A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

Ciara OPrey, Marlene Sinclair, Dianne Liddle, Elaine Madden, Julie McCullough, Ciara Hughes

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Aim. To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy.
Background. International research demonstrates that 25–30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness.
Design. A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy.
Data sources. Cochrane library (1898–2013), PubMed (1996–2013), MEDLINE(1946–2013), AMED (1985–2013), Embase (1974–2013), Cinahl (1937–2013), Index to Thesis (1716–2013) and Ethos (1914–2013).
Review methods. Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool.
Results. Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However,osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.
Conclusion. There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.
LanguageEnglish
Pages1702-1716
Number of pages15
JournalJournal of Advanced Nursing
Volume70
Issue number8
Early online date9 Mar 2014
DOIs
Publication statusPublished - Aug 2014

Fingerprint

Pelvic Pain
Complementary Therapies
Low Back Pain
Pregnancy
Chiropractic
Randomized Controlled Trials
Evidence-Based Practice
Information Storage and Retrieval
Acupuncture
PubMed
MEDLINE
Libraries
Outcome Assessment (Health Care)
Pain
Research

Keywords

  • complementary and alternative medicine
  • healthcare professionals
  • low back
  • pain
  • nursing
  • pelvic pain
  • midwifery pregnancy
  • systematic literature review

