Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration

Waterfield, Jackie; Bartlam, Bernadette; Bishop, Annette; Holden, Melanie; Barlas, Panos; Foster, Nadine E

doi:10.2522/ptj.20140298

Cited by 15 publications

(23 citation statements)

References 38 publications

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“…Training of physiotherapists will be important in a full trial as although all the participating physiotherapists had completed national standards of training in acupuncture, none were using it to manage women with pregnancy-related LBP prior to the pilot RCT training. This reflected our previous findings during the development of this pilot RCT that highlighted physiotherapists lack of experience of using acupuncture with pregnant women and concerns about safety [11]. The questionnaires completed by the physiotherapists showed marked increases in their self-confidence in assessing and managing pregnancy-related LBP and increased use of recommended management approaches such as providing written information, advice on safe pharmacological options and strengthening and pelvic floor exercises with more supervision of exercise by the physiotherapist.…”

Section: Discussionsupporting

confidence: 77%

“…Standard care (SC): the SC intervention was informed by the results of our studies undertaken prior to this pilot trial [8, 11, 12]. SC comprised a high quality and comprehensive self-management booklet, which was posted to participants following randomisation.…”

Section: Methodsmentioning

confidence: 99%

“…In order to inform the interventions and methods of the pilot RCT, we previously investigated (i) current UK physiotherapy management of pregnancy-related LBP [8], (ii) the views of physiotherapists about using acupuncture for pregnancy-related LBP [11] and (iii) the views of women with pregnancy-related LBP and midwives about a RCT, including recruitment and consent procedures and safety concerns [12]. …”

Section: Introductionmentioning

confidence: 99%

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Evaluating acupuncture and standard care for pregnant women with back pain: the EASE Back pilot randomised controlled trial (ISRCTN49955124)

Bishop

Ogollah²,

Bartlam

et al. 2016

Pilot Feasibility Stud

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BackgroundLow back pain (LBP) and pelvic girdle pain (PGP) during pregnancy are common and often accepted as a ‘normal’ part of pregnancy. Many women receive little in the way of treatment, and yet pain interferes with sleep, daily activities and work and leads to increasing requests for induction of labour or elective caesarean section. The aim of this study was to assess the feasibility of a full RCT evaluating the benefit of acupuncture for pregnancy-related back pain.MethodsThis study is a single-centre, three-arm pilot RCT in one large maternity unit and associated antenatal and physiotherapy clinics. Women were eligible if they had pregnancy-related LBP with or without PGP. Exclusions included a history of miscarriage, high risk of early labour or pre-eclampsia, PGP only and previous acupuncture. Interventions were standard care (SC): a self-management booklet with physiotherapy if needed. SC+TA: the booklet and physiotherapy comprising true (penetrating) acupuncture, advice and exercise. SC+NPA: the booklet and physiotherapy comprising non-penetrating acupuncture, advice and exercise. Remote telephone randomisation used a 1:1:1 allocation ratio stratified by gestational weeks. Three measures of pain/function were compared to inform the primary outcome measure in a full RCT: the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI) and 11-point 0–10 numerical rating scale for pain. Analysis focused on process evaluation of recruitment, retention, descriptive information on outcomes, adherence to treatment, occurrence of adverse events and impact of physiotherapist training.ResultsOne hundred twenty-five women were randomised (45% of those eligible) between April and October 2013; 73% (n = 91) provided 8-week follow-up data. Three of six recruitment methods accounted for 82% of total uptake: screening questionnaire at the 20-week scan, community midwives issuing study cards, and self-referral following local awareness initiatives. Physiotherapists’ self-confidence on managing pregnancy-related LBP improved post training. The PGQ is suitable as the primary outcome in a full trial. The average number of treatment sessions in both SC+TA and SC+NPA was six (in line with treatment protocols). No serious adverse events attributable to the trial treatments were reported.ConclusionsA full RCT is feasible and would provide evidence about the effectiveness of acupuncture and inform treatment choices for women with pregnancy-related LBP.Trial registration ISRCTN49955124

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Section: Discussionsupporting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating acupuncture and standard care for pregnant women with back pain: the EASE Back pilot randomised controlled trial (ISRCTN49955124)

