Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review

Klotz, Susanne; BSc, PT Mila Schön; Ba, Gesche Ketels; Löwe, Bernd; Brünahl, Christian

doi:10.1080/09593985.2018.1455251

Cited by 39 publications

(58 citation statements)

References 67 publications

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“…Physical therapy to the pelvic region was focused on imparting patient control of the muscle relaxation and contraction processes, which may contribute to improving muscle relaxation and consequently to changing the muscle width. e literature supports such a causative linkage, as studies have reported a lengthening of the levator ani muscle following MPT in CPPS patients that was correlated with the degree of improvement in clinical pain ratings [45,77,78]. e current study did not compare the muscle length and width between women with CPPS and healthy women, which eliminates the possibility to derive any conclusions about a possible anatomical impairment in the muscle prior to the intervention.…”

Section: Discussionmentioning

confidence: 75%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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Background. Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose. This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods. The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results. Along with an improvement in the clinical pain intensity (p=0.001) and sensitivity to experimental pain tests (p=0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p=0.04; p=0.001; p=0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p=0.001). Conclusions. The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

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Section: Discussionmentioning

confidence: 75%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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“…As another example, we did not include any of the maternal, urological or gynecological, even though there is a body of literature pointing that physical therapy can be useful for addressing incontinence and pelvic pain [70,71]. However, we found that underlying evidence base on use of physical therapy for on the chronic pelvic pain and incontinence still is considered insufficient [72,75], and the vast majority of urological and gynecological conditions are not typically treated with physical rehabilitation. In addition, data weren't available in the GBD to identify particular urological/gynecological conditions potentially amenable for rehabilitation, i.e., there are no GBD "impairments" for consequences of such as urological/gynecological conditions such as incontinence or pelvic pain.…”

Section: Data Selectionmentioning

confidence: 99%

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

Jesus

Landry

Hoenig

2019

Preprint

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Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions amenable to physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts amenable to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99%CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts amenable to physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs amenable to physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries Age-standardized YLD Rates significantly decreased (p < 0.01; r² = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs, globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced.

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“…Comparing the study intervention with non-standardized physical therapy can be considered a limitation because of the heterogeneous treatment. However, there is no consensus on a standardized physical therapy approach in CPP, 6 and comparing the intervention with the "usual treatment" offered to these women provides real-world clinical data. Furthermore, the lack of blinding of the data collectors and patients is a limitation, and there might be a selection bias because one-third of the eligible women declined to participate.…”

Section: Discussionmentioning

confidence: 99%

“…2 A systematic review of physical therapy treatment for CPP summarized that positive results can be achieved with single modalities such as manual techniques and exercises, but the evidence is limited. 6 Physical therapy focusing on body awareness and cognitive techniques has been highlighted as a promising therapy, and a future avenue for research in CPP. 6 Group-based physical therapy is considered time saving and cost efficient; it can be as effective in reducing pain as individual treatment and can provide social affinity for the participants.…”

Section: Introductionmentioning

confidence: 99%

“…6 Physical therapy focusing on body awareness and cognitive techniques has been highlighted as a promising therapy, and a future avenue for research in CPP. 6 Group-based physical therapy is considered time saving and cost efficient; it can be as effective in reducing pain as individual treatment and can provide social affinity for the participants. 7 Despite this, no randomized controlled trials (RCTs) on group-based physical therapy for CPP have been identified.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Group‐based multimodal physical therapy in women with chronic pelvic pain: A randomized controlled trial

Nygaard

Rydningen

Stedenfeldt

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Chronic pelvic pain in women is a complex condition, and physical therapy is recommended as part of a broader treatment approach. The objective of this study was to compare structured group‐based multimodal physical therapy in a hospital setting (intervention group) with primary‐care physical therapy (comparator group) for women with chronic pelvic pain. Material and methods Women aged 20‐65 years with pelvic pain ≥6 months and referred for physical therapy were eligible. The primary outcome measure was change in the mean pelvic pain intensity from baseline to 12 months, measured using the numeric rating scale (0‐10). Secondary outcomes were changes in scores of “worst” and “least” pain intensity, health‐related quality of life, movement patterns, pain‐related fear of movements, anxiety and depression, subjective health complaints, sexual function, incontinence, and obstructed defecation. The differences between the groups regarding change in scores were analyzed using the independent t test and Mann‐Whitney U test. Sensitivity analysis of the primary outcome was performed with a linear regression model adjusted for the baseline value. A P value <.05 was considered statistically significant. Results Of the 62 women included, 26 in the intervention group and 25 in the comparator group were available after 12 months for data collection and analysis. The difference between the groups for change in the mean pain intensity score was −1.2 (95% CI −2.3 to −0.2; P = .027), favoring the intervention group. The intervention group showed greater improvements in respiratory patterns (mean difference 0.9; 95% CI 0.2‐1.6; P = .015) and pain‐related fear of movements (mean difference 2.9; 95% CI −5.5 to −0.3; P = .032), and no significant differences were observed between the groups for the other secondary outcomes. Conclusions Although the reduction in the mean pelvic pain intensity with group‐based multimodal physical therapy was significantly more than with primary‐care physical therapy, the difference in the change between the groups was less than expected and the clinical relevance is uncertain.

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Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review

Cited by 39 publications

References 67 publications

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

Group‐based multimodal physical therapy in women with chronic pelvic pain: A randomized controlled trial

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