تأثیر ورزش در آب بر شدت درد و ناتوانی در زنان باردار مبتلا به کمردرد: یک کارآزمایی بالینی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مشاوره در مامایی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

2 استادیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

3 کارشناس ارشد آمار زیستی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

4 مربی گروه مامایی، مرکز تحقیقات رشد کودکان، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران

چکیده

مقدمه: کمردرد، یکی از مشکلات شایع و پرهزینه دوران حاملگی است. ورزش یکی از راهبردهای درمانی است، لذا مطالعه حاضر با هدف تعیین تأثیر ورزش در آب بر بهبود درد و ناتوانی زنان باردار مبتلا به کمردرد انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی- تصادفی در سال 1398 بر روی 54 زن باردار مراجعه‌کننده به مراکز سلامت شهر قزوین و مبتلا به کمردرد انجام شد. نمونه‌ها با استفاده از تخصیص تصادفی بلوکی به دو گروه مداخله و کنترل تقسیم شد. گروه مداخله در 24 جلسه کلاس ورزش در آب از هفته 34-20 بارداری شرکت کردند. گروه کنترل مراقبت‌های استاندارد دوران بارداری را دریافت کردند. پرسشنامه ناتوانی رولند موریس و آنالوگ بصری درد قبل، 4 و 8 هفته بعد از مداخله در دو گروه تکمیل شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 24) و آزمون‌های یو من‌ویتنی و فریدمن انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: ورزش در آب تأثیر معناداری بر میانگین نمره شدت درد (76/1±14/8، 42/1±44/1) و میزان ناتوانی کمردرد (45/2±44/3، 98/2±29/17) در گروه مداخله نسبت به گروه کنترل بعد از 8 هفته مداخله داشت (001/0>p).
نتیجه‌گیری: ورزش در آب در دوران بارداری می‌تواند شدت درد و ناتوانی در زنان مبتلا کمردرد را بهبود بخشیده و به‌عنوان یک روش غیر‌دارویی برای زنان باردار کم‌خطر مبتلا به کمردرد توصیه می‌شود.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of water exercise on pain intensity and disability in pregnant women with low back pain: A clinical trial

نویسندگان [English]

  • Masoumeh Rezaei Niaraki 1
  • Hamideh Pakniat 2
  • Maryam Mafi 3
  • Fatemeh Ranjkesh 4
1 M.Sc. Student of Counseling in Midwifery, Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
2 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
3 M.Sc. in Biostatistics, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
4 Instructor, Department of Midwifery, Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
چکیده [English]

Introduction: Low back pain is one of the most common and costly problems during pregnancy. Exercise is one of the therapeutic strategies. Therefore, this study was performed with aim to determine the effect of water exercise on improving pain and disability in pregnant women with low back pain.
Methods: This randomized clinical trial study was conducted on 54 pregnant women with low back pain referred to the healthcare centers in Qazvin in 2019. The subjects were randomly divided into two groups of intervention and control using block allocation. The intervention group participated in 24 sessions of water exercise from 20 to 34 weeks of pregnancy. The control group received the standard prenatal care. The Roland-Morris Questionnaire (RMQ) and the Visual Analogue Scale (VAS) were completed before, 4 and 8 weeks after the intervention in both groups. Data were analyzed by SPSS software (version 24) and U Mann-Whitney and Friedman tests. P< 0.05 was considered statistically significant.
Results: Water exercise had significant effect on the mean score of pain intensity (1.44±1.42, 8.14±1.76) and the disability of low back pain (3.44±2.45, 17.29±2.98) in the intervention group compared to the control group after 8 weeks of intervention (p<0.001).
Conclusion: Water exercise during pregnancy can improve pain intensity and disability in women with low back pain; it is recommended as a non-pharmacological method for low-risk pregnant women with low back pain.

کلیدواژه‌ها [English]

