運動治療對於懷孕造成的骨盆區域疼痛是否具有療效？

Can Therapeutic Exercise Reduce Pregnancy-related Pelvic Girdle Pain?

張瑞元(Jui-Yuan Chang) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 31卷5期 (2006/10) Pp. 309-315

摘要

目的：探討婦女在懷孕過程中發生之骨盆區域疼痛，是否可以利用運動治療減緩疼痛並改善其生活品質。方法：先以個案呈現方式勾勒本問題之臨床意義及考慮面向，再以文獻回顧的方式於MEDLINE、PubMed、CINAHL等資料庫搜尋1996至2006年的文章。以pelvic girdle pain和pregnancy為關鍵字，再利用人工閱讀方式挑選出合適且為隨機控制之臨床試驗(Randomized controlled Trials-RCTs)相關研究論文作為本文分析對象。結果：共挑選出四篇文章，其中的兩篇為同一研究不同時期之追蹤報告。第一篇研究結果認為，穩定腰椎與收縮骨盆底肌的運動治療和針灸治療皆可降低疼痛，改善生活品質，但針灸治療療效優於運動治療。兩篇同一病患系列的研究利用懸吊系統(Sling Exercise Therapy-SET)進行骨盆附近特定肌群穩定運動，治療組大幅改善了疼痛情況以及生活品質，即使兩年後的追蹤，成效依然較控制組顯著。最後一篇研究將受試者分成資訊、居家運動、診所運動三組，其研究結果顯示三組之療效並無顯著差異。結論：強調收縮腹橫肌及骨盆底肌的腰椎穩定運動可以增加骨盆穩定度，降低因懷孕引起的骨盆區域疼痛，亦能改善婦女們的生活品質；除了運動治療、傳統針灸治療亦顯示療效，希望在未來有更多設計嚴謹之研究發表，以利臨床應用。

關鍵字

骨盆區域疼痛 ； 運動治療 ； 穩定運動 ； 懷孕 ； 物理治療

並列摘要

Background and Purpose: To determinate whether therapeutic exercise for women with pregnancy-related pelvic girdle pain can reduce pain and improve quality of life. Methods: A clinical question was raised from a case with pelvic girdle pain. Her chief complaints, history and results of physical examination were reported. Then we searched MEDLINE, PubMed and CINAHL databases, using keywords ”pelvic girdle pain and pregnancy” to find the published papers between 1996 and 2006. Afterward, manual searching was used to choose appropriate and randomized controlled trials (RCTs) research correlated to our topic. Results: Totally, four studies were used. Two of them were published from the same project at different follow-up time. The first research concluded that stabilizing exercises with pelvic floor muscles contraction as well as acupuncture therapy can both reduce pain and improve quality of life, but acupuncture therapy was superior to stabilizing exercise. The subjects in the 2nd and 3rd articles received exercises designed to improve the stabilization of pelvic girdle muscles using a suspension exercise system. Comparing to the control group, the intervention group relieved the pain condition significantly and also improved their quality of life, even at two-year follow-up. The subjects in the last study were grouped into information, home exercise and clinical exercise groups. The results suggested that no significant difference among these three groups. Conclusions: Stabilizing exercises program focusing on transverse abdominis and pelvic floor muscles contraction can increase the stability of pelvic girdle, reduce pregnancy-related pelvic girdle pain and improve quality of life. However, more well-designed studies were needed to provide stronger evidence in clinical practice.

並列關鍵字

Pelvic girdle pain ； Exercise ； Stabilizing exercise ； Pregnancy ； Physical therapy