Cite this

@article{b093833542c44fd5a2bb7ca451a84aaf,
title = "A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy",
abstract = "Aim. To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy. Background. International research demonstrates that 25–30{\%} of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness. Design. A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy. Data sources. Cochrane library (1898–2013), PubMed (1996–2013), MEDLINE(1946–2013), AMED (1985–2013), Embase (1974–2013), Cinahl (1937–2013), Index to Thesis (1716–2013) and Ethos (1914–2013). Review methods. Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool. Results. Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However,osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.Conclusion. There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.",
keywords = "complementary and alternative medicine, healthcare professionals, low back, pain, nursing, pelvic pain, midwifery pregnancy, systematic literature review",
author = "Ciara OPrey and Marlene Sinclair and Dianne Liddle and Elaine Madden and Julie McCullough and Ciara Hughes",
note = "Reference text: Ansari N.N., Hasson S., Keyhani S. & Jalaie S. (2010) Low back pain during pregnancy in Iranian women: prevalence and risk factors. Physiotherapy Theory Practice 26(1), 40–48. Assendelft W.J.J., Morton S.C., Yu E.I., Suttorp M.J. & Shekelle P.G. (2003) Spinal manipulative therapy for low-back pain: a meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine 138, 871–881. Balshem H., Helfand M., Sch€unemann H., Oxman A., Kunz R., Brozek J., Vist G., Falck-Ytter Y., Meerpohl J. & Norris S. (2011) GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 64(4), 401–406. Berg G., Hammar M., Moller-Nielsen J., Linden U. & Thorblad J. (1988) Low back pain during pregnancy. Obstetrics and Gynecology 71, 71–75. Beurskens A.J.H.M., De Vet H.C.W. & Koke A.J.A. (1996) Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 65, 71–76. Biester K., Lange S., Kaiser T. & Potthast R. (2006) High drop outs in trials included in Cochrane reviews. Cochrane Colloquium. Retrieved from http://cmr.cochrane.org/?CRGReportID=9965 on 21 July 2013. Bombardier C. (2000) Outcome assessments in the evaluation of treatment of spinal disorders. Spine 25, 3100–3101. Chambers D., Bagnall A.M., Hempel S. & Forbes C. (2006) Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine 99(10), 506–520. Charpentier K., Leboucher J., Lawani M., Tourni H., Dumas G. & Pinti A. (2012) Back pain during pregnancy and living conditions – a comparison between Beninese and Canadian women. Annals of Physical and Rehabilitation Medicine 3, 148– 169. Consort (2010) Harms: Item 19-All important harms or unintended effects in each group. Retrieved from http://www.consortstatement. org/consort-statement/13-19—results/item19_harms/ on 31 October 2013. Dumas G., Reid J., Wolfe L., Griffin M. & McGrath M. (1995) Exercise, posture and back pain during pregnancy: part 1. Exercise and posture. Clinical Biomechanics 10(2), 99–103. Elden H., Ladfors L., Olsen M.F., Ostgaard H. & Hagberg H. (2005) Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle {\circledC} 2014 John Wiley & Sons Ltd 13 pain: randomised single blind controlled trial. British Medical Journal 330(7494), 761–764. Elden H., Fagevik-Olsen M., Ostgaard H., Stener-Victorin E. & Hagberg H. (2008) Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: a randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham treatment. British Journal of Obstetrics & Gynaecology 115(13), 1655–1668. Enck P. & Klorasterhalfen S. (2005) The placebo response infunctional bowel disorders: perspectives and putative mechanisms. Neurogastroenterology Motility 17, 325–331. Ernst E. & Posadski P. (2012) Reporting of adverse effects in randomized controlled trials of chiropractic manipulations: a systematic review. New Zealand Medical Journal 125(1353), 87– 140. Fast A., Shapiro D., Ducommun E.J., Friedmann L.W., Bouklas T. & Floman Y. (1987) Low back pain in pregnancy. Spine 12, 368–371. Garshasbi A. & Faghih Zadeh S. (2005) The effect of exercise on the intensity of low back pain in pregnant women. International Journal of Gynecology and Obstetrics 88(3), 271–275. Hall H., Griffiths D. & McKenna L. (2011) The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery 27(6), 817–824. Hall H., McKenna L. & Griffiths D. (2012) Midwives’ support for Complementary and Alternative Medicine: a literature review. Women and Birth 25(1), 4–12. Higgins J.P.T. & Green S. (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Retrieved from www.cochrane-handbook.org on 12 April 2013. House of Lords Select Committee on Science and Technology Sixth Report (2000) Retrieved from http://www.publications. parliament.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm on 9 January 2012. Hughes C.M., Smyth S. & Lowe-Strong A.S. (2009) Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. Multiple Sclerosis 5(11), 1329–1338. Jordan K., Dunn K.M., Lewis M. & Croft P. (2006) A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. Journal of Clinical Epidemiology 59, 45–52. Kaptchuk T.J., Kelley J.M., Conboy L.A., Davis R.B., Kerr C.E., Jacobson E.E., Kirsch I., Schyner R.N., Nam B.H., Nguyen L.T., Park M., Rivers A.L., McManus C., Kokkotou E., Drossman D.A., Goldman P. & Lembo A.J. (2008) Components of placebo effect: randomised Controlled trial in patients with irritable bowel syndrome. British Medical Journal 336(7651), 999–1003. Kihlstrand M., Stenman B., Nilsson S. & Axelsson O. (1999) Water gymnatstics redueced the intesnsity of back/low back pain in pregnant women. Acta Obstetricia et gynaecologica Scandinavica 78, 180–185. Kvorning N., Holmberg C., Grennert L., Aberg A. & Akeson J. (2004) Acupuncture relieves pelvic and low back pain in late pregnancy. Acta Obstetricia et Gynecologica Scandinavica 83(3), 246–250. Licciardone J.C., Buchanan S. & Hensel K.L. (2010) Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American Journal of Obstetrics and Gynecolology 43, 1–8. Lund L., Lundenberg