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Shijagurumayum Acharya R1,2, Therese Tveter A3, Grotle M3,4, Eberhard Gran M2,5,6, Stuge B7
1Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Department of Physiotherapy, Kavre, Nepal, 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 3Oslo Metropolitan University, Department of Physiotherapy, Faculty of Health Sciences, Oslo, Norway, 4Oslo University Hospital, Formi, Oslo, Norway, 5Norwegian Institute of Public Health, Department of Child Health, Oslo, Norway, 6Akershus University Hospital, Health Services Research Unit, Lorenskog, Norway, 7Oslo University Hospital, Division of Orthopaedic Surgery, Oslo, Norway
Background: Low back pain (LBP) and pelvic girdle pain (PGP) are commonly reported during pregnancy and affect the pregnant woman's well-being. Still, these conditions are often considered as a normal part of pregnancy. LBP and PGP have been reported in many developed and developing countries, however, there is limited evidence of the prevalence and severity of pregnancy-related LBP and PGP in Nepal.
Purpose: The primary aim of this study was to assess the prevalence and severity of LBP and PGP in pregnant Nepalese women. A secondary aim was to determine factors that influence LBP and PGP during pregnancy.
Methods: A cross-sectional study with successive recruitment of pregnant women was conducted at two district hospitals in Nepal from May 2016 to May 2017. Participants completed questionnaires on sociodemographics, pregnancy- and workload characteristics, the Pelvic Girdle Questionnaire, the Oswestry Disability Index, the Numerical Pain Rating Scale, Pelvic Organ Prolapse Symptom Score, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the 5-item version of the Edinburgh Postnatal Depression Scale. The registration of LBP and PGP was done using a body chart. The women who reported LBP and/or PGP also responded to questions regarding pain frequency, specific PGP locations, if the LBP and/or PGP limited their usual activities or changed their daily routine for more than 1 day, concern regarding the pain, and belief of LBP and/or PGP disappearance after delivery. Univariate and multivariate logistic regression were used to assess the associations between independent variables and LBP and PGP.
Results: A total of 1284 pregnant women were included in the study. The mean age of the participants was 25 (Standard deviation (SD) 4), with a mean of 24 (SD 10) gestation weeks. The reported prevalence of pregnancy-related LBP and/or PGP was 34%. Pain intensity was high with a mean score of 6 (SD 2). The median (25th - 75th percentiles) disability scores by the total Pelvic Girdle Pain Questionnaire and Oswestry Disability Index were 20 (10-32) and 30 (21-28), respectively. The women were not much concerned about LBP and/or PGP, even though only 52% believed that the pain would disappear after delivery. The adjusted odds ratios for LBP and/or PGP with increased body mass index (20-24, 25-30, >30) were 0.7 (95% confidence interval (CI), 0.44-1.21), 1.1 (95% CI, 0.66-1.83) and 1.5 (95% CI, 0.78-2.94), having pelvic organ prolapse symptoms was 6.6 (95% CI, 4.93-8.95) and women with educated husbands (primary or secondary, higher secondary or above) were 1.1 (95% CI, 0.53-2.16) and 1.7 (95% CI, 0.84-3.47).
Conclusion(s): Pregnant Nepalese women commonly report LBP and/or PGP. The women experienced low disability despite severe pain intensity and poor belief in recovery.
Implications: The present study shows that LBP and PGP are prevalent in Nepalese pregnant women and that women experience severe pain intensity with belief of persistent pain post-partum. Hence, our study implicates the need to address the complaints of LBP and PGP during pregnancy, and for health care providers to deliver early information and treatment to prevent long-lasting pain.
Keywords: Pelvic girdle pain, low back pain, pregnancy
Funding acknowledgements: The Norwegian State Educational Loan Fund through the Norwegian Quota Scheme, Norway.
Purpose: The primary aim of this study was to assess the prevalence and severity of LBP and PGP in pregnant Nepalese women. A secondary aim was to determine factors that influence LBP and PGP during pregnancy.
Methods: A cross-sectional study with successive recruitment of pregnant women was conducted at two district hospitals in Nepal from May 2016 to May 2017. Participants completed questionnaires on sociodemographics, pregnancy- and workload characteristics, the Pelvic Girdle Questionnaire, the Oswestry Disability Index, the Numerical Pain Rating Scale, Pelvic Organ Prolapse Symptom Score, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the 5-item version of the Edinburgh Postnatal Depression Scale. The registration of LBP and PGP was done using a body chart. The women who reported LBP and/or PGP also responded to questions regarding pain frequency, specific PGP locations, if the LBP and/or PGP limited their usual activities or changed their daily routine for more than 1 day, concern regarding the pain, and belief of LBP and/or PGP disappearance after delivery. Univariate and multivariate logistic regression were used to assess the associations between independent variables and LBP and PGP.
Results: A total of 1284 pregnant women were included in the study. The mean age of the participants was 25 (Standard deviation (SD) 4), with a mean of 24 (SD 10) gestation weeks. The reported prevalence of pregnancy-related LBP and/or PGP was 34%. Pain intensity was high with a mean score of 6 (SD 2). The median (25th - 75th percentiles) disability scores by the total Pelvic Girdle Pain Questionnaire and Oswestry Disability Index were 20 (10-32) and 30 (21-28), respectively. The women were not much concerned about LBP and/or PGP, even though only 52% believed that the pain would disappear after delivery. The adjusted odds ratios for LBP and/or PGP with increased body mass index (20-24, 25-30, >30) were 0.7 (95% confidence interval (CI), 0.44-1.21), 1.1 (95% CI, 0.66-1.83) and 1.5 (95% CI, 0.78-2.94), having pelvic organ prolapse symptoms was 6.6 (95% CI, 4.93-8.95) and women with educated husbands (primary or secondary, higher secondary or above) were 1.1 (95% CI, 0.53-2.16) and 1.7 (95% CI, 0.84-3.47).
Conclusion(s): Pregnant Nepalese women commonly report LBP and/or PGP. The women experienced low disability despite severe pain intensity and poor belief in recovery.
Implications: The present study shows that LBP and PGP are prevalent in Nepalese pregnant women and that women experience severe pain intensity with belief of persistent pain post-partum. Hence, our study implicates the need to address the complaints of LBP and PGP during pregnancy, and for health care providers to deliver early information and treatment to prevent long-lasting pain.
Keywords: Pelvic girdle pain, low back pain, pregnancy
Funding acknowledgements: The Norwegian State Educational Loan Fund through the Norwegian Quota Scheme, Norway.
Topic: Women's & men's pelvic health; Musculoskeletal
Ethics approval required: Yes
Institution: University of Oslo,Norway; Kathmandu University School of Medical Sciences, Nepal
Ethics committee: The Norwegian Regional Ethics Committee; The Nepal Health Research Council;
Ethics number: (REK Nord, 2015/2209); (112/2016)
All authors, affiliations and abstracts have been published as submitted.
