Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review

2012 ◽  
Vol 3 (2) ◽  
pp. 70-81 ◽  
Author(s):  
S. Loving ◽  
J. Nordling ◽  
P. Jaszczak ◽  
T. Thomsen
Keyword(s):  
Clinical Trials ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Intervention Studies ◽  
Clinical Intervention ◽  
Evidence Base ◽  
Risk Of Bias ◽  
Randomised Clinical Trials ◽  
Multidisciplinary Intervention

AbstractBackground and purposeChronic pelvic pain (CPP) is a debilitating condition among women with a major impact on health-related quality of life, work productivity and health care utilisation. The exact prevalence of chronic pelvic pain is not known, but 3.8% is commonly suggested. Musculoskeletal dysfunction is frequently cited as a possible aetiology. Physiotherapy is therefore recommended as one treatment modality. The aim of this systematic review was to source and critically evaluate the evidence for an effect of physiotherapy on pain, physical activity and quality of life in the treatment of female CPP.MethodsElectronic databases, conference proceedings, text books and clinical guidelines were searched for quantitative, observational, and prospective clinical intervention studies of female chronic pelvic pain where physiotherapy was a sole or significant component of the intervention. Trial inclusion, data extraction according to predefined criteria and risk of bias assessment were performed by two independent authors. Methodological quality of the included clinical intervention studies was assessed using The Cochrane Collaboration’s tool for assessing risk of bias. Review Manager (RevMan) version 5.0 was used for data analysis. Effect estimates (relative risk, mean difference and mean change) with 95% confidence intervals were calculated for the above outcomes. For significant outcomes the numbers needed to treat were calculated.ResultsThe search strategy identified 3469 potential articles. Of these, 11 articles, representing 10 studies, met the inclusion criteria. There were 6 randomised clinical trials, 1 cohort study and 3 case series. Methodological quality was dependent on study type. Accordingly, level of evidence was judged higher in randomised clinical trials than in the other study types. Physiotherapy treatments varied between studies and were provided in combination with psychotherapeutic modalities and medical management. This did not allow for the ‘stand-alone’ value of physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions, outcome measures and times of follow-up, prevented meta-analysis. Narrative synthesis of the results, based on effect estimates and clinically relevant pain improvement, disclosed some evidence to support an effect of multidisciplinary intervention and Mensendieck somatocognitive therapy on female chronic pelvic pain.ConclusionChronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. There seems to be some evidence to support the use of a multidisciplinary intervention in the management of female chronic pelvic pain. Somatocognitive therapy is a new approach that appears to be promising and randomised clinical trials are underway in order to establish its evidence base.ImplicationsBased on the findings of this review, recommendations for physiotherapy in chronic pelvic pain clinical guidelines, textbooks and narrative reviews should be interpreted with caution due to the lack of a sufficient evidence base. Only small and largely non-randomised studies have been undertaken of physiotherapeutic interventions and this greatly limits the available evidence on which to base clinical practice. High quality randomised clinical trials are therefore urgently needed.

scholarly journals A review of trauma and orthopaedic randomised clinical trials published in high-impact general medical journals

2021 ◽  
Author(s):  
Luke Farrow ◽  
William T. Gardner ◽  
Andrew D. Ablett ◽  
Vladislav Kutuzov ◽  
Alan Johnstone
Keyword(s):  
Clinical Trials ◽  
Sample Size ◽  
Trial Design ◽  
Sample Size Calculation ◽  
High Impact ◽  
Risk Of Bias ◽  
Randomised Clinical Trials ◽  
Medical Journals ◽  
General Medical Journals

Abstract Introduction The recent past has seen a significant increase in the number of trauma and orthopaedic randomised clinical trials published in “the big five” general medical journals. The quality of this research has, however, not yet been established. Methods We therefore set out to critically appraise the quality of available literature over a 10-year period (April 2010–April 2020) through a systematic search of these 5 high-impact general medical journals (JAMA, NEJM, BMJ, Lancet and Annals). A standardised data extraction proforma was utilised to gather information regarding: trial design, sample size calculation, results, study quality and pragmatism. Quality assessment was performed using the Cochrane Risk of Bias 2 tool and the modified Delphi list. Study pragmatism was assessed using the PRECIS-2 tool. Results A total of 25 studies were eligible for inclusion. Over half of the included trials did not meet their sample size calculation for the primary outcome, with a similar proportion of these studies at risk of type II error for their non-significant results. There was a high degree of pragmatism according to PRECIS-2. Non-significant studies had greater pragmatism that those with statistically significant results (p < 0.001). Only 56% studies provided adequate justification for the minimum clinically important difference (MCID) in the population assessed. Overall, very few studies were deemed high quality/low risk of bias. Conclusions These findings highlight that there are some important methodological concerns present within the current evidence base of RCTs published in high-impact medical journals. Potential strategies that may improve future trial design are highlighted. Level of evidence Level 1.

