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

Arthralgia / etiology Attitude of Health Personnel Consensus Humans Models, Theoretical Pelvic Girdle Pain / etiology Sacroiliac Joint

Journal

PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319

Informations de publication

Date de publication:
08 2019
Historique:
pubmed: 7 6 2019
medline: 23 9 2020
entrez: 7 6 2019
Statut: ppublish

Résumé

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. 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. 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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1002/pmrj.12199 PMID: 31169360
pubmed: 31169360
doi: 10.1002/pmrj.12199
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

S11-S23

Informations de copyright

© 2019 American Academy of Physical Medicine and Rehabilitation.

Auteurs

Paul W 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.

Jacek Cholewicki (J)

MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI.

John M Popovich (JM)

MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI.

Angela S Lee (AS)

MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI.

Payam Aminpour (P)

Department of Community Sustainability, Michigan State University, Natural Resource Building, East Lansing, MI.

Steven A Gray (SA)

Department of Community Sustainability, Michigan State University, Natural Resource Building, East Lansing, MI.

Michael T Cibulka (MT)

Physical Therapy Program, Maryville University, St. Louis, MO.

Mel Cusi (M)

School of Medicine, Sydney, University of Notre Dame Australia, Darlinghurst, Australia.

Brian F Degenhardt (BF)

A.T. Still University, Kirksville, MO.

Gary Fryer (G)

College of Health & Biomedicine, Victoria University, Melbourne, Australia.

Annelie Gutke (A)

Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Göteborg, Göteborg, Sweden.

David J Kennedy (DJ)

Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.

Mark Laslett (M)

Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand; Southern Musculoskeletal Seminars, New Zealand.

Diane Lee (D)

Diane Lee & Associates, South Surrey, Canada.

Jan Mens (J)

Department of Rehabilitation Medicine & Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands.

Vikas V Patel (VV)

Department of Orthopaedic Surgery, University of Colorado, Denver, CO.

Heidi Prather (H)

Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.

Bengt Sturesson (B)

Department of Orthopedics, Aleris, Ängelholm Hospital, Ängelholm, Sweden.

Brit Stuge (B)

Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.

Andry 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.

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques de l'appareil locomoteur et du système nerveux › Phénomènes physiologiques du système nerveux › Sensation › Douleur › Arthralgie › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude du personnel soignant › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › Techniques d'investigation › Modèles théoriques › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur pelvienne › Douleur de la ceinture pelvienne › Building a Collaborative Model of Sacroiliac...
questionsmedicales.fr › Appareil locomoteur › Squelette › Articulations › Articulation sacro-iliaque › Building a Collaborative Model of Sacroiliac...