Background
Lumbopelvic pain is one of the most common complications of pregnancy. The most frequent pain location and the most severe pain are related to the pelvic girdle. Posterior pelvic girdle pain (PGP) has been defined as pain localized between the iliac crests and the gluteal folds with or without radiation down the leg. Anterior PGP is experienced in the symphysis and can occur in addition to posterior PGP or as a separate syndrome, often termed symphysiolysis.
PGP is provoked or increased by everyday activities such as walking, standing, sitting and lying down. It has been shown that PGP can increase after as little as 30 minutes of activity, which limits most daily activities and the ability to work. At the individual level, consequences such as decreased health-related quality of life and a higher proportion of depressive symptoms are seen. At the societal level, consequences are seen in high sick leave costs, with lumbopelvic pain standing for the main part of the social benefits for pregnant women.
Since effective treatments have been described, it is important to identify women who suffer from PGP. According to guidelines, provocation tests are needed to identify PGP and to exclude lumbar causes, but there is no consensus concerning which tests to choose. Identification of women with severe PGP is also important since they have the highest risk of persistent pain both during and after pregnancy. Among the large group of women with lumbopelvic pain in pregnancy, women with PGP have reported the greatest consequences in terms of pain intensity, disability and health-related quality of life. Outcomes of clinical tests has been shown to predict risk of persistent pain, emphasizing the importance of examination in addition to solely a pain drawing and questions about pain bearing activities when used for screening of PGP in trials and in clinical practice.
Large surveys must be done to learn more about the aetiology and incidence of PGP, and to identify the relatively few women with severe persistent PGP. Likewise, when doing longitudinal studies or follow-up studies after treatment, it could be an advantage to have a practical and inexpensive way to screen for PGP. Large surveys are expensive and diagnosis is usually defined by pain drawings and questionnaires. Since there is uncertainty as to whether women with PGP can be identified by questionnaires alone, an initial screening for PGP using self-administered tests may be suitable. These tests may increase the chance of more specifically identifying women with PGP. Self-administered tests could also be used in perinatal care where midwifes can ask women with suspected PGP to perform the tests under supervision. The information from the results of the tests can guide midwifes when they advice these women and refer them to physical therapy and other treatments.
To investigate the possibility to use a self-administered test, tests were developed based on frequently used clinical tests recommended by the European Guidelines. As several tests are recommended for a more reliable diagnosis, a series of tests was developed. An initial study was done with the aim to examine which self-administered tests that were most sensitive and specific and had the highest percentage of agreement in pregnant women with and without PGP. In that trial, the women performed the tests after verbal instructions, at the clinic directly before the standardised tests were performed by an examiner. The results indicated that pregnant women can perform a screening by provocation the pain by self-administered tests. However, an evaluation of the agreement of the tests performed after written instructions in a more natural setting than the clinic, such as home is valuable.
The purpose of this study was to investigate the agreement between self-administered tests performed at home and tests performed by an examiner in a clinic on women with suspected PGP. Additionally we wanted to compare the classification made by an examiner and the classification by self-administered tests combined with response to questionnaire.