Chronic Pelvic Pain in women. Group based multimodal physical therapy
ForfatterNygaard, Ane Sigrid
Introduction - The aims of this thesis were (1) to describe the characteristics of women with chronic pelvic pain (CPP) referred for physical therapy after evaluation at a tertiary hospital, (2) to compare group-based multimodal physical therapy (intervention group) with primary care physical therapy (comparator group), and (3) to explore if selected pre-treatment characteristics were associated with treatment outcome.
Methods - Women aged 20-65 years with pelvic pain ≥6 months were eligible. The primary outcome measure was change in the mean pelvic pain intensity from baseline to 12 months. Baseline data were presented with descriptive statistics. A randomized controlled trial was conducted to compare changes between the groups, analyzed with the independent samples t-test and the Mann-Whitney U-test. Associations between baseline variables and treatment outcome were investigated with a multivariable linear regression model.
Results - The women reported complex symptoms of both physical and psychological complaints, with a range of different health histories and –statuses. The group-difference in change in the mean pain intensity score was −1.2 (95% confidence interval, −2.3 to −0.2; p=0.027), favoring the intervention group. Pelvic pain duration of ≥ six years was associated with less pain reduction (regression coefficient 1.3, 95% CI 0.3 to 2.4), and higher baseline pain intensity was associated with higher pain reduction (regression coefficient -0.6, 95% CI -1.1 to -0.1) after physical therapy treatment.
Conclusions - Women with CPP represent a heterogeneous group. The reduction of the mean pain intensity from baseline to 12-months was greater in the intervention group than in the comparator group, but the group-difference was smaller than expected and the clinical relevance is uncertain. We hypothesize that pain duration and pain severity are of distinct importance in terms of treatment outcome. The results in all the three papers support further investigations of subgroups within CPP.
Paper I: Nygaard, A.S., Stedenfeldt, M., Øian, P. & Haugstad, G.K. (2019). Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study. Scandinavian Journal of Pain, 19(2), 355-364. Also available at https://doi.org/10.1515/sjpain-2018-0308. Accepted manuscript available in Munin at https://hdl.handle.net/10037/17092.
Paper II: Nygaard, A.S., Rydningen, M., Stedenfeldt, M., Wojniusz, S., Larsen, M., Lindsetmo, R.O., Haugstad, G.K. & Øian, P. (2020). Group-based multimodal physical therapy in women with chronic pelvic pain: A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 99(10), 1320-1329. Also available in Munin at https://hdl.handle.net/10037/20486.
Paper III: Nygaard, A.S., Haugstad, G.K., Wilsgaard, T., Øian, P. & Stedenfeldt, M. (2020). Baseline pain characteristics predict change in pain intensity after physical therapy treatment in women with chronic pelvic pain. Secondary analysis of data from a randomized controlled trial. Scandinavian Journal of Pain, 20(4), 793-800. Also available at https://doi.org/10.1515/sjpain-2020-0026.
ForlagUiT The Arctic University of Norway
UiT Norges arktiske universitet
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