T., Lonnberg L. & Svenson E. (2006) Decrease in pregnant women’s pelvic pain after acupuncture: a randomised controlled single-blind study. Acta Obstetricia et Gynecologica Scandinavica 85, 12–19. Macedo A., Banos J.E. & Farre M. (2008) Placebo response in the prophylaxis of migraine: a meta-analysis. European Journal of Pain 12, 68–75. Manheimer E., Pirotta M.V. & White A.R. (2008) Acupuncture for pelvic and back pain in pregnancy: a systematic review. American Journal of Obstetrics and Gynecolology 198(3), 254–259. Mens J.M.A., Vleeming A., Stoeckart R., Stam H.J. & Snijders C.J. (1996) Understanding peripartum pelvic pain: implications of a patient survey. Spine 21(11), 1363–1370. Moher D., Liberati A., Tetzlaff J. & Altman D.G. (2009) Preferred reporting for systematic reviews and meta-analyses. Plos Medicine 6(7), e10000097. Retrieved from http://www. plosmedicine.org/article/info{\%}3Adoi{\%}2F10.1371{\%}2Fjournal. pmed.1000097 on 10 January 2013. National Health Service (NHS) (2013) The placebo effect. Retrieved from www.nhs.uk/Livewell/complementary…/Pages/ placebo-effect.aspx on 17 April 2013. National Institute of Clinical Excellence (2008a) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40145/40145.pdf on 10 January 2013. National Institute of Clinical Excellence (2008b) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40145/40145.pdf on 10 January 2012. National Institute of Clinical Excellence (2010) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40115/40115.pdf on 10 January 2012. Ostelo R.W. & De Vet H.C. (2005) Clinically important outcomes in low back pain. Best Practice & Research Clinical Rheumatology 19, 593–607. Ostgaard H.C., Zetherstrom G. & Roos-Hansson & Svanberg B, (1994) Reduction of back and posterior pelvic pain in pregnancy. Spine 19, 894–900. Ostgaard H.C., Roos-Hanson E. & Zetherstr€om G. (1996) Regression of back and posterior pelvic pain after pregnancy. Spine 21(23), 2777–2780. Park J., White A., Stevinson C., Ernst E. & James M. (2002) Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupuncture Medicine 20, 168–174. Pennick V. & Liddle S.D. (2013) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley. com/doi/10.1002/14651858.CD001139.pub3/pdf on 13 August 2013. Peterson D., Haas M. & Gregory T. (2012) A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation and Neuro Emotional Technique for the treatment of pregnancy related low back pain: a randomized controlled trial. Chiropractic & Manual Therapies 20(18). Retrieved from http:// chiromt.com/content/pdf/2045-709X-20-18.pdf on 1 October 2012. Preyde M. (2000) Effectiveness of massage therapy for subacute low- back pain: a randomized controlled trial. Canadian Medical Association Journal 162(13), 1815–1820. Quinn F., Baxter G.D. & Hughes C.M. (2008) Complementary therapies in the management of low back pain: a survey of reflexologists. Complementary Therapies in Medicine 16, 11–14. Richens Y., Smith K. & Leddington Wright S. (2010) Lower back pain during pregnancy: advice and exercises for women. British Journal of Midwifery 18(9), 562–566. Sabino J. & Graeur J. (2008) Pregnancy and low back pain. Current Review in Musculoskeletal Medicine 1, 137–141. Salaffi F., Stancati A., Silvestri C.A., Ciapetti A. & Grassi W. (2004) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain 8, 283–291. Sch€unemann H., Bro e.J. & Oxman A. (2009) GRADE handbook for grading quality of evidence and strength of recommendation Version 3.2. The GRADE Working Group. Retrieved from www.cc-ims.net/ gradepro 2009 on 12 December 2012. Sinclair M., Liddle D., Hughes C.M., O’Prey C. & McCullough J. (2013) Low back pain and/or pelvic pain in pregnancy: Early results from an online survey. Unpublished Poster presentation at: The Royal College of Nursing Conference, March 20-22, 2013, Belfast, Northern Ireland. Stratford P.W., Binkley J.M., Riddle D.L. & Guyatt G.H. (1998) Sensitivity to change of the Roland-Morris back pain questionnaire: part 1. Physical Therapy 78, 1186–1196. Stuber K.J. & Smith D.L. (2008) Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. Journal Manipulative Physiology Therapy 31(6), 447– 454. Sysko R. & Walsh B.T. (2007) A systematic review of placebo response in studies of bipolar mania. Journal of Clinical Psychiatry 68, 1213–1217. Tsukayama H., Yamashita H., Kimura T. & Otsuki K. (2006) Factors that influence the applicability of sham needle in acupuncture trials: two randomized, single-blind, crossover trials with acupuncture-experienced subjects. Clinical Journal Pain 22, 346–349. Van Tulder M., Furlan A.D. & Gagnier J.J. (2005) Complementary and Alternative Medicine for low back pain. Best Practice and Research Clinical Rheumatology 19(4), 639–694. Vickers A.J., Cronin A.M., Maschino A.C., Lewith G., MacPherson H., Foster N.E., Sherman K.J., Witt C.M. & Linde K. (2012) Acupuncture for chronic pain: individual patient data metaanalysis. Archives of Internal Medicine 172(19), 1444–1453. Vincent C. & Furnham A. (1996) Why do patients turn to complementary medicine? An empirical study. British Journal of Clinical Psychology 35(1), 37–48. Wang S.M., DeZinno P. & Ferrno L. (2005) Complementary and Alternative Medicine for low back pain in pregnancy: a cross sectional survey. Journal of Alternative Complementary Medicine 11, 459–464. Wang S.M., DeZinno P., Lin E.C., Lin H., Yue J.J., Berman M.R. & Braveman & Kain ZN, (2009) Auricular acupcunture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study. American Journal of Obsetrics & Gynaecology 201(3), 271–279. Wedenberg K., Moen B. & Norling A. (2000) A prospective randomize study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstetricia et Gynecologica Scandinavica 79, 331–335. White P., Lewith G.&Hopwood V. (2003) The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial. Pain 106, 401–409. Williams J. & Mitchell M. (2007) Midwifery managers’ views about the use of complementary therapies in the maternity services.",
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T1 - A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