  • Low back pain
  • pregnancy
  • Water exercise
  1. Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship?. Sleep medicine reviews 2010; 14(2):107-14.
  2. Gutke A, Östgaard HC, Öberg B. Association between muscle function and low back pain in relation to pregnancy. Journal of rehabilitation medicine 2008; 40(4):304-11.
  3. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Practice 2010; 10(1):60-71.
  4. Gutke A, Östgaard HC, Öberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine 2006; 31(5):E149-55.
  5. Saccomanni B. Low back pain associated with pregnancy: a review of literature. European Orthopaedics and Traumatology 2011; 1(5):169-74.
  6. Hasanabadi H, Bahri N, Tara F, Bahri N. The effects of exercise on back pain during pregnancy: a review article. Iran J Obstet Gynecol Infertil 2014; 17(127):16-28.
  7. Robinson HS, Vøllestad NK, Veierød MB. Clinical course of pelvic girdle pain postpartum–impact of clinical findings in late pregnancy. Manual therapy 2014; 19(3):190-6.
  8. Ferreira CW, Alburquerque-Sendı´ n F. Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: a systematic review. Physiotherapy theory and practice 2013; 29(6):419-31.
  9. Sabino J, Grauer JN. Pregnancy and low back pain. Current reviews in musculoskeletal medicine 2008; 1(2):137-41.
  10. Owe KM, Nystad W, Bø K. Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study. Scandinavian journal of medicine & science in sports 2009; 19(5):637-45.
  11. Verbunt JA, Smeets RJ, Wittink HM. Cause or effect? Deconditioning and chronic low back pain. Pain 2010; 149(3):428-30.
  12. Joy EA, Mottola MF, Chambliss H. Integrating exercise is medicine® into the care of pregnant women. Current sports medicine reports 2013; 12(4):245-7.
  13. Garshasbi A, FAGHIH ZS. The effect of exercise on the intensity of low back pain and kinematics of spine in pregnant women. Daneshvar Medicine 2010; 17(88):45-50.
  14. Nascimento SL, Surita FG, Cecatti JG. Physical exercise during pregnancy: a systematic review. Current Opinion in Obstetrics and Gynecology 2012; 24(6):387-94.
  15. Hinman SK, Smith KB, Quillen DM, Smith MS. Exercise in pregnancy: a clinical review. Sports health 2015; 7(6):527-31.
  16. Liddle SD, Pennick V. Interventions for preventing and treating low‐back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews 2015(9):Cd001139.
  17. Kinser PA, Pauli J, Jallo N, Shall M, Karst K, Hoekstra M, et al. Physical activity and yoga-based approaches for pregnancy-related low back and pelvic pain. Journal of Obstetric, Gynecologic & Neonatal Nursing 2017; 46(3):334-46.
  18. Rodriguez-Blanque R, Sánchez-García JC, Sánchez-López AM, Mur-Villar N, Aguilar-Cordero MJ. The influence of physical activity in water on sleep quality in pregnant women: A randomised trial. Women and Birth 2018; 31(1):e51-8.
  19. Artal R, O'toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British journal of sports medicine 2003; 37(1):6-12.
  20. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol 2015; 126(6):e135-142.
  21. Backhausen MG, Tabor A, Albert H, Rosthøj S, Damm P, Hegaard HK. The effects of an unsupervised water exercise program on low back pain and sick leave among healthy pregnant women–A randomised controlled trial. PloS one 2017; 12(9):e0182114.
  22. Roland M, Morris R. A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine. 1983; 8(2):145-50.
  23. Ostelo RW, De Vet HC, Knol DL, Van Den Brandt PA. 24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. Journal of clinical epidemiology 2004; 57(3):268-76.
  24. Borg GA. Psychophysical bases of perceived exertion. Medicine & science in sports & exercise 1982.
  25. Scott KL, Hellawell M. Effects of water-and land-based exercise programmes on women experiencing pregnancy-related pelvic girdle pain: a randomized controlled feasibility study. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy 2018; 122:21-9.
  26. Ramezanpour MR, Mohammad Nezhad M, Akhlaghi F. The effects of 12 weeks body balance and pelvic floor muscles exercise on back pain intensity during pregnancy. Iran J Obstet Gynecol Infertil 2018; 20(11):1-7.
  27. Yan CF, Hung YC, Gau ML, Lin KC. Effects of a stability ball exercise programme on low back pain and daily life interference during pregnancy. Midwifery 2014; 30(4):412-9.
  28. Stafne SN, Salvesen KÅ, Romundstad PR, Stuge B, Mørkved S. Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial. Acta obstetricia et gynecologica Scandinavica 2012; 91(5):552-9.
  29. Bandpei M, Ahmadshirvani M, Fakhri M, Rahmani N. The effect of an exercise program and ergonomic advices on treatment of pregnancy-related low back pain: a randomized controlled clinical trial. Journal of Mazandaran University of Medical Sciences 2010; 20(77):10-9.
  30. Coll CD, Domingues MR, Hallal PC, da Silva IC, Bassani DG, Matijasevich A, et al. Changes in leisure-time physical activity among Brazilian pregnant women: comparison between two birth cohort studies (2004–2015). BMC Public Health 2017; 17(1):1-4.
  31. Mottola M. Pregnancy, physical activity and weight control to prevent obesity and future chronic disease risk in both mother and child. Current Women's Health Reviews 2015; 11(1):31-40.
  32. Artal R. Exercise in pregnancy: guidelines. Clinical obstetrics and gynecology 2016; 59(3):639-44.
  33. Soultanakis HN. Aquatic exercise and thermoregulation in pregnancy. Clinical obstetrics and gynecology 2016; 59(3):576-90.
  34. Sedaghati P, Daneshmandi H, Saremi A, Ashtari M. Effect of eight weeks aquatic gymnastics training on the intensity of low back pain in primiparous women. Journal of Sabzevar University of Medical Sciences 2018; 25(3):279-286.
  35. Keane LG. Comparing AquaStretch with supervised land based stretching for chronic lower back pain. Journal of bodywork and movement therapies 2017; 21(2):297-305.
  36. Intveld E, Cooper S, van Kessel G. The effect of aquatic physiotherapy on low back pain in pregnant women. International Journal of Aquatic Research and Education 2010; 4(2):5.
  37. Shi Z, Zhou H, Lu L, Pan B, Wei Z, Yao X, et al. Aquatic exercises in the treatment of low back pain: a systematic review of the literature and meta-Analysis of eight studies. American journal of physical medicine & rehabilitation 2018; 97(2):116-22.
  38. Igarashi Y, Nogami Y. The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials. European journal of preventive cardiology 2018; 25(2):190-9.