Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study
Received 28 March 2008; received in revised form 20 February 2009; accepted 6 April 2009.
Abstract
Objective
The purpose of this study was to describe the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a diagnosis-based clinical decision rule.
Methods
This was a prospective observational cohort of consecutive patients with PRLP. Data on 115 patients were collected at baseline and on 78 patients at the end of the active treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ). Pain intensity was measured using the Numerical Rating Scale for pain (NRS). Patients were also asked to self-rate their improvement. Care was provided by a chiropractic physician/physical therapist team.
Results
Fifty-seven patients (73%) reported their improvement as either “excellent” or “good.” The mean patient-rated improvement was 61.5%. The mean improvement in BDQ was 17.8 points. The mean percentage of improvement in BDQ was 39% and the median was 48%. Mean improvement in pain was 2.9 points. Fifty-one percent of the patients had experienced clinically significant improvement in disability and 67% patients had experienced clinically significant improvement in pain. Patients were seen an average 6.8 visits. Follow-up data for an average of 11 months after the end of treatment were collected on 61 patients. Upon follow-up, 85.5% of patients rated their improvement as either “excellent” or “good.” The mean patient-rated improvement was 83.2%. The mean improvement in BDQ was 28.1 points. The mean percentage of improvement in BDQ was 68% and the median was 87.5%. Mean improvement in pain was 3.5 points. Seventy-three percent of the patients had experienced clinically significant improvement in disability and 82% patients had experienced clinically significant improvement in pain.
Conclusions
The management strategy used in this study appeared to yield favorable outcomes in this patient population and appears to be a safe option for patients with PRLP, although because of this study's sample size, rare complications are not likely to be detected. In addition, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized, controlled trials are necessary to distinguish treatment effects from the natural history of PRLP.
aClinical Director, Rhode Island Spine Center, Pawtucket, Rhode Island
bClinical Assistant Professor, Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
cAdjunct Associate Professor, Department of Research, New York Chiropractic College, Seneca Falls, NY
dAssociate Professor of Epidemiology, Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Manoa, Hawaii
eStaff Chiropractic Physician, Rhode Island Spine Center, Pawtucket, Rhode Island
Submit requests for reprints to: Donald R. Murphy, DC, Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860
ABSTRACT