Diagnostic Examination for Pelvic Girdle Pain since the European Guidelines: A structured review of clinical trials, 2009-2014.

Item

Title
Diagnostic Examination for Pelvic Girdle Pain since the European Guidelines: A structured review of clinical trials, 2009-2014.
Author(s)
Smith Legrand, R
Abstract
Background. The European guidelines for the diagnosis and treatment of pelvic girdle pain (PGP) (Vleeming et at. 20088) proposed a definition for PGP that would apply to all populations and recommended seven diagnostic exams to test the entire pelvis: pain provocation tests of the SIJ and symphysis pubis, and a functional test of the pelvis The guidelines also stated that PGP is related to non-optimal stability of the pelvic joints, pain originates from peri-articular as well as intra-articular sources, and intra-articular injection cannot serve as a reference standard for diagnosis A separate body of literature studying SIJ pain based their definition and diagnostic procedure on International Association for the Study of Pain (IASP) criteria Meta-analysis of studies using this criteria have recommended diagnosis of SIJ pain based on 3 or more positive SIJ stress tests PGP is a separate condition from LBP and studying it properly requires clear diagnosis. Objective. To determine clinical examinations being used to diagnose PGP in clinical trials since the European guidelines. Method: Keyword search of PubMed, CINAHL and Cochrane library databases for clinical trials 2009-2014 was conducted. Selected trials were reviewed for diagnostic protocol and PEDro scored by two ndependent reviewers. Results: Seven clinical trials were found meeting inclusion criteria, four pregnancy-related PGP and three SIJ studies Two pregnancy trials used 4 and 5 of the 7 European guideline recommended tests Most commonly used SIJ provocation tests were P4, followed by Patrick's Faber. 2 SIJ trials based diagnosis on 3 or more positive SIJ tests One trial used active straight leg raise (ASLR) to functionally test the pelvis No trials used long dorsal sacroiliac ligament (LDL) palpation. Approaches to ruling out lumbar sources of pain varied PEDro scores ranged from 3 to Discussion: Clinical examination to determine PGP in clinical trial divided into three basic groups two pregnancy trials partially complied with European guideline recommendations; two SIJ trials complied with best practice according to current research in the IASP-based SIJ literature; three other trials (2 pregnancy, 1 SIJ) used minimalist or alternative testing, 2 of which were insufficient to appropriately diagnose PGP. A body of research suggests that PGP is a heterogeneous condition and non-optimal stability is an underlying mechanism in some PGP disorders ASLR has been proposed both as a test to discriminate PGP and to functionally test the pelvis for sub-groups of altered pelvic mechanics or motor control dysfunction. ASLR is incompletely understood; more research is needed to confirm its use diagnostically. No standard exists for how to exclude lumbar sources of pain. Conclusion: European guidelines attempted to create a unified definition and diagnostic protocol for all populations, but the historical divide in the literature remains Research is needed to confirm diagnostic accuracy of these seven tests as a composite in each population. Further research is also needed to determine best practice for exclusion of lumbar sources of pain and diagnostic testing that can differentiate sub-groups within the PGP disorder.
presented at
European School of Osteopathy
Date Accepted
2015
Date Submitted
2.12.2016 16:55:00
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
15920
Inst-Identifier
1229
Keywords
Clinical trials, diagnosis, pelvic girdle pain, sacroiliac joint
Recommended
0
Item sets
Thesis

Smith Legrand, R, “Diagnostic Examination for Pelvic Girdle Pain since the European Guidelines: A structured review of clinical trials, 2009-2014.”, Osteopathic Research Web, accessed May 1, 2025, https://www.osteopathic-research.com/s/orw/item/561