Pelvic girdle pain - associations between risk factors in early pregnancy and disability or pain intensity in late pregnancy: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Recent studies have shown high prevalence rates for pelvic girdle pain (PGP) in pregnancy. Some risk factors for developing PGP have been suggested, but the evidence is weak. Furthermore there is almost no data on how findings from clinical examinations are related to subsequent PGP. The main purpose for this study was to study the associations between socio-demographical, psychological and clinical factors measured at inclusion in early pregnancy and disability or pain intensity in gestation week 30.</p> <p>Methods</p> <p>This is a prospective cohort study following women from early to late pregnancy. Eligible women were recruited at their first attendance at the maternity care unit. 268 pregnant women answered questionnaires and underwent clinical examinations in early pregnancy and in gestation week 30. We used scores on disability and pain intensity in gestation week 30 as outcome measures to capture the affliction level of PGP. Multiple linear regression analysis was used to study the associations between potential risk factors measured in early pregnancy and disability or pain intensity in gestation week 30.</p> <p>Results</p> <p>Self-reported pain locations in the pelvis, positive posterior pelvic pain provocation (P4) test and a sum of pain provocation tests in early pregnancy were significantly associated with disability and pain intensity in gestation week 30 in a multivariable statistic model. In addition, distress was significantly associated with disability. The functional active straight leg raise (ASLR) test, fear avoidance beliefs and the number of pain sites were not significantly associated with either disability or pain intensity.</p> <p>Conclusions</p> <p>The results suggest that a clinical examination, including a few tests, performed in early pregnancy may identify women at risk of a more severe PGP late in pregnancy. The identification of clinical risk factors may provide a foundation for development of targeted prevention strategies.</p

Pelvic girdle pain and disability during and after pregnancy : a cohort study

Pelvic girdle pain (PGP) is frequently reported in pregnancy and impacts the women’s activity level. Both prevalence and severity of PGP is uncertain. Most women recover after delivery, but a considerable number develop chronic pain and functional problems. It is important to identify clinical risk factors for PGP that could be targeted by treatment strategies. Main objectives: estimate the prevalence of PGP at different times; examine the associations between responses to clinical tests and disability; identify risk factors for development of PGP and disability during and after pregnancy 326 pregnant women were studied and followed through pregnancy. Data were collected by questionnaires and clinical examinations in early pregnancy, gestation week 30, and 12 weeks postpartum. Socio-demographical and psychological factors as well as pain locations and responses to clinical tests were used as explanatory variables. Disability and pain intensity were used as response variables. PGP was reported by 35%, 62% and 31% of the women in early pregnancy, gestation week 30, and 12 weeks postpartum respectively. Disability varied at all times independent of the presence or absence of PGP. Pain locations in the pelvic area, responses to clinical tests and disability were strongly associated in gestation week 30. Pain locations in the pelvic area and positive pain provocation tests, assessed in early pregnancy, were risk factors for disability and pain intensity in late pregnancy. Distress was also associated with disability. Sum of positive pain provocation tests in late pregnancy was risk factor for both disability and pain intensity 12 weeks postpartum. Number of pain sites in other bodily areas and pre-pregnancy low back pain was risk factor for pain intensity and disability respectively. The large variation in disability at all times, independent of PGP, shows that pregnancy itself impacts function. The high prevalence of PGP is probably an overestimation of affliction and stresses the importance of functional assessment

Measuring physical performance in highly active older adults: associations with age and gender?

Background Higher age is associated with reduced physical capability in the general population. The role of age and gender for physical performance in older adults who exercises regularly is, however, not clear, and there is also a lack of recommendations for outcomes to address physical performance for this population. Aims To explore the associations between physical performance, age and gender, and to examine the suitability and feasibility of clinical field tests for physical performance in active older adults. Methods In this cross-sectional study we included 105 persons, 70–90 years of age, who had exercised regularly for ≥ 12 months. The field tests were Short Physical Performance Battery (SPPB), Timed Up and Go and gait speed for mobility; One-leg standing (OLS) test and Mini-BESTest for balance; Stair test for endurance, 30 s sit-to-stand, and grip strength for muscle strength. Results We found associations between age and physical performance, and the associations were slightly stronger for women. Men performed better on tests of muscle strength, balance and endurance, while no gender differences were found in mobility. Grip strength was not associated with mobility tests for men. All tests were feasible, while SPPB and OLS had ceiling and floor effects that limit their suitability in this population. Conclusions Both age and gender were associated with physical performance. We recommend using the gait speed, Mini-BESTest, 30 s sit-to-stand, grip strength and stair tests to assess physical performance in physically active older adults

Fysisk aktive eldre og treningsvaner?

