Rehabilitation Issues in Women
Key Reference Articles
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The following
are recommended as key reference articles on PM&R issues in women by Joanne
Smith, MD. Click on the articles to view their abstracts.
1. TITLE: Back pain in relation to pregnancy: a 6-year
follow-up.
AUTHORS: Ostgaard HC; Zetherstrom G; Roos-Hansson E
SOURCE: Spine 1997 Dec 15;22(24):2945-50 STUDY DESIGN: A
prospective randomized controlled 6-year follow-up study of women with back
pain during pregnancy. OBJECTIVES: To describe the long-term development of
back pain in relation to pregnancy and to identify the effects of a
physiotherapy and patient education program attended during pregnancy. SUMMARY
OF BACKGROUND DATA: Pain incidence and intensity during pregnancy can be
reduced by physiotherapy. No study has described the development of pain
experienced for a period of years after delivery or the long-term effect of
physiotherapy. METHODS: Pregnant women, registered consecutively, were randomly
assigned to one control group and to two intervention groups and were observed
throughout pregnancy, with follow-up after 3 months and 6 years. RESULTS: 362 women
completed the first phase of the study. After 3 months, 351 and after 6 years,
303 women had been observed. Back pain among 18% of all women before pregnancy
and among 71% during pregnancy declined to 16% after 6 years. Pain intensity
was highest in Week 36 (visual analog score, 5.4) and declined markedly 6 years
later (visual analog score, 2.5). Slow regression of pain after partus
correlated with having a back pain history before pregnancy, (r = 0.30; P <
0.05), with high pain intensity during pregnancy (r = 0.45; P < 0.01), and
with much residual pain 3 months after pregnancy (r = 0.41; P < 0.01). These
correlations were not found in the intervention groups. Furthermore, frequency
of back pain attacks at 6 years correlated with frequency of attacks during
pregnancy (r = 0.41; P < 0.01) and with a vocational factor (r = -0.25; P
< 0.01). Physiotherapy and patient education had no effects on back pain
development among women without pain during pregnancy. CONCLUSIONS: Back pain
during pregnancy regressed spontaneously soon after delivery and improved in
few women later than 6 months post partum. Expected correlations between back
pain in relation to pregnancy and back pain 6 years later were not present in
the intervention groups who had attended a physiotherapy and education program
during pregnancy. The program had no prophylactic effects on women without back
or pelvic pain during pregnancy.
2. TITLE: The ghost joint: transient osteoporosis of the
hip.
AUTHORS: Bruinsma BJ; LaBan MM
SOURCE: Arch Phys Med Rehabil 1990 Apr; 71(5):295-8
ABSTRACT: Seven adult patients identified as having idiopathic
transient osteoporosis of the hip (TOH) are reported. TOH is an uncommon
entity, most often seen in women during the third trimester pregnancy and in
middle-aged men. It is characterized by groin limited hip range of motion,
nonspecific laboratory findings, radiographic evidence of osteopenia, and
spontaneous recovery usually within two to nine months. Diagnosis remains dependent
on clinical recognition and x- ray confirmation. Radioisotope scanning aids in
the diagnosis; both bone and synovial biopsies are often less productive.
Treatment consists of joint protection with limited weightbearing, range of
motion exercise, progressive ambulation, and analgesics. An awareness of TOH
facilities, appropriate diagnosis and treatment curtails unnecessary diagnostic
procedures.
3. TITLE: Musculoskeletal considerations in pregnancy
AUTHORS: Heckman JD; Sassard R
SOURCE: J Bone Joint Surg Am 1994 Nov;76(11):1720-30
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