Background
Methods
1 | postpartum women OR “postnatal women” OR “after delivery” OR “postpartum period” OR “postpartum females” OR “birth” OR “after birth” OR “natal” OR “perinatal” OR “puerperium” | Population |
2 | exercise OR “postpartum exercise” OR “postnatal exercise” OR “postpartum training” OR “postpartum practices” OR “abdominal training” OR “exercise prescription” OR “abdominal training “OR “female athlete” OR “physical activities” OR “physical fitness” | Interventions |
4 | back pain OR “backache” OR “low back pain “OR “lower back pain “OR “upper back pain” OR “high back pain” OR “anterior pelvic pain” OR “posterior pelvic pain” OR “buttocks pain” OR “pelvic pain” OR “symphysis pain” OR “sacroiliac joint pain” OR “pelvic girdle pain” OR “lumbar pelvic pain” OR “lumbosacral pain” OR “lumbar pain” OR “postpartum-related LBP” OR “self management of LBP” OR “vertebrogenic pain” | Outcome |
5 | core muscles OR “trunk muscles” OR “core stabilisation” OR “transverses abdominis” OR “lumbar multifidus” OR “musculoskeletal” OR “musculoskeletal conditions” OR “musculoskeletal disorders” | |
6 | physical endurance OR “endurance” OR “core muscle strength” | |
7 | 1 AND 2 AND 3 AND 4 AND 5 AND 6 |
Methodological quality assessment and data analysis
Author/Publication year/country | Publication title | Design | Population/Sample | Quality rating |
---|---|---|---|---|
Mens et al., [46] 2000 Netherlands | Diagonal Trunk Muscle Exercises in Peripartum Pelvic Pain: A Randomised Clinical Trial | Randomised controlled trial | Total: 44 women | ‘Good’ |
Intervention group: 16 | ||||
Control group 1: 14 | ||||
Control group 2: 14 | ||||
Stuge et al., [47]a 2004 | The Efficacy of a Treatment Program Focusing on Specific Stabilising Exercises for Pelvic Girdle Pain After Pregnancy: A Randomised Controlled Trial | Randomised, single-blind, clinically controlled study with a stratified group design | Total: 81 women | ‘Good’ |
Intervention group: 40 | ||||
Control group: 41 | ||||
One year postpartum: | ||||
Intervention group: 39 | ||||
Stuge et al., [51]a
2004 Norway | The Efficacy of a Treatment Program Focusing on Specific Stabilising Exercises for Pelvic Girdle Pain After Pregnancy: A Two-Year Follow-up of a Randomised Clinical Trial | Control group: 39 | ||
Two year postpartum: | ||||
Intervention group: 30 | ||||
Control group: 35 | ||||
Gutke et al., [48] 2010 Sweden | Specific muscle stabilising as home exercises for persistent pelvic girdle pain after pregnancy: a Randomised, Controlled Clinical Trial | Prospective, randomised, single-blinded clinically controlled study | Total: 86 Women | ‘Good’ |
Intervention group: 32 | ||||
3-month follow-up analysis (n = 26) | ||||
6-month follow-up analysis (n = 24) | ||||
Control group: 54 | ||||
3-month follow-up analysis (n = 39) | ||||
6-month follow-up analysis (n = 36) | ||||
Chaudry et al., [49] 2013 Pakistan | Effectiveness of core stabilisation exercises along with postural correction in postpartum back pain | A randomised controlled trial with non-probability sampling | Total: 40 women | ‘Fair’ |
Intervention group: 20 | ||||
Control group: 20 |
Results
Study selection
Domains | Risk of bias | |||
---|---|---|---|---|
Mens et al. [46] | Gutke et al. [48] | Chaudry et al. [49] | ||
Random sequence generation | Low risk of bias | Low risk of bias | Low risk of bias | Low risk of bias |
Allocation concealment | Low risk of bias | Low risk of bias | Low risk of bias | Unclear risk of bias |
Blinding of participants and personnel | Unclear risk of bias | Low risk of bias | Low risk of bias | Unclear risk of bias |
Incomplete outcome data | Low risk of bias | Low risk of bias | Low risk of bias | Unclear risk of bias |
Selective reporting | Low risk of bias | Low risk of bias | Low risk of bias | Unclear risk of bias |
Other sources of bias | Low risk of bias | Low risk of bias | Low risk of bias | Unclear risk of bias |
Study characteristics
Interventions and comparators
Outcomes
Primary outcome: Changes in LPP
Author/Publication year | Intervention | Comparator | Intervention duration and frequency | Outcome measures | Effectiveness of the intervention (P<05) |
---|---|---|---|---|---|
