To investigate the effect of manual therapy as ‘add on’ to a 6 weeks lasting exercise program, patient education and additional MT compared to controls receiving the same intervention without MT on pain and disability in women with PGP. Secondary aim is to investigate the effect of MT in the control group after the first 6 weeks, with a follow up at 18 weeks and 1 year and perform a subgroup analysis.
A single blind longitudinal randomized control trial with a crossover design was performed in women both pregnant as postpartum with PGP. The primary outcome variable was pain intensity, measured using Numerical Pain Rating Scale (NPRS). Secondary outcome variable was disability, measured using Quebec Back Pain Disability Scale (QBPDS). Fifty two woman were randomly allocated into two groups. The intervention group (N= 27) similar treatment without MT (N=25) After 7 weeks the control (exercise) group received MT, while the intervention (MT) group received no treatment. Evaluation took place at 7, 18 weeks and 1 year after baseline.
After 7 weeks pain intensity decreased significantly in both groups (NPRS score MT-group 2,28 ± 1.542, p=0,00control group 4.05 ± 2.627, p=0.006) Only the decrease in the intervention group is clinically relevant. Disability decreased significantly in the intervention group (QPDS score 19.40 ± 16.005, p=0.001 vs 29.95 ± 16783, p=0.822). This is clinically relevant. At 18 weeks after receiving MT as well the control group demonstrated a decrease in pain intensity on the NPRS (1,15 ± 1.599, p=0,00) and QPBDS (6,15 ± 9.103, p=0,00) with respect to their score post treatment after the first 7 weeks. This is significant and clinically relevant. At 18 weeks the intervention group still improved on NPRS (1,48 ± 2.136, p=0,00) and QPBDS ( 12,05 ± 15.088, p=0,00).
At 1 year both groups remained stable, NPRS (1,00 ± 1.414, p=0,00 vs 1,20 ± 1.852, p=0,00) and QPBDS (6,27 ± 8.322, p=0,00 vs 5,35 ± 7.350, p=0,00)
MT in addition to an exercise program and patient education is more effective for reducing pain and disability in pregnant woman with PGP than exercise program and patient education alone at 7 weeks after baseline. This effect remains till 1 year follow up.
We recommend care providers and clinicians aiming to reduce pain intensity and disability in women with PGP to use manual therapy in addition to a exercise program and patient education in their treatment protocol. Further research is needed to explore the underlying added value of manual therapy.
pelvic girdle pain
manual therapy
