IntroductionTwenty five per cent of pregnant women with musculoskeletal pain have disabling symptoms that negatively influence quality of life. Studies have reported varying effects of non-pharmacological interventions including exercise, manipulation and pelvic belts for pregnant women with musculoskeletal problems. The overall effectiveness and acceptability of these interventions is uncertain due to lack of synthesised evidence. This protocol is for the first systematic review of community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions from studies published until August 2020.Methods and analysisA detailed search of PubMed, CINAHL, CENTRAL, Global Index Medicus, African Index Medicus, African Journal Online, Western Pacific Region Index Medicus, Latin American and Caribbean Centre on Health Science Information, Index Medicus for South-East Asia Region, IRIS (WHO digital publications), British Library for Development Studies and Google Scholar. Additional studies will be located from the reference list of identified studies and relevant systematic reviews. The databases will be searched from inception to August 2020. Appraisal of study quality will be performed with the Mixed Methods Appraisal Tool. Data will be synthesised using a mixed-studies synthesis design—the convergent synthesis. The description of interventions in all study designs will be summarised narratively. Meta-analyses will be used to statistically summarise the effectiveness of interventions in randomised controlled trials and the factors that influence these. Other quantitative studies will be summarised narratively to answer the objectives. Thematic synthesis will be used to summarise results of qualitative studies. The outcomes of interest include pain, disability and quality of life. This paper is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guidelines.Ethics and disseminationEthical clearance is not required. Findings will be presented at conferences and published in peer-reviewed journals.PROSPERO registration numberCRD42020189535.
Background Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. Objectives To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. Search strategy Twelve bibliographic databases and reference list of related studies from inception until January 2022. Selection criteria All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). Data collection and analysis Data were extracted using modified Cochrane’s data extraction template. Studies were evaluated using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). Main results Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention. Conclusions Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes. Funding There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.
Background Majority of pregnant women experience pain and discomfort due to musculoskeletal conditions; with over a quarter experiencing some disability; all of which reduce quality of life during pregnancy. Community-based non-pharmacological interventions are more affordable, accessible, and acceptable, and have the capacity to reduce inequalities. Objectives To summarise community-based non-pharmacological interventions and determine their effectiveness for improving pain, disability, and quality of life amongst pregnant women with musculoskeletal conditions. Search Strategy Twelve bibliographic databases (and reference list of relevant systematic reviews) were searched from inception until March 2022. Selection Criteria All primary studies of community-based non-pharmacological interventions for pregnant women with musculoskeletal conditions reported in English which investigated pain, disability and quality of life were included. Data Collection and Analysis Data were extracted using modified Cochrane’s data extraction template. Studies were appraised using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This review registration number with PROSPERO is CRD42020189535. Main Results 33 studies involving 4,930 pregnant women with low back pain, pelvic pain, and lumbopelvic pain. Osteopathic manipulation plus standard obstetric care produced significantly superior reduction in pain intensity and disability than sham ultrasound therapy plus standard obstetric care amongst pregnant women with low back pain (moderate level of evidence). There was limited or conflicting evidence for other results. Acupuncture was more effective than placebo in reducing disability/sick leave but not pain intensity and quality of life. There was little or no added benefit of craniosacral therapy to standard obstetric care. Exercise and spinal manipulative therapy were equally effective, and better than no treatment. Home versus in-clinic exercise and aquatic versus land-based exercise were similar in effectiveness with conflicting evidence when compared with standard obstetric care. Wide flexible lumbopelvic belts or the addition of textured sacral pad was better than thin rigid lumbopelvic belts, belts without padding, or no belt. Kinesiotaping may not be better than placebo. Effectiveness of self-management programmes was inconsistent. Conclusions Community-based non-pharmacological interventions were better than no treatment and were better or as effective as standard obstetric care in improving pain intensity, disability, and quality of life.
Background Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. Objectives To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. Search Strategy Twelve bibliographic databases and reference list of related studies from inception until January 2022. Selection Criteria All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). Data Collection and Analysis Data were extracted using modified Cochrane’s data extraction template. Studies were evaluated using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). Main Results 27 studies involving 6,242 pregnant women with GDM involved self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Limited/conflicting evidence was found for other outcomes and interventions. Conclusions Community-based non-pharmacological interventions are more effective than placebo; and are more/as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.
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