Mens et al., [46] 2000 | Instructions given by videotape with training of the diagonal trunk muscles (n=16). | Comparator 1: Instructions given by videotape with training of the longitudinal trunk muscles (n=14). | 8-week duration. | Intensity of pain and fatigue in the morning and evening based on Visual Analogue Scale (VAS). | No significant differences in pain intensity, fatigue, HQRL, or mobility measures between the experimental group and both control groups. |
Light exercises to be performed 3 times per day and heavy exercises 3 times per week | |||||
Health-related quality of life (HQRL) based on Nottingham Health Profile (NHP). | |||||
Comparator 2: Instructions given by videotape without exercises (n=14). | Gluteal pain provoked by the Posterior Pelvic Pain Provocation (PPPP) test on the left and right sides. | Experimental group scored better than the control groups with repect to gluteal pain provoked by the PPPP test on the right side. | |||
Mobility of pubic symphysis (radiographic examination). | |||||
Physical therapy with specific stabilising exercises (n=40). | Physical therapy without specific stabilising exercises (n=41). | 18 to 20 weeks duration. | Pain intensity in the morning and evening based on VAS. | After the intervention and 1 year follow up: | |
Functional status (Oswestry LBP Disability Questionnaire). Health-related quality of life (SF-36 Health survey). | Pain intensity in the morning and evening was significantly reduced in the intervention group. Functional status in the intervention group significantly better than the control group. | ||||
Physical endurance (Sӧrensen Test, ASLR test). | |||||
Health-related quality of life shows significant improvement in the intervention group with largest effect in physical function, role physical and bodily pain. | |||||
3 days a week with a daily duration of 30 to 60 min | |||||
Significant differences in functional status, evening pain, and morning pain between the groups were maintained 2 years after delivery. | |||||
Health-Related Quality of Life at 2 years after delivery revealed that significant differences persisted between the groups in physical functioning, role physical, and bodily pain. | |||||
No significant differences between the 2 groups were seen for the other 5 subscales (general health, vitality, social functioning, role emotional, and mental health). | |||||
Gutke et al., [48] 2010 | Specific stabilising exercises focused on the transversely Oriented abdominal, the lumbar multifidus, and the pelvic floor muscles. | No exercise. | Total duration not reported ≥ 2 times per day and to perform each exercise with 10 repetitions. | Disability based on the Oswestry Disability Index (ODI) version 2.0. | For ODI, no difference could be demonstrated between the intervention and control groups at 3- or 6-month follow-up. Significant difference in pain frequency was demonstrated between the two groups at the 3-month follow-up in favour of the intervention group. |
Instructed to resume normal activities. | |||||
Pain intensity measured with VAS (0–100 mm) for current pain and average pain during the previous week. | |||||
Pain frequency (always, day and night to several times per week, or occasionally to never). | |||||
Health related quality of life (HRQL) measured using EuroQol instrument (EQ-5D and EQ-VAS). | |||||
No differences could be found between the groups regarding pain intensity, | |||||
Wellbeing measured with VAS (0–100 mm) with defined end-points (low value indicating high wellbeing). | HRQL or wellbeing. | ||||
Chaudry et al., [49] 2013 | Core stabilisation exercises along with postural correction in different positions. | Simple back strengthening exercises in different positions. | Total duration not reported. | Back pain (Visual analogue scale VAS). | Significant improvement in ADLs and IADLs in intervention group compared to control group. |
3 sessions of half an hour during the stay in hospital. | Activities of Daily Livings (ADLs) and Instrumental Activities of Daily Livings (IADLs) | ||||
Significant improvement in muscle power in intervention group compared to control group. | |||||
Mobility (dependent and independent). | |||||
Muscles power. Manual Muscle Testing (MMT). | |||||
Pedal edema. | Significant improvement in mobility in intervention group compared to control group. | ||||
Intervention group showed improvement in edema compared to control group, but p-value was insignificant. |