Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association

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Abstract

Background:

Examination, diagnosis, prognosis, intervention, and the use of outcomes measures by physical therapists in the antepartum population with pelvic girdle pain should be guided by current evidence. The creations of clinical practice guidelines (CPGs) is a crucial process for examining and maintaining the validity of recommendations, as well as provide classification and definition using the International Classification of Functioning, Disability, and Health (ICF) terminology related to impairment of body function, structure, activity limitations, and participation restrictions.

Methods:

(1) Using ICF terminology to (a) categorize mutually exclusive impairment patterns to base intervention strategies and (b) to serve as measures of change in function over course of care. (2) Description of supporting evidence was produced by a systematic searched MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews (through 2012) for any relevant articles related to prevalence, risk factors, examination, classification, outcome measures, and intervention strategies for pelvic girdle pain in the antepartum population. Each literary article was reviewed by 2 reviewers and required greater than 95% agreement among reviewers via Key Questions from the Evidence Based Physical Therapy for determination of article quality for the appropriate of level of evidence (I-V) established by the Centers for Evidence-Based Medicine and grades of evidence for strength according to the guidelines of Guyatt et al and modified by Law and MacDermid (A-F).

Results:

A total of 105 references were included and the following recommendations were found with evidence. The evidence is moderate to strong for identification of risk factors, clinical course, diagnosis/classification, and outcome measures. There is theoretical/foundational evidence for activity/participation levels and expert opinion for imaging. Conflicting evidence was found for interventions including the use of support belts, and exercise. The evidence for manual therapy can best be described as weak/emergent at this time.

Conclusions:

This CPG can be used to guide clinicians in their clinical reasoning processes in the examination and intervention of females with prenatal pelvic girdle pain. The organization and classification of the document can guide research to address the paucity of evidence especially in the interventions with this population.

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