Body mechanics among pregnant women with lumbopelvic pain: A cross- sectional study

doi:10.21203/rs.3.rs-2219614/v1

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Body mechanics among pregnant women with lumbopelvic pain: A cross- sectional study

https://doi.org/10.21203/rs.3.rs-2219614/v1

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This cross-sectional study aimed to assess the knowledge and practice of body mechanics (BMs) among pregnant women with lumbopelvic pain (LPP) and to determine the association between LPP and BMs. The study was conducted using a purposive sample of 110 pregnant women with LPP. A structured questionnaire was used to collect data. Descriptive statistics, a chi-square test (X2) (α = 5%), and a multinomial regression model were used. More than half (53.6%) of the participants were knowledgeable about BMs, and 55.5% did not perform their daily activities correctly. There was a significant association between the level of BMs knowledge and the severity of pain (p = 0.024), and the level of practice was significantly associated with pain severity (p = 0.038). The odds ratio (OR = 5.105) was higher among those with severe pain and those who did not practice correct BMs. The odds ratio (OR = 4.581) was higher among those with very severe pain and poor knowledge of BMs. Inadequate knowledge and limited practice of daily activities according to BMs principles were significantly associated with pain intensity in pregnant women with LPP in the 14th − 30th weeks of gestation.

Body mechanic

daily activities

knowledge

lumbopelvic pain

pregnancy

Pregnancy-related physical and psychological changes can cause musculoskeletal disorders, such as pregnancy-related low back pain (LBP) and/or pelvic girdle pain (PGP). LBP is "pain or discomfort between the 12th rib and the gluteal fold," and PGP is "pain experienced between the posterior iliac crest and the gluteal fold." Both conditions are common during pregnancy (Morino et al., 2017). When both are displayed together, it is defined as lumbopelvic pain (LPP). The prevalence of LPP during pregnancy ranges from 20–90%, with most studies reporting a prevalence of > 50% (Bryndal et al., 2020). Pregnant women usually have decreased health-related quality of life (QoL) and are much more likely to experience LPP. It impairs daily functioning and increases sick leave (Aragão, 2019).

The pathophysiological mechanisms associated with LPP during pregnancy are currently unknown. The main physiological and anatomical changes that lead to LPP development include maternal weight gain, fetal enlargement, increased uterine volume, abdominal muscle stretching, increased lumbar lordosis, pelvic anteversion, and adjustment of body posture and alignment. Besides hormonal changes that lead to increased muscle–tendon and joint laxity, all these modifications cause changes in the pattern of load on the tendons, ligaments, and joints in the LP region, leading to the development of LBP (Aragão, 2019; Sonmezer et al., 2021). The first LBP was experienced by many pregnant women during pregnancy (Manyozo, 2019).

Many LPP risk factors have been investigated, including obesity, sedentary lifestyle, LBP or trauma history, increased gestational age, and decreased maternal age (Mota et al., 2015). Postural changes resulting from pregnancy have also been considered risk factors (Morino et al., 2017). Despite these negative experiences during pregnancy, women continue their daily activities such as home tasks, self-care, and caring for others. These activities require standing, walking, bending, and lifting with/without instruments. If improperly practiced, these activities can cause LBP during pregnancy despite poor posture and body mechanics (BM)(Dewi et al., 2017).

Body mechanics and position adjustments help individuals perform daily tasks safely and maintain the right action best; whether standing, sitting, or lying down, the strain on the joints, muscles, tendons, and ligaments is minimized (Toraman et al., 2014; Kang, 2017). BMs should be correctly used for every activity, even at rest (Kaur et al., 2018). The American Occupational Therapy Association recommends information about pain management, posture education, joint protection, and BMs, as well as making adaptations to the workplace and home environments essential for pregnant women (APA, 2018).

Women during pregnancy in developing countries cannot avoid their duties as housewives; they have to bend, lift, carry, push, and pull without regard for the principles of BMs. Several studies have been conducted on occupational needs, such as ergonomics and body posture during pregnancy; however, the home environment is limited. Thus, this study aimed to investigate the level of knowledge and practice concerning BM among pregnant women with LPP at home. Understanding pregnancy-related LPP and its association with incorrect BMs while performing daily activities is critical for improving antenatal care quality.

Patients and study setting

A quantitative cross-sectional study was conducted in five selected antenatal care units (ANCs) (Qaywan, HamaRash, Karezawishik, Chwarbax, and Mamostyan) among all local primary healthcare centers (PHCs) in the Sulaimaniyah Governorate, Iraq. The list of PHCs was obtained from the Director of Health (DoH), and the selection was dependent on crowdedness. The ANC unit is the first public healthcare clinic visited by women during pregnancy and postpartum. The ANCs were visited weekly for three days, from 9.0 am to 1.0 pm to recruit samples, from the first week of October 2020 to the end of October 2021. In a total of 311 pregnant women, 110 completed the registration using purposive and non-probability samplings (Diagram 1).

Inclusion Criteria

Patients aged ≥ 18 years with a singleton pregnancy of gestational age 14–30 weeks that had LPP in the lower back or pelvic region were included in this study.

Exclusion Criteria

Women with obstetric comorbidities, a history of disc prolapses, trauma, or surgery at the lumbar spine or pelvis were excluded.

Questionnaire

An administered questionnaire was used to collect data from pregnant women, including sociodemographic data (age, education, occupation, gestational body mass index (BMI), type of previous delivery, gestational age, obstetric information related to LPP, and history of LBP).