Hensikt: Undersøke hva som kjennetegner eldre personer som har trent regelmessig over tid og om helsemyndighetenes anbefalinger om fysisk aktivitet følges. Er det forskjell på de som trener hos fysioterapeut og de som har abonnement på treningssenter? Design: Tverrsnittstudie. Materiale: 105 personer over 70 år som har trent regelmessig i minst ett år. Median (range) alder var 74 (70-90) år. Metode: Spørreskjemaer og fysiske tester (styrke, utholdenhet, balanse, mobilitet). Resultat: Median (range) antall år med trening var 20 (1-70) år. 64% hadde muskelskjelettplager og 46% var kvinner. Oppgitt varighet, intensitet og hyppighet av trening samsvarer stort sett med myndighetenes anbefalinger. De fleste trente utholdenhet og styrke, kun halvparten oppga å trene balanse. En større andel av gruppen som trente hos fysioterapeut oppga medisinske grunner som motivasjon for trening. Det var ingen forskjell mellom gruppene på de fysiske testene. Konklusjon: Resultatene viser at oppgitt varighet, intensitet og frekvensen av treningen i stor grad samsvarer med anbefalingene fra Helsedirektoratet. Det var ingen forskjeller på eldre som trente hos fysioterapeut og de som trente på treningssenter, bortsett fra motivasjon for trening. Balanse og bevegelighet er dårligst ivaretatt og bør antagelig oppmuntres i større grad også hos aktive eldre

What characterizes physically active elderly and their exercise habits?

Purpose: Investigate characteristics of elderly persons who have exercised regularly over time. Are there differences between persons working out with a physiotherapist and those with subscription at a fitness center? Design: Cross-sectional study. Material: 105 persons over 70 years who have exercised regularly for at least 1 year. The median age (range) was 74 (70-90) years. Method: Questionnaires and physical tests (strength, endurance, balance, mobility). Results: Median (range) number of years with exercise was 20 (1-70) years. 64% reported musculoskeletal disorders and 46% were women. Reported duration, intensity and frequency of training was largely in accordance with recommendations from health authorities. Most participants did endurance- and strength exercises, but only about 50% did balance-exercises. A larger proportion of the group exercising with the physiotherapists reported medical reasons as motivation for exercise. No between group differences were found on physical tests. Conclusion: The results showed that the participants reported training in accordance with the Norwegian Health authorities’ recommendations. No differences were found in elderly training with physiotherapists and those attending a fitness center, except for the motivation for training. Balance and mobility exercises have less focus and should be encouraged to a greater extent also in active elderly

Generalized joint hypermobility and risk of pelvic girdle pain in pregnancy : does body mass index matter?

Background: Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive. Objectives: In this prospective cohort study of 283 pregnant women in Norway, we aimed to study the association of generalized joint mobility with pelvic girdle pain, and to evaluate if pre-pregnancy body mass index was a modifier of the association. Methods: Generalized joint hypermobility was defined as a score of &gt;= 5/9 positive tests on the Beighton score measured in early pregnancy. Primary outcome was evening pain intensity in gestation week 30, measured by a 100 mm visual analogue scale. We applied linear regression analyses to estimate age-adjusted unstandardized beta coefficients. Results: Evening pain intensity was similar among women with Beighton score &gt;= 5/9 and women with Beighton score &lt; 5/9 (age-adjusted mean difference 2.8 mm; 95% CI: -9.2 to 14.9 mm). Women with Beighton score &gt;= 5/9 and pre-pregnancy body mass index &gt;= 25 kg/m(2), reported higher evening pain than women with Beighton score &lt; 5/9 and pre-pregnancy body mass index &lt;25 kg/m(2) (age-adjusted mean difference 28.7 mm; 95% CI: 14.3-43.1 mm). Conclusions: Overall, evening pain intensity was similar among pregnant women with and without generalized joint hypermobility. However, women with a combination of generalized joint hypermobility and body mass index &gt;= 25 kg/m(2) reported higher evening pain compared to women with normal joint mobility and body mass index &lt;25 kg/m(2), suggesting that body mass index may modify the association. The estimates could be imprecise due to the small study sample, and our findings should be interpreted with caution