral to help them cope with PPGP. Conclusions: Findings from this study highlighted the complexity of living with PPGP as women attempted to deal with the unexpected impact on daily life by seeking support from partners and families, while also struggling with societal expectations. Although women with PPGP used a number of coping strategies, they sought greater support from healthcare professionals to effectively manage PPGP. These findings have important implications for the provision of health care to women living with PPGP

Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial

Background Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. Methods Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. Discussion This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. Conclusion Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia

Does muscle energy technique have an immediate benefit for women with pregnancy-related pelvic girdle pain?

Objective: Pregnancy‐related pelvic girdle pain (PPGP) is a common and debilitating condition. Muscle energy techniques (METs) are used in the management of PPGP. This study aimed to determine the immediate effectiveness of a MET in the management of pain in women with PPGP within a single session of physiotherapy. Methods: This study was a randomized, crossover, sham‐controlled trial. Women (N = 80), M (SD), 30 (5) years of age and 29 (5) weeks of gestation with PPGP were included in the study. All participants were treated with a MET and sham transcutaneous electrical nerve stimulation in a randomized order, followed by standard physiotherapy during a single physiotherapy session. The primary outcome measures were the self‐report of pain using a visual analogue scale and function using the Timed Up and Go. The secondary outcome was the duration of single leg stance (SLS). Clinical measures were taken prior to the first intervention and immediately following each of the interventions, a total of four times. Results: There was no statistically significant difference between scores for the visual analogue scale, Timed Up and Go, or duration of SLS between participants following the use of a MET, sham transcutaneous electrical nerve stimulation, or standard care, which was recorded after each intervention (p ≥ 0.72). There was a consistent and statistically significant (p value, mean difference) improvement in pain (p < 0.001, 2.6), function (p < 0.001, 1.0 s), and left SLS (p < 0.001, 4.4 s) and right SLS (p < 0.001, 4.7 s) from baseline compared with each time of measurement thereafter. Conclusions: The improvements measured may have been due to a placebo effect with the knowledge that care is being provided, mechanical unloading during the session, or familiarization with the test procedures. The mechanism(s) that led to improvements in pain and function remain unknown, however, does not preclude from women with PPGP being offered physiotherapy care

“We are not there yet”: perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia

Abstract Background Pregnancy-related pelvic girdle pain (PPGP) is a common condition worldwide. Women report being unprepared about PPGP, and state they receive little recognition and support from healthcare professionals. Situated within the Common-Sense Model and Convergent Care Theory, this study sought to gain a conceptual understanding of the perceptions, beliefs and experiences of healthcare professionals who provide routine care for women with PPGP in Australia. Methods A qualitative research design, using individual, semi-structured interviews with purposive sampling of healthcare professionals (N=27) consisting of doctors (N=9), midwives (N=9) and physiotherapists (N=9). Most participants were female (22/27) with a range of professional experience. An interview guide consisting of open-ended questions was used with a flexible and responsive approach. Thematic analysis was performed where interview data were transcribed, coded, grouped into meaningful categories and then constructed into broad themes. Results Four themes were identified: 1. Identity and impact of PPGP; 2. What works well?; 3. What gets in the way?; and 4. Quality care: What is needed? Healthcare professionals recognised PPGP as a common and disabling condition, which created a large impact on a woman’s life during pregnancy. Stepped-level care, including education and physiotherapy intervention, was seen to be helpful and led to a positive prognosis. Barriers at patient, clinician and organisation levels were identified and led to consequences for women with PPGP not receiving the care they need. Conclusion This study elucidates important implications for health care delivery. Acknowledging that PPGP is a common condition causing difficulty for many women, healthcare professionals identified strong teamwork and greater clinical experience as important factors in being able to deliver appropriate healthcare. Whilst healthcare professionals reported being committed to caring for women during pregnancy, busy workloads, attitudes towards curability, and a lack of formal education were identified as barriers to care. The findings suggest timely access, clear referral pathways and an integrated approach are required for best care practice for women with PPGP. A greater emphasis on the need for multidisciplinary models of care during pregnancy is evident

Does therapist-assisted exercise improve pregnancy related pelvic girdle pain? : a randomised, cross-over, blinded, sham-controlled trial

