C.N. Igwesi-Chidobe1, G.N. Emmanuel1, O.C. Okezue1, P.C. Onyekere1
1University of Nigeria, Department of Medical Rehabilitation, Enugu, Nigeria

Background: Nearly every woman experiences musculoskeletal (MSK) pain during pregnancy. About twenty five percent of these women have disabling symptoms. Exercise reduces pain and disability in pregnant women with MSK conditions. However, most exercise-based interventions are delivered in specialist hospitals using sophisticated equipment. These interventions may be inaccessible to poor pregnant women in the community. Community-based exercise programmes are affordable multicomponent exercise-based interventions that combine individual and environmental change strategies across multiple settings; and are delivered within the community using simple tools.

Purpose: To summarise published research evidence regarding the effects of community-based exercise programmes on pain and disability; and compare their effectiveness with usual obstetric care in reducing pain and disability amongst pregnant women with MSK conditions.

Methods: Twelve bibliographic databases (PubMed, CINAHL, CENTRAL, GIM, AIM, AJO, WPRIM, LILACS, IMEMR, IRIS, BLDS, Google Scholar) were systematically searched from inception until 16th August 2020. The mixed-methods appraisal and Cochrane Collaboration’s tools were used for quality and risk of bias assessments. Within-group effects of community-based exercise programmes (pre-test/post-test changes) were summarised narratively for all included studies. Meta-analyses were conducted with high quality randomised controlled trials (RCTs) that compared the effectiveness of community-based exercise programmes with usual obstetric care in reducing pain and/or disability amongst pregnant women with any MSK conditions. Low-quality studies that compared community-based exercise programmes with usual obstetric care were synthesised narratively.

Results: 9096 unique citations were retrieved. The full texts of 147 articles were reviewed. Seven randomised controlled trials (RCTs) met the inclusion criteria and were included. They compared community-based exercise interventions with routine obstetric care that were delivered in maternity health centres. They included 865 pregnant women with low back pain and/or pelvic pain in Sweden (2), Iran (2), Norway (1), USA (1) and Brazil (1). The community-based exercise programmes included supervised multimodal exercises combined with postural education with or without videos and pamphlets, manual therapy, pelvic belts, or home exercises delivered by physiotherapists (4), chiropractor (1), primary care physician (1), or midwife (1). The usual obstetric care was delivered by obstetricians or midwives and included prenatal education with or without thermotherapy, rest, advice about exercises and postural awareness, or referral to orthopaedic and neurological services.  
All studies reported improvements in pain and/or disability after community-based exercise interventions in within-group analyses. No significant differences were observed between the effectiveness of community-based exercise interventions and usual obstetric care in reducing pain intensity [3 RCTs: 0.94 (-0.09, 1.96); p= 0.07] and disability [2 RCTs: 0.19 (–0.28, 0.65); p=0.44] from the meta-analyses. Low quality RCTs reported better outcomes for community-based exercise interventions than usual obstetric care in reducing pain intensity (3 RCTs), sick leave (2 RCTs) and disability (1 RCT).

Conclusion(s): Community-based exercise programmes may be as effective as primary obstetric care in reducing pain and disability associated with pregnancy-related MSK conditions. High quality RCTs are required to confirm these findings.

Implications: Community-based exercise programmes can reduce pain and disability; and may be recommended to pregnant women with MSK conditions for whom other exercise-based interventions are inaccessible.

Funding, acknowledgements: None

Keywords: Community exercise, low-income, pregnant women

Topic: Community based rehabilitation

Did this work require ethics approval? No
Institution: University of Nigeria
Committee: University of Nigeria
Reason: N/A as the study is a systematic review

All authors, affiliations and abstracts have been published as submitted.

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