Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts.

Autor: Hodges PW; The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia., Cholewicki J; MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI., Popovich JM Jr; MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI., Lee AS; MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI., Aminpour P; Department of Community Sustainability, Michigan State University, Natural Resource Building, East Lansing, MI., Gray SA; Department of Community Sustainability, Michigan State University, Natural Resource Building, East Lansing, MI., Cibulka MT; Physical Therapy Program, Maryville University, St. Louis, MO., Cusi M; School of Medicine, Sydney, University of Notre Dame Australia, Darlinghurst, Australia., Degenhardt BF; A.T. Still University, Kirksville, MO., Fryer G; College of Health & Biomedicine, Victoria University, Melbourne, Australia., Gutke A; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Göteborg, Göteborg, Sweden., Kennedy DJ; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN., Laslett M; Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand; Southern Musculoskeletal Seminars, New Zealand., Lee D; Diane Lee & Associates, South Surrey, Canada., Mens J; Department of Rehabilitation Medicine & Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands., Patel VV; Department of Orthopaedic Surgery, University of Colorado, Denver, CO., Prather H; Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO., Sturesson B; Department of Orthopedics, Aleris, Ängelholm Hospital, Ängelholm, Sweden., Stuge B; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway., Vleeming A; Department of Anatomy, Medical Osteopathic College of the University of New England, Biddeford, ME.; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
Jazyk: angličtina
Zdroj: PM & R : the journal of injury, function, and rehabilitation [PM R] 2019 Aug; Vol. 11 Suppl 1, pp. S11-S23. Date of Electronic Publication: 2019 Jul 23.
DOI: 10.1002/pmrj.12199
Abstrakt: Background: Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized.
Objective: To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments.
Design: To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments.
Results: From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief.
Conclusions: The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.
(© 2019 American Academy of Physical Medicine and Rehabilitation.)
Databáze: MEDLINE
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