AU - OPrey, Ciara

AU - Sinclair, Marlene

AU - Liddle, Dianne

AU - Madden, Elaine

AU - McCullough, Julie

AU - Hughes, Ciara

N1 - Reference text: Ansari N.N., Hasson S., Keyhani S. & Jalaie S. (2010) Low back pain during pregnancy in Iranian women: prevalence and risk factors. Physiotherapy Theory Practice 26(1), 40–48. Assendelft W.J.J., Morton S.C., Yu E.I., Suttorp M.J. & Shekelle P.G. (2003) Spinal manipulative therapy for low-back pain: a meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine 138, 871–881. Balshem H., Helfand M., Sch€unemann H., Oxman A., Kunz R., Brozek J., Vist G., Falck-Ytter Y., Meerpohl J. & Norris S. (2011) GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 64(4), 401–406. Berg G., Hammar M., Moller-Nielsen J., Linden U. & Thorblad J. (1988) Low back pain during pregnancy. Obstetrics and Gynecology 71, 71–75. Beurskens A.J.H.M., De Vet H.C.W. & Koke A.J.A. (1996) Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 65, 71–76. Biester K., Lange S., Kaiser T. & Potthast R. (2006) High drop outs in trials included in Cochrane reviews. Cochrane Colloquium. Retrieved from http://cmr.cochrane.org/?CRGReportID=9965 on 21 July 2013. Bombardier C. (2000) Outcome assessments in the evaluation of treatment of spinal disorders. Spine 25, 3100–3101. Chambers D., Bagnall A.M., Hempel S. & Forbes C. (2006) Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine 99(10), 506–520. Charpentier K., Leboucher J., Lawani M., Tourni H., Dumas G. & Pinti A. (2012) Back pain during pregnancy and living conditions – a comparison between Beninese and Canadian women. Annals of Physical and Rehabilitation Medicine 3, 148– 169. Consort (2010) Harms: Item 19-All important harms or unintended effects in each group. Retrieved from http://www.consortstatement. org/consort-statement/13-19—results/item19_harms/ on 31 October 2013. Dumas G., Reid J., Wolfe L., Griffin M. & McGrath M. (1995) Exercise, posture and back pain during pregnancy: part 1. Exercise and posture. Clinical Biomechanics 10(2), 99–103. Elden H., Ladfors L., Olsen M.F., Ostgaard H. & Hagberg H. (2005) Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle © 2014 John Wiley & Sons Ltd 13 pain: randomised single blind controlled trial. British Medical Journal 330(7494), 761–764. Elden H., Fagevik-Olsen M., Ostgaard H., Stener-Victorin E. & Hagberg H. (2008) Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: a randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham treatment. British Journal of Obstetrics & Gynaecology 115(13), 1655–1668. Enck P. & Klorasterhalfen S. (2005) The placebo response infunctional bowel disorders: perspectives and putative mechanisms. Neurogastroenterology Motility 17, 325–331. Ernst E. & Posadski P. (2012) Reporting of adverse effects in randomized controlled trials of chiropractic manipulations: a systematic review. New Zealand Medical Journal 125(1353), 87– 140. Fast A., Shapiro D., Ducommun E.J., Friedmann L.W., Bouklas T. & Floman Y. (1987) Low back pain in pregnancy. Spine 12, 368–371. Garshasbi A. & Faghih Zadeh S. (2005) The effect of exercise on the intensity of low back pain in pregnant women. International Journal of Gynecology and Obstetrics 88(3), 271–275. Hall H., Griffiths D. & McKenna L. (2011) The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery 27(6), 817–824. Hall H., McKenna L. & Griffiths D. (2012) Midwives’ support for Complementary and Alternative Medicine: a literature review. Women and Birth 25(1), 4–12. Higgins J.P.T. & Green S. (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Retrieved from www.cochrane-handbook.org on 12 April 2013. House of Lords Select Committee on Science and Technology Sixth Report (2000) Retrieved from http://www.publications. parliament.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm on 9 January 2012. Hughes C.M., Smyth S. & Lowe-Strong A.S. (2009) Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. Multiple Sclerosis 5(11), 1329–1338. Jordan K., Dunn K.M., Lewis M. & Croft P. (2006) A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. Journal of Clinical Epidemiology 59, 45–52. Kaptchuk T.J., Kelley J.M., Conboy L.A., Davis R.B., Kerr C.E., Jacobson E.E., Kirsch I., Schyner R.N., Nam B.H., Nguyen L.T., Park M., Rivers A.L., McManus C., Kokkotou E., Drossman D.A., Goldman P. & Lembo A.J. (2008) Components of placebo effect: randomised Controlled trial in patients with irritable bowel syndrome. British Medical Journal 336(7651), 999–1003. Kihlstrand M., Stenman B., Nilsson S. & Axelsson O. (1999) Water gymnatstics redueced the intesnsity of back/low back pain in pregnant women. Acta Obstetricia et gynaecologica Scandinavica 78, 180–185. Kvorning N., Holmberg C., Grennert L., Aberg A. & Akeson J. (2004) Acupuncture relieves pelvic and low back pain in late pregnancy. Acta Obstetricia et Gynecologica Scandinavica 83(3), 246–250. Licciardone J.C., Buchanan S. & Hensel K.L. (2010) Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American Journal of Obstetrics and Gynecolology 43, 1–8. Lund L., Lundenberg T., Lonnberg L. & Svenson E. (2006) Decrease in pregnant women’s pelvic pain after acupuncture: a randomised