Community-based non-pharmacological interventions for improving pain, disability, and quality of life in pregnant women with musculoskeletal conditions: a systematic review

Abstract

Abstract Background Majority of pregnant women experience pain and discomfort due to musculoskeletal conditions; with over a quarter experiencing some disability; all of which reduce quality of life during pregnancy. Community-based non-pharmacological interventions are more affordable, accessible, and acceptable, and have the capacity to reduce inequalities. Objectives To summarise community-based non-pharmacological interventions and determine their effectiveness for improving pain, disability, and quality of life amongst pregnant women with musculoskeletal conditions. Search Strategy Twelve bibliographic databases (and reference list of relevant systematic reviews) were searched from inception until March 2022. Selection Criteria All primary studies of community-based non-pharmacological interventions for pregnant women with musculoskeletal conditions reported in English which investigated pain, disability and quality of life were included. Data Collection and Analysis Data were extracted using modified Cochrane’s data extraction template. Studies were appraised using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This review registration number with PROSPERO is CRD42020189535. Main Results 33 studies involving 4,930 pregnant women with low back pain, pelvic pain, and lumbopelvic pain. Osteopathic manipulation plus standard obstetric care produced significantly superior reduction in pain intensity and disability than sham ultrasound therapy plus standard obstetric care amongst pregnant women with low back pain (moderate level of evidence). There was limited or conflicting evidence for other results. Acupuncture was more effective than placebo in reducing disability/sick leave but not pain intensity and quality of life. There was little or no added benefit of craniosacral therapy to standard obstetric care. Exercise and spinal manipulative therapy were equally effective, and better than no treatment. Home versus in-clinic exercise and aquatic versus land-based exercise were similar in effectiveness with conflicting evidence when compared with standard obstetric care. Wide flexible lumbopelvic belts or the addition of textured sacral pad was better than thin rigid lumbopelvic belts, belts without padding, or no belt. Kinesiotaping may not be better than placebo. Effectiveness of self-management programmes was inconsistent. Conclusions Community-based non-pharmacological interventions were better than no treatment and were better or as effective as standard obstetric care in improving pain intensity, disability, and quality of life.