pregnancy

APTA Guideline: Pelvic Girdle Pain Management in Pregnant Women

The American Physical Therapy Association (APTA) has released a new guideline for making pain management recommendations to pregnant women experiencing pelvic girdle pain (PGP).

Approximately 70% of pregnant women experience PGP at some point over the course of their pregnancy. PGP can cause changes in posture, gait, and activity level, which can significantly impair women in several areas of their lives.
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The new guideline was finalized using terminology from The International Classification of Functioning, Disability, and Health (ICF). Classifications were formed based on supporting evidence, which was found via searches of MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews through 2012. A total of 105 references were included in the analysis. Each reference was reviewed by 2 experts and was evaluated for quality and level of evidence.

According to the APTA, PGP-related recommendations should be based on the following:

  • Risk factors. These include previous pregnancy, orthopedic dysfunction (such as hip and/or leg dysfunction), increased body mass index (BMI), smoking, dissatisfaction with work, and belief that one’s current condition will not improve.
  • Clinical course. This includes PGP developing early in pregnancy, pain in multiple different areas, and abnormal results on multiple physical therapy assessments.
  • Examination and diagnosis. It is important to remember that other pregnancy-related conditions may appear similar to PGP. This guideline identifies important clinical tests and outcome questionnaires for evaluating women with PGP.
  • Physical therapy interventions. These may include the use of a support belt, exercise programs, or manual therapy techniques, although current evidence for these measures is weak or conflicting. Additionally, although strong evidence shows that women with PGP face high risk of falls, little evidence exists to support measures that reduce this risk, including activity limitations.

“This [clinical practice guideline] can be used to guide clinicians in their clinical reasoning processes in the examination and intervention of females with prenatal pelvic girdle pain,” the researchers concluded. “The organization and classification of the document can guide research to address the paucity of evidence especially in the interventions with this population.”

—Christina Vogt

Reference:

Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the section on women’s health and the orthopaedic section of the American Physical Therapy Association. 2017;41(2):102-105. doi:10.1097/JWH.0000000000000081.