Evaluation of an Orthotic Intervention for the Management of Pregnancy Related Pelvic Girdle Pain (PGP)

Abstract

The overall aim of the thesis was to evaluate the effectiveness of a novel orthotic intervention, a customised Dynamic Elastomeric Fabric Orthosis (DEFO), in the management of both antenatal and post-partum pelvic girdle pain (PGP). In the first instance the fabric, from which the DEFO was constructed, underwent testing to determine if the different colour fabrics available possessed the same underlying fabric stiffness and elastic hysteresis to ensure that each orthotic was standardised. Laboratory testing identified significant differences in both fabric stiffness and elastic hysteresis, between colours. The findings of this study enabled standardisation of the intervention by using a single coloured customised DEFO (Black), ensuring rigor of the planned evaluation studies.

A randomised controlled trial, with participants experiencing antenatal PGP, was then completed assessing the effectiveness of the novel customised DEFO in comparison to a standard issue pelvic belt (Serola Belt). It found that there was both a statistically (p<.05) and clinically significant (one point minimal clinically important difference (MCID)) change in favour of the DEFO in reducing both day and night pain as measured by the numerical pain rating scale (NPRS).

Following impromptu discussions with participants experiencing long-standing PGP, and a further review of the literature, it was evident that this was an under-researched area. A single case study series was therefore undertaken to explore the potential effectiveness of the customised DEFO in reducing pain and improving function and quality of life in women with chronic (> 3months) PGP. The single case study series also afforded an opportunity to identify potential outcome measures that could be used if a larger trial was considered in the future. This single case study series suggests that a customized DEFO could potentially reduce pain, increase health related quality of life, improve mood and increase activity levels for persons suffering from chronic post-partum PGP, thereby hopefully identifying a possible new treatment option for managing this condition. The results of this single case study series provides the basis for a larger clinical trial.

Conclusion This thesis has provided an evaluation of orthotic intervention for pregnancy related PGP. The results have shown that orthotic intervention in antenatal PGP can provide an improvement in PGP related symptoms such as pain and function. This research has helped to fill a knowledge gap and provided current evidence to move towards improved clinical care. Furthermore, this thesis has provided a more in-depth awareness into chronic post-partum PGP and the magnitude of improvement that may be associated with the customized DEFO. The results of this single case study series provides the basis for a larger clinical trial.