controlled single-blind study. Acta Obstetricia et Gynecologica Scandinavica 85, 12–19. Macedo A., Banos J.E. & Farre M. (2008) Placebo response in the prophylaxis of migraine: a meta-analysis. European Journal of Pain 12, 68–75. Manheimer E., Pirotta M.V. & White A.R. (2008) Acupuncture for pelvic and back pain in pregnancy: a systematic review. American Journal of Obstetrics and Gynecolology 198(3), 254–259. Mens J.M.A., Vleeming A., Stoeckart R., Stam H.J. & Snijders C.J. (1996) Understanding peripartum pelvic pain: implications of a patient survey. Spine 21(11), 1363–1370. Moher D., Liberati A., Tetzlaff J. & Altman D.G. (2009) Preferred reporting for systematic reviews and meta-analyses. Plos Medicine 6(7), e10000097. Retrieved from http://www. plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal. pmed.1000097 on 10 January 2013. National Health Service (NHS) (2013) The placebo effect. Retrieved from www.nhs.uk/Livewell/complementary…/Pages/ placebo-effect.aspx on 17 April 2013. National Institute of Clinical Excellence (2008a) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40145/40145.pdf on 10 January 2013. National Institute of Clinical Excellence (2008b) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40145/40145.pdf on 10 January 2012. National Institute of Clinical Excellence (2010) Antenatal care: routine care for the healthy pregnant woman. Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40115/40115.pdf on 10 January 2012. Ostelo R.W. & De Vet H.C. (2005) Clinically important outcomes in low back pain. Best Practice & Research Clinical Rheumatology 19, 593–607. Ostgaard H.C., Zetherstrom G. & Roos-Hansson & Svanberg B, (1994) Reduction of back and posterior pelvic pain in pregnancy. Spine 19, 894–900. Ostgaard H.C., Roos-Hanson E. & Zetherstr€om G. (1996) Regression of back and posterior pelvic pain after pregnancy. Spine 21(23), 2777–2780. Park J., White A., Stevinson C., Ernst E. & James M. (2002) Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupuncture Medicine 20, 168–174. Pennick V. & Liddle S.D. (2013) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley. com/doi/10.1002/14651858.CD001139.pub3/pdf on 13 August 2013. Peterson D., Haas M. & Gregory T. (2012) A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation and Neuro Emotional Technique for the treatment of pregnancy related low back pain: a randomized controlled trial. Chiropractic & Manual Therapies 20(18). Retrieved from http:// chiromt.com/content/pdf/2045-709X-20-18.pdf on 1 October 2012. Preyde M. (2000) Effectiveness of massage therapy for subacute low- back pain: a randomized controlled trial. Canadian Medical Association Journal 162(13), 1815–1820. Quinn F., Baxter G.D. & Hughes C.M. (2008) Complementary therapies in the management of low back pain: a survey of reflexologists. Complementary Therapies in Medicine 16, 11–14. Richens Y., Smith K. & Leddington Wright S. (2010) Lower back pain during pregnancy: advice and exercises for women. British Journal of Midwifery 18(9), 562–566. Sabino J. & Graeur J. (2008) Pregnancy and low back pain. Current Review in Musculoskeletal Medicine 1, 137–141. Salaffi F., Stancati A., Silvestri C.A., Ciapetti A. & Grassi W. (2004) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain 8, 283–291. Sch€unemann H., Bro e.J. & Oxman A. (2009) GRADE handbook for grading quality of evidence and strength of recommendation Version 3.2. The GRADE Working Group. Retrieved from www.cc-ims.net/ gradepro 2009 on 12 December 2012. Sinclair M., Liddle D., Hughes C.M., O’Prey C. & McCullough J. (2013) Low back pain and/or pelvic pain in pregnancy: Early results from an online survey. Unpublished Poster presentation at: The Royal College of Nursing Conference, March 20-22, 2013, Belfast, Northern Ireland. Stratford P.W., Binkley J.M., Riddle D.L. & Guyatt G.H. (1998) Sensitivity to change of the Roland-Morris back pain questionnaire: part 1. Physical Therapy 78, 1186–1196. Stuber K.J. & Smith D.L. (2008) Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. Journal Manipulative Physiology Therapy 31(6), 447– 454. Sysko R. & Walsh B.T. (2007) A systematic review of placebo response in studies of bipolar mania. Journal of Clinical Psychiatry 68, 1213–1217. Tsukayama H., Yamashita H., Kimura T. & Otsuki K. (2006) Factors that influence the applicability of sham needle in acupuncture trials: two randomized, single-blind, crossover trials with acupuncture-experienced subjects. Clinical Journal Pain 22, 346–349. Van Tulder M., Furlan A.D. & Gagnier J.J. (2005) Complementary and Alternative Medicine for low back pain. Best Practice and Research Clinical Rheumatology 19(4), 639–694. Vickers A.J., Cronin A.M., Maschino A.C., Lewith G., MacPherson H., Foster N.E., Sherman K.J., Witt C.M. & Linde K. (2012) Acupuncture for chronic pain: individual patient data metaanalysis. Archives of Internal Medicine 172(19), 1444–1453. Vincent C. & Furnham A. (1996) Why do patients turn to complementary medicine? An empirical study. British Journal of Clinical Psychology 35(1), 37–48. Wang S.M., DeZinno P. & Ferrno L. 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PY - 2014/8

