Factors associated with return to meaningful activities following physiotherapy for pelvic girdle pain during pregnancy: 3-year follow-up of a randomised controlled trial

Objectives To investigate whether women who experienced pelvic girdle pain (PGP) during pregnancy were able to engage in meaningful activities at 4 months and 3 years post partum, and to identify factors associated with long-term functional outcomes. Design Long-term follow-up of a randomised controlled trial comparing acupuncture and transcutaneous electrical nerve stimulation for pregnancy-related PGP. Setting Physiotherapy outpatient clinics in Sweden. Participants In total, 113 pregnant women with clinically verified PGP were randomised in the original trial; 86 participated in the initial study phase, 77 attended the 4-month follow-up and 57 completed the 3-year follow-up questionnaire. Primary and secondary outcome measures The primary outcome was functioning, assessed using the Patient-Specific Functional Scale (PSFS). Secondary outcomes included self-reported PGP, overall functioning and the prognostic value of pelvic pain provocation tests at 4 months post partum for persistent PGP at 3 years. Results 3 years post partum, the mean PSFS score was 8.64, and 45.6% of the participants scored 10, indicating full return to baseline activities. In repeated linear regression analyses, estimated PSFS scores were approximately 3 points lower at baseline and post-treatment compared with the 3-year follow-up (both p<0.001), indicating improved functioning over time, with no differences between treatment groups. Higher pain-related concern and higher Pelvic Girdle Questionnaire scores were associated with greater activity limitations (estimate −0.21, p=0.019 and −0.06, p<0.001, respectively). Logistic regression showed that the number of positive pelvic provocation tests at 4 months post partum significantly predicted self-reported PGP at 3 years (OR 2.98, 95% CI 1.26 to 7.05, p=0.013). Conclusions Most women with pregnancy-related PGP regained functioning by 4 months post partum, and this recovery was sustained at 3 years. The number of positive pelvic provocation tests at 4 months post partum predicted persistent pain at 3 years, suggesting potential prognostic value for identifying women at risk of long-term PGP and informing postpartum follow-up strategies. Trial registration number In ‘FoU i Sverige’ (R&D in Sweden) No. 12726. https://www.researchweb.org/is/sverige/project/127261 .