Active Interventions for the Prevention and Treatment of Pregnancy-Related Lumbopelvic Pain: A Systematic Review and Meta-Analysis.

Lumbopelvic pain (LPP) is common during pregnancy. Reviews of interventions for LPP have generally been inconclusive. We hypothesize that distinguishing between preventive and therapeutic studies, and recognizing that usual care varies between countries, may lead to more robust conclusions. The aim of this study is to determine whether active interventions are effective in preventing or treating LPP during pregnancy, with the ultimate goal of answering the question of which active intervention produces the best outcome. An extensive literature review was conducted to identify studies comparing active interventions with usual care for LPP during pregnancy. Two experienced researchers determined the components of the active intervention: pelvic floor exercises, pelvic stabilizing exercises, or cardiovascular training. Information regarding usual care was gathered from the included studies via a PubMed search, the internet, and through personal contact with experts. The search yielded 33 publications with 38 studies. Pain reduction in all therapeutic non-Scandinavian studies (n = 20) showed statistically significant reductions in pain, with an overall effect size of 2.85 (95% CI 1.36 to 4.34; p < 0.001). In contrast, the effect size of the Scandinavian therapeutic studies (n=2) showed a trend in favor of the control group. For preventive studies, the effect size for pain reduction in the non-Scandinavian studies (n= 6) was 1.10 (95% CI 0.49 to 1.70; p < 0.001), whereas in the Scandinavian studies (n=4) it was 0.06 (95% CI -0.04 to 0.17; p = 0.24). The results regarding disability and prevention of developing sick leave or LPP showed largely the same pattern. No evidence that any specific active intervention was superior to another was found. In summary, studies conducted outside Scandinavia indicate that active interventions are effective for both the treatment and prevention of LPP during pregnancy, whereas studies conducted in Scandinavian countries do not demonstrate such effects. The most plausible explanation for this discrepancy is that active interventions are already incorporated into usual care in Scandinavian countries, resulting in minimal differences between intervention and control groups. From a biomechanical perspective, the successful interventions were highly diverse, suggesting that their effectiveness is unlikely to be explained by biomechanical mechanisms alone. Instead, a common factor across all active interventions appears to be psychosocial in nature. A key element of successful interventions seems to be reassurance, emphasizing that movement-related pain is not harmful to either the mother or the baby. We conclude that active interventions appear to be beneficial for both the treatment and prevention of LPP during pregnancy. The effectiveness of these interventions does not appear to depend on the specific type of active intervention used.