Backache

StudyRef.PopulationInterventionOutcomesResultsCommentsStudy typeEL
Young and Jewell, 20032113 RCTs
RCT 1: 92 pregnant women at 36 weeks of gestation
RCT 2: 258 women attending hospital in Sweden for an ultrasound scan
RCT 3: 60 women in Sweden with pelvic or back pain arising before 32 weeks of gestation
RCT 1: Ozzlo pillow used for 1 week to support the pregnant abdomen when lying in a lateral position vs. a standard hospital pillow (control)
RCT 2: 20 1-hour weekly water gymnastic classes involving exercise and relaxation in water vs. no intervention
RCT 3: 10 acupuncture sessions vs. 10 physiotherapy group sessions
RCT 1: moderate or better improvement in backache; relief of insomnia
RCT 2: number of days of sick leave due to back pain after 32 weeks of gestation
RCT 3: numbers of women rating treatment as good or excellent
RCT 1:
Effect of Ozzlo pillow on backache: (n = 184) (improvement less than moderate) OR 0.32 (95% CI 0.18 to 0.58)
Effect of Ozzlo pillow on sleep: (n = 184) (benefit rated less than moderate) OR 0.35 (95% CI 0.20 to 0.62)
RCT 2:
Effect of water gymnastics on sick leave days due to back pain (n = 241) OR 0.38 (95% CI 0.16 to 0.88)
RCT 3:
Effect of acupuncture vs. physiotherapy on back pain (treatment rated as good or excellent) OR 6.58 (95% CI 1.00 to 43.16)
SR1a
Kristiansson et al., 1996206200 consecutive women attending an antenatal clinic. Average age 27.9 yearsSurvey during pregnancy questionnaires and physical examinationsFrequency of back painOnset of back pain before pregnancy: 25.6%
Onset of back pain during pregnancy: 61%
Prevalence of back pain during weeks of pregnancy:
  • 12 weeks: 19%
  • 24 weeks: 47%
  • 36 weeks: 49%
SY3
Ostgaard et al., 1991207950 pregnant women attending an antenatal clinic in SwedenWomen were reviewed at 12th week and every second week until deliveryIncidence of back pain49% complained of back pain during pregnancy but half of these had back pain before pregnancy
Onset of back pain during pregnancy 27% (n = 210)
SY3
Fast et al., 1987208200 women (black, white, Hispanic and oriental origin) interviewed within 24 to 36 hours after giving birth on a maternity ward (of a county hospital in the USA)Questionnaire relating to personal data and occurrence and manifestation of low back painFrequency of back pain during pregnancy
Month of onset of back pain
56% complained of back pain during pregnancy
48% no back pain during pregnancy
60.7% of women with back pain onset was between 5th to 7th month of pregnancy
SY3
Stapleton et al., 20022091530 respondents to a South Australian Omnibus Population Survey, 1120 (73%) had had at least one pregnancy > 20 weeksPopulation survey including specific questions on back pain during pregnancyIncidence of back pain during pregnancy
Severity of back pain during pregnancy
397/1120 (35.5%) reported back pain during one or more pregnancies
61.8%(n = 246) had at least moderately severe backache
9% (n = 35) were disabled by the pain
Survey on backache questions was dependent upon retrospective recall. Therefore reliability is unclearSY3
Mantle et al., 1977210180 women (mean age 26 years) delivering at a London Hospital between May 1973 and August 1973Questionnaire administered to women within 24 hours of delivery, asking about back pain during pregnancyIncidence of back pain and severity of backache during pregnancy
Month of onset of backache
Time of day when backache most troublesome
48% (n = 87) troublesome or severe backache
52% (n = 92) none or not worth troubling about backache
Peak month of onset of pregnancy: 54% (n = 47) onset of mild or severe backache during 5th to 7th month
Time of day backache most troublesome: 40% evening and 26% night
SY3
Field et al., 199921226 pregnant working women, between 14 and 30 weeks of gestation, with an interest in relaxation exercisesRandomly assigned:
Massage therapy (n = 14) (x 10, 20-minute massages over 5 weeks) vs. progressive muscle relaxation class (n = 12) (a 20-minute relaxation class and encouraged to do these at home twice a week for 5 weeks)
Relief of back pain
Pregnancy anxiety
Sleep scale disturbance
Back pain relief scores:
For massage group: first day (pre- or post- massage) 4.6/2.2 (p = 0.005)
