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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Robinson
Hilde Stendal
HS
Department of Nursing and Health Sciences, Institute of Health and Society, University of Oslo, PO Box 1153 Blindern, NO 0318 Oslo, Norway. h.s.robinson@medisin.uio.no
Veierød
Marit B
MB
Mengshoel
Anne Marit
AM
Vøllestad
Nina K
NK
D000328:Adult; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D004185:Disability Evaluation; D042241:Early Diagnosis; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D009483:Neuropsychological Tests; D010147:Pain Measurement / Q000379:methods; D017699:Pelvic Pain / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D055815:Young Adult
Spine (Phila Pa 1976). 1991 May;16(5):549-52
1828912
Spine (Phila Pa 1976). 1994 Jun 1;19(11):1243-9
8073316
Spine (Phila Pa 1976). 2008 May 20;33(12):E386-93
18496334
Scand J Public Health. 2002;30(4):288-92
12680505
Man Ther. 2007 Feb;12(1):72-9
16843031
Spine (Phila Pa 1976). 2004 Feb 15;29(4):351-9
15094530
BMJ. 1999 Jun 19;318(7199):1662-7
10373170
Arch Phys Med Rehabil. 1998 Mar;79(3):288-92
9523780
Soc Psychiatry Psychiatr Epidemiol. 1998 Jul;33(7):345-54
9689897
Man Ther. 2010 Jun;15(3):280-5
20117040
Eur Spine J. 2009 May;18(5):718-26
19238458
Pain. 2003 Sep;105(1-2):371-9
14499456
Eur Spine J. 1994;3(5):258-60
7866847
Acta Obstet Gynecol Scand. 2009;88(4):378-85
19235556
Pain. 2009 Jan;141(1-2):25-30
18977088
Acta Obstet Gynecol Scand. 2004 Apr;83(4):351-7
15005782
Spine (Phila Pa 1976). 2005 Apr 15;30(8):983-91
15834344
Eur Spine J. 2002 Jun;11(3):267-71
12107796
Acta Obstet Gynecol Scand. 2006;85(2):160-4
16532908
J Clin Epidemiol. 1994 Dec;47(12):1423-35
7730851
Eur J Obstet Gynecol Reprod Biol. 1999 May;84(1):77-82
10413232
Acta Obstet Gynecol Scand. 2001 Jun;80(6):505-10
11380285
Spine (Phila Pa 1976). 1996 Nov 15;21(22):2594-602
8961447
Prim Care. 1976 Dec;3(4):751-64
1051525
Obstet Gynecol. 1988 Jan;71(1):71-5
2962023
Spine (Phila Pa 1976). 2006 Mar 1;31(5):E149-55
16508539
J Rehabil Med. 2001 Jan;33(1):21-5
11480465
Spine (Phila Pa 1976). 1996 Mar 15;21(6):702-9
8882692
Spine (Phila Pa 1976). 2002 Jan 15;27(2):196-200
11805667
Eur J Pain. 2007 Apr;11(3):256-66
16546425
Eur J Pain. 2009 Apr;13(4):426-30
18599328
Eur Spine J. 2009 Jul;18(7):1008-12
19390876
Pain. 2002 Oct;99(3):485-491
12406524
Psychol Health. 2000 Nov;14(6):1051-9
22175261
Pain. 2004 Dec;112(3):343-352
15561390
Man Ther. 2006 Nov;11(4):287-96
16386450
Acta Obstet Gynecol Scand. 2006;85(5):539-44
16752231
Man Ther. 1999 Nov;4(4):187-95
10593107
Spine (Phila Pa 1976). 1997 Dec 15;22(24):2945-50
9431631
Spine (Phila Pa 1976). 2005 Apr 15;30(8):976-82
15834343
Acta Obstet Gynecol Scand. 1999 Feb;78(2):105-10
10023871
Pain. 1993 Feb;52(2):157-168
8455963
Pain. 2009 Jan;141(1-2):6-7
19027232
Spine (Phila Pa 1976). 2001 May 15;26(10):1167-71
11413432
Eur Spine J. 2004 Nov;13(7):575-89
15338362
Spine (Phila Pa 1976). 2002 Dec 15;27(24):2831-4
12486356
Eur J Obstet Gynecol Reprod Biol. 1999 Jan;82(1):69-72
10192488
Psychol Bull. 1992 Jul;112(1):155-9
19565683
Eur Spine J. 2008 Jun;17(6):794-819
18259783