Hassan, Nowall A
(2007)
A CLINICAL PREDICTION RULE FOR CLASSIFYING POSTPARTUM SUBJECTS WITH LOW BACK AND PELVIC GIRDLE PAIN WHO DEMONSTRATE SHORT-TERM IMPROVEMENT WITH MOBILIZATION OF THE SACROILIAC JOINT.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Objective: develop a Clinical Prediction Rule (CPR) for identifying postpartum women with Low Back (LBP) or Pelvic Girdle Pain (PGP) who demonstrate short-term improvement with Sacroiliac Joint (SIJ) mobilization. Significance: Development of a CPR for classifying subject's a-prior would improve the clinical decision-making process and research. Methods: a prospective cohort of 69 postpartum women was conducted at the University of Pittsburgh Medical Center. Subjects were six weeks to one year postpartum and had a chief complaint of pain in the lower back, pelvic girdle, or thigh. Subjects completed several self-report measures, questionnaires and underwent a physical examination. Subjects then underwent a grade V mobilization to the SIJ. Success with treatment was determined using percent changes in disability scores after one mobilization and served as the reference standard for determining accuracy of the examination variables. Variables with univariate prediction of success and non-success were combined into multivariate CPR's. Results: Fifty-five subjects (80%) had success with the mobilization and 14 (20%) were categorized as non-success. A CPR for success with four variables (seated flexion test, prone knee bend test, negative posterior superior iliac spine symmetry test, and symptom location in the lower lumbar spine and/or SIJ areas only) was identified. The presence of 2/4 criteria (+LR=3.05) increased the probability of success with mobilization from 80% to 92%. A CPR for non-success with three variables (age > 35 years, visual analogue score-best > 3, and negative prone knee bend test) was identified. The presence of 2/3 criteria (+LR=11.79) increased the probability of non-success with the mobilization from 20% to 75%. Conclusion: In our sample, 80% of subjects were successful after one mobilization without an attempt at prediction. This success rate was higher than the success rate of the general LBP population of a previously developed CPR. There is a low risk accompanying this intervention, it does not take long and benefits would be experienced after one session. The broad inclusion criteria of women with LBP or PGP allows clinicians to include women without a traditional diagnosis. Clinicians may opt to try the mobilization; an alternate approach can be used if it fails.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
25 September 2007 |
| Date Type: |
Completion |
| Defense Date: |
3 July 2007 |
| Approval Date: |
25 September 2007 |
| Submission Date: |
5 July 2007 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Health and Rehabilitation Sciences > Rehabilitation Science |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Clinical Prediction Rule; Low back pain; Obstetrics and Gynecology; Pelvic girdle pain; postpartum; pregnancy |
| Other ID: |
http://etd.library.pitt.edu/ETD/available/etd-07052007-164019/, etd-07052007-164019 |
| Date Deposited: |
10 Nov 2011 19:49 |
| Last Modified: |
15 Nov 2016 13:45 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/8268 |
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