87: Biopsychosocial Factors in Quality of Life in men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

2007 ◽  
Vol 177 (4S) ◽  
pp. 31-31
Author(s):  
J. Curtis Nickel ◽  
Dean Tripp ◽  
Shannon Chuai ◽  
Mark S. Litwin ◽  
Mary McNaughton-Collins
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome

Histamine metabolism disorder in pathogenesis of chronic pelvic pain in patients with external genital endometriosis

2017 ◽  
pp. 56-60
Author(s):  
М.Р. Оразов ◽  
В.Е. Радзинский ◽  
М.Б. Хамошина ◽  
Е.Н. Носенко ◽  
Э.С. Токаева ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Peripheral Blood ◽  
Chronic Pelvic Pain ◽  
Pain Syndrome ◽  
Histamine Level ◽  
Life Assessment ◽  
Assay Method ◽  
Histamine Metabolism

Цель исследования - изучение особенностей обмена гистамина при хронической тазовой боли у пациенток с наружным генитальным эндометриозом. Методика. В сыворотке крови 100 пациенток методом высокоточного (в нг/мл) иммуноферментного твердофазного анализа определяли концентрацию гистамина. Использованы реактивы «Histamine ЕLISA», аппарат BAE-1000 Гистамин (Labor Diagnostika Nord - LDN, Германия). Оценка выраженности болевого синдрома осуществлялась по шкале ВАШ, оценка качества жизни - на основании опросника для оценки качества жизни при эндометриозе (EHR-30), оценка тревожности - опросника Спилбергера-Ханина. Результаты. Показано статистически значимое повышение уровня гистамина у пациенток с высокой интенсивностью болевого синдрома. Женщины с наружным генитальным эндометриозом, сопровождающимся интенсивным болевым синдромом в 100% случаев обнаруживали высокие уровни ситуативной и личностной тревожности, тогда как, лишь у 40% женщин (n = 16) контрольной группы выявлен умеренный уровень тревожности. Депрессивные расстройства выявлены у 58,3% женщин с хронической тазовой болью (n = 35), из них основную часть (n = 20) составили женщины с выраженной степенью болевого синдрома по ВАШ. Заключение. Психоэмоциональное состояние женщин с тазовой болью, ассоциированной с наружным генитальным эндометриозом, характеризуется высокими уровнями депрессивных и тревожных расстройств, значительным снижением уровня качества жизни. Выявлена прямая связь между интенсивностью болевого синдрома и уровнем гистамина в периферической крови пациенток с наружным генитальным эндометриозом. Objective. To study features of histamine metabolism in patients with chronic pelvic pain associated with external genital endometriosis. Methods. For quantitative assessment of histamine level in peripheral blood was taken from 100 patients which than was centrifuged. In blood serum histamine concentration was determined by enzyme-linked immunosorbent assay method with reagents «Histamine ЕLISA» on the machine BAE-1000 Histamine (Labor Diagnostika Nord - LDN, Hermany). A pain syndrome was assessed by Visual Analog Scale (VAS), quality of life assessment - by Endometriosis Health Profile Questionnaire (EHR-30), level of anxiety was determined by Spielberger-Khanin questionnaire. The results. Showed statistically higher histamine level in patients with severe pain according to VAS. After assessment of results obtained from Spielberger-Khanin questionnaire 100% experimental group’s women with external genital endometriosis (n = 60) were noted to be have high level of state and trait anxiety, then 40% women of control group (n = 16) have moderate level of anxiety. The incidence of depression in women with chronic pelvic pain was 58.3% (n = 35) and the main part (n = 20) were women with severe stage of pelvic pain according to VAS. Conclusions. Psycho emotional condition of women with external genital endometriosis associated pelvic pain characterized by higher depression and anxiety levels, with significant decrease quality of life. Direct relationship also was found between pain syndrome intensity and histamine level in peripheral blood in patients with external genital endometriosis.

