Spinal mobilization of postpartum low back and pelvic girdle pain: an evidence-based clinical rule for predicting responders and nonresponders

Abstract

Objective: To develop a clinical prediction rule (CPR) for identifying postpartum women with low back pain (LBP) and/or pelvic girdle pain (PGP) whose functional disability scores improve with a high-velocity thrust technique (HVTT) conducted by a physical therapist.

Design: Prospective cohort.

Setting: Outpatient physical therapy departments.

Participants: Sixty-nine postpartum women referred to physical therapy with the complaint of LBP and/or PGP.

Methods: Subjects underwent a physical examination and a HVTT to the lumbopelvic region.

Main outcome measures: Success with treatment was determined by the use of percent changes in disability scores and served as the reference standard for determining accuracy of the examination variables. Variables with univariate prediction of success and nonsuccess were combined into multivariate CPRs.

Results: Fifty-five subjects (80%) had success with the HVTT. A CPR for success with 4 criteria was identified. The presence of 2 of 4 criteria (positive likelihood ratio=3.05) increased the probability of success from 80% to 92%. A CPR for treatment failure with 3 criteria was identified. The presence of 2 of 3 criteria (positive likelihood ratio=11.79) increased the probability of treatment failure from 20% to 75%.

Conclusions: The pretest probability of success (80%) is sufficient to reassure the clinician about the decision to use a HVTT to the lumbopelvic region in postpartum women with LBP and/or PGP. If 2 of 3 criteria for treatment failure are met in the CPR, an alternative approach is warranted. An intervention such as the HVTT is compelling, given the need to minimize pharmaceutical remedies in women who are potentially breast-feeding post partum.