Last day (pre- or post-massage) 3.8/2.1 (p = 0.01)
For relaxation group: first day (pre- or post-relaxation) 3.4/3.3 not significant
Last day (pre- or post-relaxation) 3.2/3.5 (p = 0.01)
Method of randomisation not statedRCT1b
Ostgaard et al., 1994213407 pregnant women at a maternity care unit in SwedenRandom allocation (quasi) to 3 groups
Group A: control group no extra intervention; any development of back or pelvic pain treated according to usual routine
Group B: two 45-minute classes of back care in pregnancy
Group C: five 30-minute individual lessons on back care in pregnancy
Improvement with back or posterior pelvic pain
Sick leave frequency
Improvement with back or posterior pelvic pain following information on muscular training and body posture difference between group A and B (p < 0.05); group A and C (p < 0.05)
Improvement with back or posterior pelvic pain following information on vocational technique training between group A and B (NS); group A and C (p < 0.05)
Improvement with back or posterior pelvic pain and affect on sick leave: between group A and B (NS); between group A and C (p < 0.05)
Quasi-randomised (allocation by day of birth in month
1 to 10 Group A
11 to 20 Group B
21 to 31 Group C)
RCT1b
Noren et al., 1997214Pregnant women with any type of back pain attending an antenatal clinic in Sweden between April 1991 to February 1993Intervention group 54 women: individually designed physiotherapy programme of 5 visits (including teaching on anatomy, posture, vocational ergonomics, gymnastics, relaxation) and an exercise programme versus control group of 81 pregnant women with back pain; no specific intervention givenDuration of sick leaveAverage number of sick leave days:
Intervention group: 30.4 days/woman vs. control group 53.6 days; difference in sick leave (p < 0.001)
CCH2a
Tesio et al., 199421516 pregnant women between 12 and 30 weeks gestation with back and/or sciatica pain onset during pregnancy and unremitting for 4 weeksAutotraction, a mechanical treatment for back pain. Consists of a 3- to 6-second maximal pulling effort followed by 1-to 2-minute rest period for 25 minutes
Three treatments every, 3 days
Pain relief recoveryRecovery:
Fully recovered (n = 5)
Improved (n = 8)
No change (n = 3)
Change in pain scores from before to after treatment:
Median pain intensity as a group at start 50/100 and at end 15/100 (p < 0.001)
No control groupOPC3
Guadagnino III, 199921612 pregnant women (age range 14 to 34 years) with back pain attributed to pregnancySpinal manipulative therapy (1 to 3 techniques applied) and received treatment 2 to 3 times/week until delivery
Postal questionnaire sent to mothers at end of pregnancy
Pain intensity (scale 1 to 10)Average pain score when treatment sought: 7.58
Average pain score when maintained under care: 4.25
Method of recruitment is unclear
The questionnaire included several questions that required retrospective memory of the symptoms they experienced while receiving treatment
Significant bias affect in this study. Authors conclude that an RCT is required
CH3
McIntyre and Broadhurst, 199621720 pregnant women reporting low back pain in the second or third trimesterRotational mobilisation exercise carried out at 3 antenatal visitsResolution of pain15 patients had complete resolution of pain
3 patients had 50–80% resolution
2 patients unaccounted for
Methods of study unclearCH3
Requejo et al., 2002218A 28-year-old primigravida, 20 weeks gestation with low back pain beginning at 18 weeks gestation
Presented with pain limiting her to sit for 20 minutes and restricted ability to bend forward
Treatment 4 episodes during 2 weeks of manual joint mobilisation applied to symptomatic vertebral segmentResolution of pain improved mobilityImproved mobility (able to bend forward without pain and sit longer than 1 hour without discomfort)
Oswestry score reduced from 38/100 to 10/100
CR3

From: Evidence tables

Cover of Antenatal Care
Antenatal Care: Routine Care for the Healthy Pregnant Woman.
NICE Clinical Guidelines, No. 62.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2008 Mar.
Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.

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