O-168 Chronic pelvic pain is the most troublesome endometriosis pain symptom for women’s quality of life

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P Pijpops ◽  
S Apers ◽  
C Meuleman ◽  
C Tomassetti ◽  
E Dancet
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Pelvic Pain ◽  
General Health ◽  
Chronic Pelvic Pain ◽  
Pain Symptom ◽  
General Health Status ◽  
Pain Symptoms ◽  
Specific Health

Abstract Study question Which pre-operative endometriosis pain symptom is most troublesome for the quality-of-life of women assessed at different meta-levels? Summary answer Of five pain symptoms chronic pelvic pain is most troublesome or has the strongest correlation to women’s overall quality-of-life and overall and endometriosis-specific health status. What is known already Endometriosis affects women’s quality of life negatively, and its impact seems to depend more on women’s symptoms than on their degree of endometriosis. Experts proposed to include ‘the most troublesome symptom’ and ‘overall pain’ as core outcomes but did not define how to assess these outcomes. It would be interesting to find out which pain symptom (i.e. assessed for presence and intensity) has most impact on women’s quality-of-life assessed at different meta-levels, including: overall quality-of-life (depending on amongst others one’s professional and relational life besides health), general health status and endometriosis-specific health status. Study design, size, duration A prospective survey addressed 277 adult women scheduled for diagnostic and/or therapeutic surgery in a University endometriosis clinic between October 2016 and November 2019. Women were reminded twice of our request to fill out the coded but anonymous questionnaire package assessing five pain symptoms (i.e. chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria and dyschezia) and assessing quality-of-life at three different meta-levels. Participants/materials, setting, methods Women scored five endometriosis symptoms between 0 (no pain) and 10 (worst imaginable pain), combined into ‘overall pain’ (0-50). ‘Overall quality-of-life’ was assessed with the Linear Analogue Scale (LAS; the higher, the better). General and endometriosis-specific health status were assessed with the overall scores of the EuroQol-5D and the Endometriosis-Health-Profile-30 (the higher, the better). Pearson correlation coefficients between the six pain scores and three measures of quality-of-life were computed (p = 0.003; 0.05/18 as Bonferroni correction). Main results and the role of chance A total of 227 women took part (participation rate=82%) and the data of 202 women (mean age 31±5 years old) with surgically confirmed endometriosis were analysed. In the previous six months, the majority of women reported chronic pelvic pain (56%), dyspareunia (55%), dysmenorrhea (56%) and/or dyschezia (58.4%), while only some reported dysuria (25%). Women’s mean overall pain score was 20 (±12). Women’s mean overall quality-of-life was 65 (±16). On average women rated their general health status to be 62 (±18) and their mean endometriosis-specific health status was 53 (±18). Only the pain symptom chronic pelvic pain was correlated (p &lt; 0.001) to assessments of quality-of-Life at all three meta-levels. The correlation for endometriosis-specific health status was large (r= -0.574), while the others were medium (r= -0.343 & r= -0.324). After taking account of the Bonferroni correction for multiple testing the remaining four pain symptoms only had a medium correlation (p &lt; 0.001) to endometriosis-specific health status (r= -0.356 – -0.265; p &lt; 0.001) and they were not correlated to overall quality-of-Life or general health status. Overall pain had a medium correlation (p &lt; 0.001) to Overall quality-of-Life (r= -0.270) and general health status (r= -0.259) and a strong correlation (p &lt; 0.001) to endometriosis-specific health status (r= -0.529). Limitations, reasons for caution The majority of patients (60%) of the recruiting University endometriosis clinic had severe endometriosis (AFS-IV) and this study could be repeated in another setting. Directly asking women which pain symptom is most troublesome to them would be interesting besides exploring correlations between pain symptoms and quality of life. Wider implications of the findings Nurses, midwives and other health care professionals should devote attention to chronic pelvic pain during the anamnesis and women-centred care as this pain symptom is most troublesome for women’s quality of life. Whether surgery decreases chronic pelvic pain and overall pain is currently followed-up in the studied prospective cohort. Trial registration number Not applicable

scholarly journals Once-daily 5 mg tadalafil oral treatment for patients with chronic prostatitis/chronic pelvic pain syndrome

2018 ◽  
Vol 10 (12) ◽  
pp. 377-381 ◽  
Author(s):  
Andrea Benelli ◽  
Simone Mariani ◽  
Virginia Varca ◽  
Andrea Gregori ◽  
Franco Barrese ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Once Daily ◽  
International Prostatic Symptom Score

Background: Chronic prostatitis/chronic pelvic pain syndrome (IIIB CP/CPPS) is a condition of unclear aetiology. Many approaches have been used without satisfactory results. The aim of this study is to evaluate the efficacy of once-daily 5 mg tadalafil in pain control and improving quality of life in patients affected by CP/CPPS. Methods: Twenty patients affected by chronic prostatitis according EAU (European Association of Urology) guidelines were evaluated for once-daily 5 mg tadalafil; 14 patients were eligible for the study. The validated Italian version of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostatic Symptom Score (IPSS) questionnaires were submitted to all the patients. Every patient underwent uroflowmetry and ultrasound prostatic volume at the beginning and at the end of the study. Results: All 14 patients eligible for the study reported an improvement of symptoms during therapy: statistically significant differences were reported in terms of NIH-CPSI ( p < 0.000002) and IPSS ( p < 0.0001) during follow-up evaluations. No statistically significant improvement of uroflowmetry parameters was reported during the treatment. Conclusions: In our study the daily use of 5 mg tadalafil improves symptoms and quality of life in patients affected by CP/CPPS after 4 weeks of therapy. A larger population of patients is needed to confirm the efficacy of this therapy in CP/CPPS.