Y1 - 2014/8

N2 - Aim. To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy. Background. International research demonstrates that 25–30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness. Design. A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy. Data sources. Cochrane library (1898–2013), PubMed (1996–2013), MEDLINE(1946–2013), AMED (1985–2013), Embase (1974–2013), Cinahl (1937–2013), Index to Thesis (1716–2013) and Ethos (1914–2013). Review methods. Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool. Results. Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However,osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.Conclusion. There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

AB - Aim. To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy. Background. International research demonstrates that 25–30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness. Design. A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy. Data sources. Cochrane library (1898–2013), PubMed (1996–2013), MEDLINE(1946–2013), AMED (1985–2013), Embase (1974–2013), Cinahl (1937–2013), Index to Thesis (1716–2013) and Ethos (1914–2013). Review methods. Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool. Results. Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However,osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.Conclusion. There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

KW - complementary and alternative medicine

KW - healthcare professionals

KW - low back

KW - pain

KW - nursing

KW - pelvic pain

KW - midwifery pregnancy

KW - systematic literature review

UR - https://pure.ulster.ac.uk/en/searchAll/index/?search=11437172&pageSize=25&showAdvanced=false&allConcepts=true&inferConcepts=true&searchBy=PartOfNameOrTitle

U2 - 10.1111/jan.12360

DO - 10.1111/jan.12360

M3 - Article

VL - 70

SP - 1702

EP - 1716

JO - Journal of Advanced Nursing

T2 - Journal of Advanced Nursing

JF - Journal of Advanced Nursing

SN - 0309-2402

IS - 8

ER -