Background: Pregnancy related pelvic girdle pain (PPGP) is a common musculoskeletal disorder affecting up to 70% of pregnant women. Although PPGP resolves in most women following childbirth there is marked pain and restriction of activities of daily living. Standard treatment has consisted of education, pelvic belt application, manual therapy and independent/assisted exercises aimed at providing immediate pain relief, all of which are safe and cost effective while posing minimal risk to the mother and baby. Exercise improving muscle coordination in the pelvic region may provide pain relief in patients with lumbosacral pain. Therefore, performance of low load exercise has the potential to alleviate pain in pregnant women who are often unable to safely use analgesia. Purpose: The purpose of this study was to determine whether therapist-assisted exercise would provide immediate pain relief and improvement in function in women with PPGP. Methods: This was a repeated measure, randomised, cross-over, blinded, sham-controlled trial. Consenting volunteers had PPGP and no other significant or serious pathology or obstetric related complication. Twenty-two pregnant women (mean (SD)) 30 (5) years of age, 162 (6) cm in height, 70 (5) kg in body mass and 27 (6) weeks gestation provided written and informed consent (Ethical approved by the Westmead Hospital Human Research Ethics Committee, WMEAD13/HREC/288). Pain (visual analogue scale (VAS)) at rest and Timed Up and Go (TUG) test results were recorded prior to and following each treatment. Each participant was treated using therapist-assisted exercises (EX) and sham Transcutaneous Electrical Nerve Stimulation (sTENS) (non-conductive electrodes) in a random order. Participants were then provided standardised physiotherapy (SP) which included patient education, manual therapy, exercise prescription, pelvic belt application or referral for follow-up with a medical officer. A repeated measures ANOVA was performed to determine differences in the outcome measures with statistical significance accepted at p 0.05) or vice versa (p > 0.093). Box’s test demonstrates that there was no equality of the covariance matrices across groups and is likely due to unequal participants in the group which received EX prior to sTENS (n = 9) compared to sTENS prior to EX (n = 16). Furthermore, post hoc independent t-tests determined that each group was significantly different in the VAS score prior to treatment (p < 0.01) and that scores were similar at each subsequent measure. Conclusion(s): This preliminary pilot study does not support the use of therapist-assisted exercise in improving PPGP. However, there may be a decrease in pain over the course of a single consult regardless of the type of treatment which was administered. Implications: Changes in pain intensity reported following physiotherapy treatment may be the natural short-term progression of pain regardless of the type of treatment administered

Prevalence of pregnancy-related pelvic girdle pain and associated factors in Australia : a cross-sectional study protocol

Pregnancy-related pelvic girdle pain (PPGP) is a common musculoskeletal disorder. Women with PPGP report difficulty performing everyday functional activities, such as standing and walking. However, the magnitude of the problem remains unknown in Australia. It is important to determine how many women are affected by this condition and the factors associated with PPGP as this will direct healthcare services to being able to better manage women during pregnancy. Thus, this study aims to determine the prevalence of PPGP and associated factors in a Western Sydney population

The role of physiotherapy in managing pregnancy related pelvic girdle pain

Pregnancy related pelvic girdle pain (PPGP) is a common musculoskeletal condition with a prevalence ranging from 23% to 33% in New Zealand and Australia (Ashby & Johnson, 2015, Pierce, Homer, Dahlen, & King, 2012). Most women with PPGP report moderate to severe pain (Pierce et al., 2012). In addition, the ability to perform everyday activities such as getting up from a chair, bending and walking is affected (Elden, Ladfors, Olsen, Ostgaard, & Hagberg, 2005). Furthermore, a significant proportion of women report a persistence of symptoms following childbirth suggesting that the condition is not self-resolving (Elden, Gutke, Kjellby-Wendt, Fagevik-Olsen, & Ostgaard, 2016). With the pain and functional restrictions during and following pregnancy, PPGP is now considered a major public health issue (Elden, Lundgren, & Robertson, 2014). Generally, women with PPGP report beneficial effects following physiotherapy management (Chang, Jensen, & Lai, 2015, Fishburn & Cooper, 2015, Pierce et al., 2012). For example, an Australian study reported that 75% of women had improvement in symptoms following physiotherapy (Pierce et al., 2012). Similarly, a recent clinical trial found a statistically significant and clinically meaningful effect on pain and function following a single physiotherapy treatment session (Ceprnja & Gupta, submitted for publication). In this study, pain reduced from an average (SD) of 5.6 (2.7) before treatment to 2.8 (2.2) after physiotherapy when measured using a visual analogue scale (Ceprnja & Gupta, submitted for publication). Importantly, no adverse events have been reported following physiotherapy management indicating that physiotherapy is a very safe treatment option for PPGP (Gutke, Betten, Degerskär, Pousette, & Olsen, 2015)

Additional file 1 of “We are not there yet”: perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia

Additional file 1. Interview Guide Questions