scholarly journals Reporting of Quality of Life in Clinical Trials of Biologics for Plaque Psoriasis: A Systematic Review

2018 ◽  
Vol 2 (5) ◽  
Author(s):  
Giselle Prado ◽  
Anna J Nichols ◽  
Mercedes Florez-White ◽  
Francisco Kerdel
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Trials ◽  
Plaque Psoriasis ◽  
Dermatology Life Quality Index ◽  
Quality Index ◽  
Life Quality ◽  
Risk Of Bias ◽  
The Mean

Background: Psoriasis is a chronic remitting and relapsing skin disease. For many patients, improved quality of life (QoL) is as important as clinical improvement of lesions.Objective: To review reporting of Dermatology Life Quality Index (DLQI) in randomized controlled trials (RCTs) of biologics for adult patients with plaque psoriasis.Methods: A systematic review was conducted in 4 databases for RCTs that measured DLQI at baseline and endpoint. A data collection form was created for collecting study variables. Risk of bias was assessed using the Cochrane risk of bias tool.Results: Thirty-four RCTs enrolling 16,784 patients were included. Complete baseline and final mean DLQI data was retrieved for 24 studies (70.6%). The mean DLQI at baseline was reported in 79.4% of RCTs. The median at baseline was reported in 14.7% of RCTs. The mean DLQI at endpoint was reported in 23.5% of RCTs and the median DLQI at endpoint was reported in 5.9% of RCTs. The mean change in DLQI was reported in 64.7% of RCTs.Conclusions: DLQI was measured in most clinical trials assessing the efficacy of biologics for psoriasis. Studies did not adhere to uniform standards in publishing results, making analysis of the impact on DLQI challenging.Key Words: plaque psoriasis, quality of life, Dermatology Life Quality Index, Systematic Review, biologic therapy

scholarly journals The Use of Green Coffee Extract as a Weight Loss Supplement: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Igho Onakpoya ◽  
Rohini Terry ◽  
Edzard Ernst
Keyword(s):  
Weight Loss ◽  
Clinical Trials ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Significant Heterogeneity ◽  
Green Coffee ◽  
Significant Difference ◽  
Using Data

The purpose of this paper is to assess the efficacy of green coffee extract (GCE) as a weight loss supplement, using data from human clinical trials. Electronic and nonelectronic searches were conducted to identify relevant articles, with no restrictions in time or language. Two independent reviewers extracted the data and assessed the methodological quality of included studies. Five eligible trials were identified, and three of these were included. All studies were associated with a high risk of bias. The meta-analytic result reveals a significant difference in body weight in GCE compared with placebo (mean difference: kg; 95%CI: , ). The magnitude of the effect is moderate, and there is significant heterogeneity amongst the studies. It is concluded that the results from these trials are promising, but the studies are all of poor methodological quality. More rigorous trials are needed to assess the usefulness of GCE as a weight loss tool.

scholarly journals Chronic Pelvic Pain: Assessment, Evaluation, and Objectivation

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Maria Beatrice Passavanti ◽  
Vincenzo Pota ◽  
Pasquale Sansone ◽  
Caterina Aurilio ◽  
Lorenzo De Nardis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Pain Assessment ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Men And Women

Chronic Pelvic Pain (CPP) and Chronic Pelvic Pain Syndrome (CPPS) have a significant impact on men and women of reproductive and nonreproductive age, with a considerable burden on overall quality of life (QoL) and on psychological, functional, and behavioural status. Moreover, diagnostic and therapeutic difficulties are remarkable features in many patients. Therefore evaluation, assessment and objectivation tools are often necessary to properly address each patient and consequently his/her clinical needs. Here we review the different tools for pain assessment, evaluation, and objectivation; specific features regarding CPP/CPPS will be highlighted. Also, recent findings disclosed with neuroimaging investigations will be reviewed as they provide new insights into CPP/CPPS pathophysiology and may serve as a tool for CPP assessment and objectivation.

Evaluating Disability-Related Quality of Life in Women With Chronic Pelvic Pain

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alice L. Ye ◽  
William Adams ◽  
Lauren C. Westbay ◽  
Colleen M. Fitzgerald
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Related Quality
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