August 10, 2011 Michelle Spicka
Objective: The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for sue during pregnancy and postpartum.
Introduction:
1) In general, literature does not make a clear distinction between pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) but there is growing evidence that PGP disorders comprise a distinct subgroup with a unique clinical presentation and a need for specific management.
a. For adequate evaluation of interventions, reliable and valid outcome measures are needed
2) Outcome measures that have been validated for LBP are not necessarily the most appropriate ones for PGP
a. The Pregnancy Mobility Index (van de Pol, et al 2006) has activity items that are based on literature research and clinic experience but does not include the views of patients.
b. Current outcome measures may not adequately capture the specific problems and consequences that patients describe, and there is a discrepancy between patients’ scores and their feedback.
3) This study was designed to develop a condition-specific measure for use both during pregnancy and postpartum in research and clinical practice. After the application of Rasch analysis, the final questionnaire was assessed for test-retest reliability and construct validity.
1) Development of the PGQ
a. Structured literature search revealed no existing condition-specific measures for patients with PGP
b. Focus group of pregnant and postpartum patients was formed to review items listed on current outcome measures and to add items that were considered clinically relevant for patients with PGP
1. The process of item development was designed to lend the new measure content
validity and face validity (which was assessed by classifying the items to the WHO’S International Classification of Functioning, Disability and Health).
2) Patients recruited to be in the focus group presented with pain located distal, lateral or both in relation to L5-S1 in the buttocks, in the symphysis or both with pain onset during pregnancy or within 3 weeks after delivery
a. Fulfillment of the diagnostic criteria was based on the following tests: posterior pelvic pain provocation test, ASLR test, pain provocation of the long dorsal SI ligament, pain with palpation of the pubic symphysis, and modified Trendelenburg test.
3) The original PGQ went through several modifications until a final version ultimately was analyzed.
(Please see article for extensive description of statistical analysis)
Results:
1) Following extensive analysis (see article again), 20 and 5 items were retained in the activity and symptoms subscales, respectively.
Discussion:
1) The PGQ is the first condition-specific measure for PGP, and the present study provided evidence for its appropriateness.
a. A major strength of this study is that data was collected from people with clinically confirmed PGP…traditional clinical measures are commonly based on clinical opinions and, therefore, lack content validity from the perspective of patients.
b. It is an advantage for a single measure to cover both function and pain in PGP for sue in both research and clinical applications.
Thought Questions:
1) Is this a measure that would assist you as a clinician since it fills in the gaps between low back pain measures and other condition specific measures?
Journal club discussion
Was the method of forward backward translation of a scale validated in Norwegian adequate?
Do we need clarification on questions #17, 19, 20?
Scoring total number / 75 x 100
Can this be used for non-pregnant patients with PGP – Michelle has and feels it is a good tool for that patient population.
Ann Dunbar uses this scale
A comparison of the modified Oswestry and the Quebec Back disability scale http://ptjournal.apta.org/content/81/2/776.full
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