Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jul 23, 2021
Date Accepted: Mar 18, 2022
Investigating the efficacy of an 18-week postpartum rehabilitation and physical development intervention on occupational physical performance and musculoskeletal health in United Kingdom servicewomen: Protocol for an independent group study design
ABSTRACT
Background:
Postpartum women are at increased risk of pelvic floor dysfunction, musculoskeletal injury, poor psychological health, and have reduced physical fitness compared with pre-pregnancy. There is no formal, evidence-based rehabilitation and physical development program for returning UK servicewomen to work following childbirth.
Objective:
To examine the efficacy of a rehabilitation and physical development intervention for returning postpartum UK servicewomen to occupational fitness.
Methods:
Six weeks following childbirth, eligible servicewomen will be assigned to a training or control group in a non-randomized controlled trial. Group allocation will be based upon the location of standard pregnancy/postpartum care. The control group will receive standard care, with no prescribed intervention. The training group will start an 18-week core and pelvic health rehabilitation program from 6 weeks postpartum and a 12-week resistance and high-intensity interval training program from 12 weeks postpartum. All participants will attend four testing sessions at 6, 12, 18, and 24 weeks postpartum for the assessment of occupational physical performance, pelvic health, psychological wellbeing and quality of life, and musculoskeletal health outcomes. Occupational physical performance tests will include vertical jump, mid-thigh pull, seated medicine ball throw, and a timed 2km run. Pelvic health tests will include the Pelvic Organ Prolapse Quantification system; the Power Endurance Repetitions Fast Every Contraction Timed scheme for pelvic floor strength; musculoskeletal physiotherapy assessment; Pelvic Floor Distress Inventory 20 questionnaire; and, the International Consultation on Incontinence Questionnaire – Vaginal Symptoms. Psychological wellbeing and quality of life tests will include the World Health Organization Quality of Life questionnaire and the Edinburgh Post Natal Depression Scale. Musculoskeletal health outcomes will include: body composition; whole body areal bone mineral density; tibial volumetric bone mineral density, geometry, and microarchitecture; patella tendon properties; muscle architecture; muscle protein and collagen turnover; and, muscle mass and muscle breakdown. Data will be analyzed using linear mixed effects models, with participants included as random effects, and group and time as fixed effects to assess within- and between-group differences over time.
Results:
This study received ethical approval in April 2019 and recruitment started in July 2019. The study was paused in March 2020, due to the COVID-19 pandemic. Recruitment re-started in May 2021. Results are expected in September 2022.
Conclusions:
This study will inform best practice for the safe and optimal return of postpartum servicewomen to physically and mentally demanding jobs. Clinical Trial: ClinicalTrials.gov NCT04332757 https://clinicaltrials.gov/ct2/show/NCT04332757
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