Bishop

Ogollah²,

Bartlam

et al. 2016

Pilot Feasibility Stud

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“…As previously presented, literature reviews such as Pennick and Liddle (2013) Findings from Waterfield et al (2015) indicates physiotherapists' reluctance to perform acupuncture on pregnant women, and, although not stated, one reason for this may be to do with needling around the lumbar spine and close to the pelvis. By introducing an acupuncture approach which requires needles to be placed away from the abdomen, it may be considered a more desirable approach for physiotherapists over the usual body acupuncture approach, thus increasing its use with in pregnancy related pain.…”

Section: Chapter Summarymentioning

confidence: 93%

“…However, taking the results for Chapter 7 alone would not be recommended, due to the limitations of a feasibility study and the need for a fully powered trial. If a subsequent fully powered study did replicate findings from Chapter 7, then it may encourage 'reluctant' clinicians, as observed by Waterfield et al (2015), to consider acupuncture for PPGP.…”

Section: Implications For Future Practicementioning

confidence: 95%

Korean hand acupuncture for pregnancy related pelvic girdle pain: a feasibility study

2016

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This thesis aimed to assess the feasibility of conducting a randomised controlled trial (RCT) into the use of Korean Hand Acupuncture (KHA) for pregnancy related pelvic girdle pain (PPGP). Despite PPGP developing in approximately 20% of all pregnant women, there are currently very few studies that have investigated interventional strategies, with a dearth of UK based studies. Of extant interventions investigated to date, acupuncture has shown some promising findings, although the effects of KHA on PPGP remain unclear. In line with the MRC framework for complex interventions, any potential treatment should be subjected to feasibility testing prior to a definitive RCT. This three phase feasibility study followed a mixed methods paradigm.Phase 1 was a comparative study of 20 non pregnant women, measuring the belief that there had been a needle inserted into the skin, between a penetrating KHA (pKHA) group and a non-penetrating KHA (npKHA) group. Between group analysis found that at initial assessment (p=0.07) and one week post intervention (p=0.643), believability was similar. Qualitative comments were analysed through content analysis, and provided insight into what factors influenced their belief score, such as 'acupuncture noises'. The study findings helped to develop the intervention protocol in Phase 3. This study was the first to investigate the believability of a non penetrating form of KHA.Phase 2 recruited eight PPGP sufferers and adopted a qualitative approach, using semistructured interviews to gain an understanding of how PPGP affected them. Data was subjected to thematic analysis and produced four themes: The reality of PPGP; Support mechanisms most important in PPGP; Vulnerability and; Knowledge is power. Findings indicated PPGP is a problem that is biopsychosocial, and one which is represented via the Pelvic Girdle Questionnaire (PGQ). It demonstrated that information provision was considered as important to the participants within this study as it is to sufferers outside of the UK, and that they valued health care professional advice and support. This is the first UK based study to investigate women's experience of PPGP, the first piece of qualitative work with the lead author and interviewer being male, the first to provide a level of validity to PGQ use within the UK and the first to adopt a pragmatic philosophy.Phase 3 was a mixed methods feasibility study, assessing the acceptability and practicality of conducting a definitive RCT on KHA for PPGP. A two armed study consisting of six sessions in either a standard physiotherapy plus pKHA or a standard physiotherapy plus npKHA group. The study recruited 59 women, 40 of whom completed all six sessions. Acceptability and practicality was confirmed through content analysis of the qualitative data produced by the participants, in particular those in the pKHA group who stated they would seek out the treatment again. Further acceptability was noted as all adverse events experienced were minor and transient, and that the retention of women to the ...

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How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed‐methods study

Holden

Waterfield

Whittle

et al. 2019

Musculoskeletal Care

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Background: Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA.Methods: We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semistructured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically.Results: There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness.Conclusions: UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss.However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.

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Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration

Cited by 15 publications

References 38 publications

Evaluating acupuncture and standard care for pregnant women with back pain: the EASE Back pilot randomised controlled trial (ISRCTN49955124)

Evaluating acupuncture and standard care for pregnant women with back pain: the EASE Back pilot randomised controlled trial (ISRCTN49955124)

Korean hand acupuncture for pregnancy related pelvic girdle pain: a feasibility study

How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed‐methods study

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