Current Management for Pregnancy-related Low Back Pain by Korean Physical Therapists: A National Cross-sectional Survey Using the Vignette Method

비네트를 활용한 한국 물리치료사의 임신 관련 허리통증 환자에 대한 치료실태 조사연구

  • Han, Hee-ju (Department of Physical Therapy, Graduate School, Daejeon University) ;
  • Kim, Suhn-yeop (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 한희주 (대전대학교 대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료학과)
  • Received : 2019.10.08
  • Accepted : 2019.12.02
  • Published : 2020.02.20


Background: Pregnancy-related low back pain (PLBP) has fewer systematic guidelines than pregnancy-related pelvic girdle pain, previous studies have not evaluated physical therapy for this ailment in Korea. Objects: We aimed to provide a detailed account of clinical decision making by Korean physiotherapists while treating PLBP. Methods: In total, 955 questionnaires were distributed mainly in places of continuing education held by the Korean Physical Therapy Association from April to July 2019. The same questionnaire was posted on a website used by physiotherapists. We collected subject information, a specific Vignette typically represent symptoms of PLBP, and responses to multiple questions about decision making, subjective recognition and interest level in the field of women's health physiotherapy (WHPT). Results: The overall response rate was 56% (n = 537); of these, responses to 520 questionnaires were analyzed. Most respondents chose various combinations of physical therapy methods. There were significant differences in subjective recognition levels of WHPT according to gender (p < 0.05), age (p < 0.01), education level (p < 0.01), and clinical experience (p < 0.05). There were significant differences in interest according to gender (p < 0.01) and education level (p < 0.01). With respect to the types of treatment, significant differences were noted in selective rates for "manual therapy", "pain control", and "supportive devices" based on gender. Manual therapy tended to be chosen more with increasing age and clinical experience. With increased education level, there were fewer choices for the use of pain control. Conclusion: This is the first data on how Korean physiotherapists manage PLBP patients using the vignette method. We were able to recognize the Korean physical therapist's decision on PLBP patients, and observed statistically significant correlations. This may aid in developing future research and education plans in the WHPT field.



  1. Gutke A, Ostgaard HC, Oberg B. Predicting persistent pregnancy-related low back pain. Spine (Phila Pa 1976) 2008;33(12):E386-93.
  2. Pierce H, Homer CS, Dahlen HG, King J. Pregnancy-related lumbopelvic pain: listening to Australian women. Nurs Res Pract 2012;2012:387428.
  3. Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, et al. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J 2004;13(7):575-89.
  4. Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, et al. Pregnancy-related low back pain. Hippokratia 2011;15(3):205-10.
  5. Stuge B, Hilde G, Vollestad N. Physical therapy for pregnancyrelated low back and pelvic pain: a systematic review. Acta Obstet Gynecol Scand 2003;82(11):983-90.
  6. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract 2010;10(1):60-71.
  7. Bastiaanssen JM, de Bie RA, Bastiaenen CH, Essed GG, van den Brandt PA. A historical perspective on pregnancy-related low back and/or pelvic girdle pain. Eur J Obstet Gynecol Reprod Biol 2005;120(1):3-14.
  8. Kovacs FM, Garcia E, Royuela A, Gonzalez L, Abraira V. Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine (Phila Pa 1976) 2012;37(17):1516-33.
  9. van Benten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review. J Orthop Sports Phys Ther 2014;44(7):464-73, A1-15.
  10. Gutke A, Betten C, Degerskar K, Pousette S, Olsen MF. Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand 2015;94(11):1156-67.
  11. Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the section on women's health and the orthopaedic section of the American Physical Therapy Association. J Women Health Phys Ther 2017;41(2):102-25.
  12. Bishop A, Holden MA, Ogollah RO, Foster NE. Current management of pregnancy-related low back pain: a national crosssectional survey of U.K. physiotherapists. Physiotherapy 2016;102(1):78-85.
  13. Steiner PM, Atzmuller C, Su D. Designing valid and reliable vignette experiments for survey research: a case study on the fair gender income gap. J Methods Meas Soc Sci 2016;7(2):52-94.
  14. Corkery MB, Edgar KL, Smith CE. A survey of physical therapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD). J Man Manip Ther 2014;22(2):75-89.
  15. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA 2000;283(13):1715-22.
  16. Buchbinder R, Jolley D, Wyatt M. 2001 Volvo Award Winner in Clinical Studies: Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine (Phila Pa 1976) 2001;26(23):2535-42.
  17. Evans DW, Breen AC, Pincus T, Sim J, Underwood M, Vogel S, et al. The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. Spine (Phila Pa 1976) 2010;35(8):858-66.
  18. Keskin EA, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecol Obstet Invest 2012;74(1):76-83.
  19. Galfat DR, Mishra A. Management of low back pain in pregnancy with transcutaneous electrical nerve stimulation-a prospective study. Obstet Gynecol 2019;7(4):645-8.
  20. Kluge J, Hall D, Louw Q, Theron G, Grove D. Specific exercises to treat pregnancy-related low back pain in a South African population. Int J Gynaecol Obstet 2011;113(3):187-91.
  21. Belogolovsky I, Katzman W, Christopherson N, Rivera MJ, Allen DD. The effectiveness of exercise in treatment of pregnancy-related lumbar and pelvic girdle pain: a meta-analysis and evidence-based review. J Women Health Phys Ther 2015;39(2):53-64.
  22. Bullock JE, Jull GA, Bullock MI. The relationship of low back pain to postural changes during pregnancy. Aust J Physiother 1987;33(1):10-7.
  23. Yousef AM, Hanfy HM, Elshamy FF, Awad MA, Kandil IM. Postural changes during normal pregnancy. J Am Sci 2011;7(6):1013-8.
  24. Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva PD, Schaper A. Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol 1996;174(2):667-71.
  25. Hall H, Cramer H, Sundberg T, Ward L, Adams J, Moore C, et al. The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: a systematic review with meta-analysis. Medicine (Baltimore) 2016;95(38):e4723.
  26. Robinson HS, Balasundaram AP. Effectiveness of physical therapy interventions for pregnancy-related pelvic girdle pain (PEDro synthesis). Br J Sports Med 2018;52(18):1215-6.
  27. Carr CA. Use of a maternity support binder for relief of pregnancy-related back pain. J Obstet Gynecol Neonatal Nurs 2003;32(4):495-502.