January the 21st, 2022 – Pelvic girdle pain (PGP) is a common condition causing pain and physical impairment, which can occur during and/or after pregnancy and childbirth. A new clinical practice guideline for physiotherapy practice for PGP in the postpartum period (PGP-PP) is presented in the Journal of Physical Therapy for Women’s Health (JWHPT). the official journal of the Academy of Pelvic Health Physiotherapy (APHPT) of the American Physical Therapy Association, JWHPT is published in the Lippincott portfolio by Wolters Kluwer.
Created by the authors for the APHPT, the new document presents evidence-based recommendations for the physiotherapy management of clients with PGP-PP. The lead author is Adrienne H. Simonds, PT, PhD, of Rutgers, State University of New Jersey, Blackwood, NJ. An abstract appears in the January/February issue of the journal. The full guideline recommendations are available online at JWHPT and APHPT websites.
Postpartum pelvic girdle pain: guidelines and clinical practice for physiotherapy management
PGP-PP appears to be distinct from the common condition of pelvic girdle pain that develops during pregnancy (antepartum PGP). For some women with PGP-PP, pain becomes a persistent problem, accompanied by a fear of movement and physical activity and sometimes psychological symptoms beyond pain and disability.
Persistent PGP-PP has a “more complex” problem that “impacts[s] multiple domains of physical, cognitive, emotional and social functioning, and often requiring a multidisciplinary approach to care,” according to the guideline document. Physiotherapists are a key part of the professional team involved in the management of this potentially debilitating condition.
Dr. Simonds and the guideline team followed a formal process to develop the first evidence-based clinical practice guideline for physical therapy management of PGP-PP. The guideline presents a total of 23 recommendations in six key areas, ranked according to the strength of supporting evidence:
- Risk factors – Strong evidence suggests that women with a history of low back pain or PGP, including PGP during pregnancy, are at higher risk of developing PP-PGP. A wide range of other pregnancy-related symptoms and risk factors are possible, with varying levels of evidence.
- Systems Screening – Physiotherapists should screen for mood disorders in postpartum women, as depression is a possible risk factor for PP-PGP. There is also strong evidence to support screening for muscle deficiencies in the pelvic floor, abdomen, hip and back regions.
- Exam – Women with PP-PGP have consistent patterns of pain in the posterior and anterior pelvis, pain when rolling in bed, and pain when weight bearing. Recommendations focus on specific evidence-based tests and examinations to assess pain levels and muscle function.
- Prognosis – The prognosis of PP-PGP is greatly affected by the initial symptoms: clients with initially high pain and disability scores are expected to recover faster and return to function, while those with less severe symptoms have “minimal gains “. Evidence suggests that women with PP-PGP may experience ongoing pain and disability, even with physical therapy and other treatments.
- Response – Recommendations focus on specific physiotherapy interventions for clients with PP-PGP. Interventions with strong evidence of benefit include patient education and, combined with other physiotherapy interventions, the use of a pelvic belt. Manual therapy does not appear to be more effective than exercise in stabilizing and improving performance of the pelvic floor, back, and hip muscles.
- Theoretical models of care – The recommendations call for further research to support the use of a “specific theoretical model” for diagnosis, classification and physiotherapy intervention for PP-PGP.
The full guideline document features an in-depth review and discussion of each recommendation, linked to supporting evidence. The guideline team also proposes a new “hybrid” diagnostic model and classification system for PP-PGP, identifying three categories of charge transfer impairment. An accompanying clinical decision-making flowchart facilitates the selection of appropriate tests and intervention strategies for individual clients with PP-PGP.
The authors highlight the limitations of the available evidence, highlighting recommendations for further research in each aspect of their review. “There is a lot of work to be done to improve postpartum health, and we believe that physiotherapists are important members of an interdisciplinary team,” comments Dr. Simonds. “We hope these guidelines will streamline what is known about PP-PGP and provide a starting point for further advancements in physiotherapy care for the postpartum population.”
Click here to read “Executive Summary of Clinical Practice Guidelines for Pelvic Girdle Pain in the Postpartum Population”
On Women’s Health Physiotherapy Journal Journal of Physical Therapy for Women’s Health (JWHPT) is the official publication of the Women’s Health Section of the American Physical Therapy Association. JWHPT is a peer-reviewed publication focused on the clinical interests of physical therapists practicing in women’s health and pelvic health, as well as those of other health care providers who interact with physical therapists in the care of women’s health.
About the Pelvic Health Physical Therapy Academy
The Academy of Pelvic Health Physical Therapy (formerly Section on Women’s Health) is a 501(c)(6) nonprofit professional association of more than 3,500 physical therapists (PTs), physical therapy assistants (PTAs), and physical therapy students (PTS). ). Members provide the latest evidence-based physiotherapy services to everyone, from women of childbearing age to perimenopausal mothers, young athletes to men with incontinence or other pelvic health complications.
About Wolters Kluwer
Wolters Kluwer (WKL) is a global leader in professional information, software solutions and services for clinicians, nurses, accountants, lawyers and the tax, finance, auditing, risk, compliance and regulation. We help our customers make critical decisions every day by delivering expert solutions that combine deep domain knowledge with advanced technology and services.
Wolters Kluwer achieved annual sales of €4.6 billion in 2020. The group serves customers in over 180 countries, maintains operations in over 40 countries and employs around 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes in healthcare. We support clinical efficiency, learning and research, clinical monitoring and compliance, and data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.
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Journal of Physical Therapy for Women’s Health
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