Posted on March 3, 2017
Pregnancy-related low back and pelvic pain (LBPP) are very common, with 45% of woman affected to some extent (Vermani et al. 2010). Concerns for potential harm to the foetus mean that pharmacological pain management may be limited, and with increasing pain there may be some degree of functional disability. Prior to and during pregnancy, it has been found that the use of exercise programs can provide effective pain management for LBPP. However, the quality of the evidence available is lacking due to many limitations with the research (Pennick and Liddle 2013).
The study in question (Ozdemir et al. 2015) was carried out to provide a more robust investigation into whether individualised exercise programs increase functional capacity and relieve LBPP in pregnant woman.
The was a well-designed randomized control trial (RCT). 209 participants were assessed for eligibility and 113 were either excluded or declined to participate. This left 96 participants who consented and met the eligibility criteria. The intervention included education, training in protection methods and a standardised exercise program on top of usual care. A control group received usual care.
Participants were randomized into one of two groups using sealed, opaque envelopes and a simple randomisation method. To assess the primary outcomes of study, the Visual Analogue Scale (VAS) was used to measure change in participants’ pain level and the Oswestry Disability Index (ODI) was used to determine participants’ functional status.
Exercise levels were tracked, with participants required to keep exercise diaries. All data was collected through telephone calls once a week. After 4 weeks, a face to face interview was carried out with each participant, with their results being compared to baseline.
This study found that over 4 weeks, using the exercise program, participants with LBPP had a statistically significant improvement (p< 0.05) in functional capacity and a statistically significant reduction in pain intensity compared to the control group.
For a study to have a focused question it must address the population, intervention, control group and outcome measures (Santos et al. 2007). The research question addressed in this study clearly addressed each of these aspects.
The design and results of this study support the researchers’ aim to provide stronger evidence for use of exercise programs to relieve severity of LBPP and to promote functional ability. The intervention group showed a statistically significant improvement in both primary outcomes up to 4 weeks after ongoing treatment.
However, this study is focused on the short term effects; further research is needed to test whether exercise programs can help woman suffering with LBPP in the long term. Additionally, replication in more heterogeneous samples of women is advisable, to ensure greater external validity and generalizability.
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*According to Abdulatif et al. (2015) there are four main components that are required for a sample size calculation. 1) The expected minimal clinically relevant difference between the groups; 2) the expected standard deviation of measurements for primary outcomes; 3) the desired power of the study and 4) the desired type 1 error probability.