Effects of the combination of exercise and education in the treatment of low back and/or pelvic pain in pregnant women: Systematic review and meta-analysis

Abstract

Background: Lumbopelvic pain is considered the most frequent complication during pregnancy. Objective: To compare whether the combination of exercise with education is more effective for the treatment of low back and/or pelvic pain (PP) than each of these interventions separately in pregnant women. Search Strategy: A systematic review was performed in WOS, PEDro, PubMed, Cochrane, and Clini calTr ials.gov. The terms used were low back pain, PP, pregnancy, pregnant woman, exercise, exercise therapy, health education, and prenatal education. Selection Criteria: The PICO question was then chosen as follows: P—population: pregnant women with nonspecific low back pain or PP; I—intervention: exercise therapy plus health education; C—control: only exercise therapy or only health education; O—outcome: characteristics of pain, disability, and kinesophobia; S—study designs: randomized controlled trial. Data Collection and Analysis: Two reviewers independently screened articles for eligibility. The following inclusion criteria were applied for the selection of studies: (i) published in the past 10 years; (ii) exercise plus health education was administered compared with a group receiving either exercise or education alone; and (iii) the sample consisted of pregnant women with nonspecific low back pain or PP. This review excluded: (i) nonrandomized controlled trials; and (ii) articles whose full text was not available. The meta-analysis was performed using the random-effects model, due to the observed heterogeneity. Main Results: A total of 13 articles were selected. There is a significant decrease in pain in the combination of exercise and education compared with education alone (standardized mean difference, −0.29 [95% confidence interval, −0.47 to −0.11]). With respect to disability, there is a significant decrease in the exercise and education group compared with the group that only addressed education (standardized mean difference, −0.37 [95% CI, −0.60 to −0.14]). One article analyzed kinesophobia, reporting no significant changes. Conclusion: The combination of exercise and education seems to be more effective in reducing pain and disability in pregnant women with low back and/or PP than the use of education alone. In kinesophobia, the results found are not significant.