ORCID

Abstract

Chronic pregnancy-related pelvic girdle pain (PPGP) affects an estimated 10% of post-partum women and is typically recalcitrant to conservative management. One novel option to manage this is a customised Dynamic Elastomeric Fabric Orthosis (DEFO), however, currently non studies have evaluated the clinical and cost-effectiveness or acceptability of this orthotic in post-partum women. Further, the mechanism of action of this orthotic is unknown. One mechanism may be to impart an effect on the disturbed body perception, which preliminary evidence has demonstrated is affected in women with PPGP. Current understanding is limited by an absence of research into women with PPGP and limitations with testing methods for body perception. The primary aim of the thesis was to evaluate the feasibility of conducting a randomised controlled trial (fRCT) in women with chronic PPGP. An additional aim was to design a central measure of implicit body perception to allow the assessment of women experiencing pain spanning the midline and evaluate the reliability of this in women with PPGP. A remotely delivered fRCT in (n=24) participants experiencing chronic (>3 months) post-partum PPGP, compared standard care (advice and exercise) to standard care plus a DEFO. The pre-defined progression criteria indicated that in its current format, it is not yet feasible to progress to a definitive trial. The primary challenge was participant recruitment, achieving 40% of its target. The DEFO demonstrated some promise in reducing worst night-time pain at 24-weeks, as assessed by the NPRS (-2.63 (SD 2.88)). Implicit and explicit somatoperception did not change. Qualitative interviews (n=8) supported the remote delivery of the trial, but with a preference to incorporate a face-to-face session.A narrative review identified the most appropriate measures to study explicit and implicit body perception at the pelvic girdle; Freemantle Back Awareness questionnaire (FreBAQ) and the two-point estimation task (2-PE). The 2-PE measure lacked data on healthy individuals and had only been tested in unilateral pain. Considering this, a central version of the measure was designed, requiring reliability testing. A reliability and agreement (remote versus in-person) study was undertaken in 22 pain-free women. Two repeated measures stabilised the reliability, with good to excellent intra-rater reliability at the pelvic girdle for the central (ICC 0.89 95%CI 0.73-0.95) and lateral measure (ICC 0.91 95%CI 0.78-0.96). Inter-rater was good for all measures (in-person and remote) except for the in-person lumbar spine. There was satisfactory agreement between the in-person and remote methods of assessment of the 2-PE; lateral mean difference -3.20, and central measure (pelvic girdle), mean difference 8.09, with no proportional bias.Comparison of the sensory perception measure data between pain-free women and those with PPGP demonstrated that women with PPGP more accurately estimated their pelvic girdle area during the 2-PE measure. However, the difference was not statistically significant (p = 0.08). Further work is required to understand if perceptual changes (as measured with the 2-PE measure) are modified with treatment and correlate with the report of an enlarged or shrunken pelvis as measured by the FreBAQ.In conclusion, this thesis has evaluated the feasibility of conducting a RCT in women with PPGP. The results have shown that in its current format, it is not feasible to run a definitive trial. Of major importance, a greater understanding of the barriers and opportunities for recruitment of women with PGP is required. This thesis has filled a knowledge gap related to the understanding of body perception in women with PPGP. Designing a central measure, to allow the assessment of women experiencing pain spanning the midline, collecting data in a pain-free population, and comparing this to women with PPGP provides the basis for further work to understand perceptual disturbances in women with PPGP.

Keywords

Pelvic Girdle Pain, Orthotic Devices, Perception

Document Type

Thesis

Publication Date

2025

Embargo Period

2025-04-16

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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