The effectiveness of physiotherapy interventions for Pregnancy-Related lumbopelvic pain: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND Lumbopelvic pain (LPP) is common during pregnancy. However, there is a lack of strong systematic reviews summarizing the evidence on conservative care. AIMS To evaluate the effectiveness of physiotherapy interventions compared to standard obstetric care (SOC) or other treatments for physical function, pain intensity, and quality of life in pregnant women with LPP. METHODS Medline, Emcare, Embase, Emcare, Physiotherapy Evidence Database (PEDro), Web of Science, and Cochrane Central Register were searched for randomized controlled trials evaluating physiotherapy interventions for pregnancy-related LPP. Risk of bias was assessed using Cochrane Risk of Bias 2, and evidence was summarized using the GRADE framework. When appropriate, a meta-analysis was conducted to synthesize the available evidence. RESULTS Thirty-one trials were included (n = 3279 screened): 23 investigated exercise, 7 manual therapy, 3 electrophysical modalities, and 2 education. Exercise was not better than SOC for the short-term pain (low certainty evidence, MD = -18.80, 95 % CI -45.97 to 8.33), but was superior at 6-12 weeks (moderate certainty evidence, MD = -25.84, 95 % CI -35.04 to -16.64). After a sensitivity analysis, exercise significantly improved physical function compared to SOC at 0-5 weeks (low certainty evidence, SMD= -0.65 95 % CI -1.25 to -0.04). Exercise was superior to SOC at 6-12 weeks (very-low certainty evidence, SMD -2.79 95 % CI -4.64 to -0.95). CONCLUSION Exercise interventions show low certainty evidence for improving pain and physical function in pregnancy-related LPP over medium-term periods. Higher quality research is necessary, and future studies should adhere to standardized reporting guidelines and include larger sample sizes.