Improvement in Quality of Life for Six Pregnant Patients Undergoing Chiropractic Care: The Promise of PROMIS

CASE SERIES

Improvement in Quality of Life for Six Pregnant Patients Undergoing Chiropractic Care: The Promise of PROMIS

Joel Alcantara, DC Bio & Jeanne Ohm, DC Bio

Journal of Pediatric, Maternal & Family Health - Chiropractic ~ Volume 2013 ~ Issue 1 ~ Pages 11-14

Abstract

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Introduction: The use of health-related quality of life (HRQoL) measures in chiropractic pregnant patients remains virtually non-existent.  In this paper pregnant patients are characterized showcasing the use of the NIH PROMIS program to determine baseline HRQoL measures.

Methods: In addition to describing sociodemographic and clinical data, patient-centered outcomes measures utilizing the PROMIS-29 Profile V1.0 are demonstrated.

Results:   Six pregnant patients (average age=33.33 years) with average parity at 0.33 and mean gestation of 20 weeks are described. Their primary caregivers were obstetrician/gynecologists, nurse-midwives and midwives. All were aware of concurrent chiropractic care. The patients presented with NMS complaints and for wellness care. The PROMIS scoring demonstrated the dynamic nature of the HRQoL domains in pregnant patients with improvements (i.e., fear/anxiety, pain interference and satisfaction with social roles) and decrements (i.e., physical functioning and sleep disturbance) in HRQoL domains.

Discussion:   Evidence-informed practice expects that some aspect of chiropractic patients’ HRQoL measures will have demonstrable improvements. The use of PROMIS within a chiropractic Practice Based Research Network (PBRN) offers promise in this regard.

Conclusion:  Pregnant patients attending chiropractic care within a PBRN are characterized using PROMIS HRQoL measures. The use of valid outcome measures to demonstrate chiropractic effectiveness should be further implemented in research and practice.

Keywords:  Chiropractic, Practice Based Research Network, pregnancy, Health-related quality of life, PROMIS

Breech Pregnancy Corrected with Chiropractic

A case study of a pregnant woman, whose fetus presented breech and was successfully turned with chiropractic care, was published in the Journal of Pediatric, Maternal & Family Health on December 4, 2012. The title of the case study was, Resolution of breech presentation after application of Webster Technique in a 35-year-old female: A case study. The 35-year-old pregnant woman was in the 30th week of her pregnancy. The woman’s doula (a labor coach or midwife) established that the fetus was in breech position. The woman was in good health and had been receiving chiropractic care for headaches and low back pain with good results for the previous two years. This was the woman’s second pregnancy, with her first child delivered vaginally. Previous studies have determined that breech presentations occur in 3 to 4 percent of all pregnancies, with the often resulting decision to birth by cesarean section rather than vaginally for the safety of mother and baby. Breech presentations often turn after the 35th week of pregnancy, but 87 percent of breech pregnancies are delivered by caesarian section. Though safety is argued as the case for a caesarian section, the rate of morbidity was 3.6 percent in a study of 2,088 women birthing with caesarian section. Fetal morbidity can also result from caesarian section with reports of fetal heart-rate abnormalities, spinal cord injuries, skull fractures, long bone fractures, genital injury, and respiratory problems. A chiropractic examination was performed, and postural abnormalities were found, as well as a decrease of lateral flexion of 5 degrees, and lumbar range of motion significantly decreased due to the pregnancy. Motion palpation found several spinal misalignments, and EMG scans and thermography correlated the determination that spinal subluxations were present in the patient. Chiropractic care began for the woman using Webster’s Technique—a technique that uses sacrum adjustments and trigger point release in the abdomen area to reestablish pelvic function which can allow the fetus to turn to the desired head-down birth position. After four adjustments in four weeks using Webster’s Technique, the fetus turned from the breech position to the normal birth position. A healthy female baby was delivered vaginally by the mother at a home birth. The use of the Chiropractic Webster’s Technique resolved a breech presentation, and a possible caesarean section into a normal, natural and healthy birthing experience.

Pregnant Women with Low Back Pain Helped by Chiropractic

A qualitative study of pregnant women with low back pain, and their chiropractors was published on Oct. 9, 2012 in Chiropractic & Manual Therapies with the title of "The treatment experience of patients with lowback pain during pregnancy and their chiropractors: A qualitative study". The pregnant women, all in their second or third trimester and suffering with low back pain, were interviewed by the study’s authors to investigate their feelings about the experience of chiropractic care during their pregnancy. Anonymity and confidentiality of the study’s respondents were protected by assigning a number to each respondent. Low back pain is a common symptom during pregnancy. Between 50 to 80 percent of pregnant women report low back pain during pregnancy because of hormonal, postural, and structural adjustments to the body. Chiropractic care for low back pain during pregnancy is safe and effective according to previously published studies and reviews. Positive results with no adverse effects were experienced by all the pregnant women in the study. A reduction in low back pain, increase in range of motion, and better function were some of the reported experiences. “It really allowed me to function. I could barely walk before or stand, the pain was intense, but after I went to the chiropractor I found I could function day to day, I could walk from the bus stop to work, I could do these things, so that was pretty significant. It’s just helping me function. It’s just teaching me how to pick up my daughter so I don’t hurt myself. To still function, to still play with my daughter and be able to go to the grocery store and do all these things without really hurting myself. As well as it allows me to sleep at night,” said patient number 05. In addition to the reduction or elimination of lower back pain, some of the pregnant women reported that chiropractic care increased their overall quality of life, and increased mobility. “I can walk longer periods of time. So that’s excellent. I can go standing for four to five hours. Because prior to that I’d be standing 40 minutes to do the dishes and I’d be in agony. Even the basic things, like picking things up off the floor, you’d get stuck in that position, I haven’t experienced that yet [in this pregnancy]. Or just sitting for long periods of time, because I do work an office job from home, so I do sit long periods of time. I know for most people [they] have to get up and stretch for a couple minutes, even in doing that I’ve been doing okay,” said patient number 01. Some respondents had sought chiropractic care for previous pregnancies due to low back pain, and continued with chiropractic care for later pregnancies because of positive results. Pregnant patient number 11 said, “It worked so well the first time, I’d even come away from the appointment feeling better. It was almost an immediate fix. So because of my positive experience the first time, there was no question that I was going to use chiropractic care for the second pregnancy.” The study results conclude that chiropractic care for pregnant women suffering from low back pain is effective for pain relief, increased range of motion, increased mobility, and overall better quality of life. “I think after the treatment, it was decreased pain and increased sense of mobility, increased range of motion and decreased sense of frustration and grumpiness,” said patient number 06.