During pregnancy, women may experience low back pain (LBP), pelvic girdle pain (PGP) or a combination of both (lumbopelvic pain [LBPP]) which impacts on activities of daily living and their quality of life. Incidence rates are estimated at between 57-90% for LBP and 4-76% for PGP. For women who experience LBP or PGP during pregnancy, up to half will continue to have some pain complaints one year after childbirth.
This systematic review aimed to investigate the short-term and long-term effectiveness and acceptability of a prevention strategy compared to control, on episodes of LBP, PGP or LBPP in women during pregnancy.
Electronic databases were searched from their inception to January 2023. Randomised and quasi-randomised controlled trials enrolling pregnant women without LBP or PGP at the onset of the study were included. Trials needed to compare an experimental group receiving a prevention strategy aimed at preventing LBP, PGP or LBPP during pregnancy to a control group receiving no intervention, placebo, sham or waitlist control. Trials also needed to include at least one of the outcomes of interest, i.e. incidence of LBP, PGP, or LBPP, sick leave and acceptability in the short-term [<12 week] and long-term [> 12 weeks]. Acceptability was measured by the number of participants who withdrew due to any reason out of total number of participants randomly assigned to each group. Risk of bias in each included trial was assessed using the PEDro scale.
Meta-analysis was conducted using a random-effects model, with the reporting of relative risk (RR) and 95% confidence intervals (CI). Trials were grouped by specific prevention strategy, outcome and time points. The GRADE approach was used to rate the certainty of evidence, with the quality of evidence beginning at moderate certainty because it was not possible to assess occurrence of publication bias (small number of trials).
This review included six randomised controlled trials enrolling 2231 pregnant women aged 23-31 years and gestational ages 12-24 weeks. All were low-risk single-child pregnancies and most women were considered sedentary. Eligible trials evaluated two strategies, education combined with exercise and stand-alone exercise. All trials were at a low risk of bias (median PEDro score 7, range 6 to 8). All trials provided data on new events of LBP, PGP or LBPP.
Stand-alone exercise likely reduces the risk of LBP (RR 0.92, 95% CI 0.85–0.99; 2 trials, n=621, moderate certainty evidence), has uncertain effects on reducing the risk of PGP (RR 0.87, 95% CI 0.53–1.44, 1 trial, n=105, very low certainty evidence) and likely does not reduce the risk of LBPP (RR 0.92, 95% CI 0.68–1.25, 2 trials n=1156, moderate certainty evidence) in the long-term. Stand-alone exercise is likely acceptable among women with LBPP (RR 0.60, 95% CI 0.42–0.84, moderate certainty evidence) but uncertain among women with LBP (low certainty evidence).
Education combined with exercise likely does not reduce the risk of LBP or PGP in the short-term (LBP: RR 1.06, 95% CI 0.85–1.31; PGP: RR 1.19, 95% CI 0.71–1.98) or long term (LBP: RR 1.05, 95% CI 0.85–1.30; PGP: RR 1.02, 95% CI 0.80–1.29) (2 trials, n= 438; moderate certainty evidence). There was uncertainty regarding education combined with exercise on LBPP (very low certainty evidence) and no difference between intervention and control groups for acceptability in the short term (very low certainty evidence) and long term (moderate certainty evidence) (2 trials, n=454).
Current moderate quality evidence supports stand-alone exercise as an acceptable intervention for pregnant women with lumbopelvic pain and has a small protective effect regarding episodes of low back pain in the long-term. Further high-quality studies are still required to confirm effects on preventing low back pain, pelvic girdle pain and lumbopelvic pain in the short and long-term.
Santos FF, Lourenço BM, Souza MB, Maia, LB, Oliveira VC, Oliveira MX. Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations. Physiotherapy 118 (2023) 1–11 https://doi.org/10.1016/j.physio.2022.09.004