Then, the valid and reliable numerical rating score (NRS) (Alghadir et al., 2018), which was adopted by (Wikström et al., 2019) to assess LPP intensity was used that is a straight line with symbols spaced 1.0 cm apart and scored from 0 to 10. The participants rated pain intensity by circling one number that includes 0: no pain, 1–2: mild pain, 3–5: moderate pain, 9: severe pain, and 10: very severe pain.

LPP was confirmed to have pain between the 12th ribs and gluteal fold (Morino et al., 2017), and the participants were asked to pinpoint the area of pain. The diagnosis of LBP is usually based on symptoms owing to the few existing diagnostic tests and scales (Bryndal et al., 2022). Therefore, pain onset was the final question regarding pregnancy-related LPP.

Another tool was a self-administered/created questionnaire based on a literature review (Toraman et al., 2014; Wanless, 2017; Manyozo, 2019; Bryndal et al., 2020). This part comprises 44 illustrations arranged in six dimensions; 1. standing (four images), 2. sitting on the ground (six images); 3. sitting on a chair (10 images), 4. carrying and lifting (eight images), 5. housework (eight images), and 6. sleeping position out of bed (eight images)). Seven academic experts (two physiotherapists, two professional nurses, an obstetrician with two rheumatologists, and a rehabilitation doctor) assessed the questionnaire for validation. In addition, a pilot study was conducted for simplicity and clarity in ten pregnant women. The number then decreased from 68 to 44 that coveres10 to 15 minutes. These illustrations demonstrate that most basic activities of daily living (BADL) are performed locally by pregnant women. According to the World Confederation for Physical Therapy, BADL are defined as activities that cover domains such as dressing, eating, mobility, toileting, and hygiene (Bianco et al., 2014). In this study, these six dimensions were considered BADL. All the images displayed a mixture of 50% proper and 50% improper BMs, which were used to assess the two main objectives.

Study Protocol

First, participants’ knowledge of BM was assessed by selecting one scale (0 = I do not know; 1 = Incorrect; and 2 = Correct). Second, a scale was used to determine the practical aspects of BM by selecting one score (0 = never, 1 = sometimes, and 2 = always). The questionnaire was prepared in English and translated into Kurdish, which the participants easily answered. Cronbach's alpha was used to measure the reliability and internal consistency of both questionnaires. First, BM knowledge was (0.881), and second, BM practice frequency was (0.810), which shows a high level of internal consistency for our scale with this specific sample. It was performed to test this study's instruments' clarity, validity, and applicability and to evaluate the subject's required time, and it was applied to ten pregnant women. Based on the pilot study's results and the tool's revision by expertise (orthopedic, obstetric, physical therapist, and nurse), and considering their comments, necessary modifications were made. All the participants included in the pilot study were excluded from the study.

Statistical analysis

Data were analyzed using the Statistical Package of Social Sciences (SPSS; version 27.0). All analyzed data for categorical variables were interpreted using descriptive statistics, frequencies, and percentages. The chi-squared test (X2; α = 5%) was used to measure significant associations between categorical variables, and the significance level (P-value) was set at > 0.05. A multinomial regression model was used to obtain odds ratios (OR), and a 95% confidence interval (CI) was calculated.

Most participants (71%) were young (≤ 30 years), followed by 28% in the ≥ 31-year age group. The majority (44.50%) of BMI belonged to the group (25–30 kg/m²), followed by one-third (30%) within the group (30–35 kg/m²); besides the heterogeneity in gestational age, a minimum to a maximum of 14 to 30 weeks. Most women (70.9%) were housewives, and most (64.5%) had university degrees. Over two-thirds (73.6%) of the participants were not physically active, and 96.4% of them stated that they had not participated in any physical activity. Two-thirds (61.8%) were multi- or grand-multi, and nearly half (49%) were primipara. Two-fifths (41.8%) of participants had a history of previous pregnancy LB.

Half (50%) of the subjects had experienced severe pain, followed by very severe pain intensity, which was reported by over one-third (36.4%) of the pregnant women (Fig. 1). In addition, there is a discrepancy between the level of knowledge and practice of BM among subjects, as 55.5% performed daily activities inappropriately, while 53.6% were knowledgeable about correct BM (Fig. 2).

The participants were used to standing in a mixed manner between incorrect (74.6%) or correct (61.8%). For sitting on the ground, the majority (62.7%) sat in a bad posture, and 69.8% slept in a poor alignment. On the other hand, the participants usually habituated to perform their daily activities in both directions (correct & incorrect) BM, nearly at the same rate, such as lifting (incorrect 64.5% & correct 74.4%), house working (incorrect 62.5% & correct 79.5%) and in-out-bedding (incorrect 70% & correct 80.9%), and the same for sitting on the chair (Fig. 3).

Participants reported a higher rate (90.9%) of sleeping on their sides and lying without using a pillow between their legs for support and alignment. Regarding the house working, most (82.2%) participants stood in the kitchen straightly and near the surface with broad base support symmetrically. A higher percentage (81.8%) commonly lifted an item on the ground with half-kneeling, a straight spine, and legs and arms to stand. The fourth most famous action was in-out bedding (80.9%). Pregnant women use their arms for support while lying down on their sides and raising both bent legs together. In the standing posture, most (79.1%) of pregnant women preferred to stand with shifting body weight to one side, asymmetrically, and in hyper-lordotic posture. Most of them were habituated to sitting cross-leg on the ground (76.4%), and their appearance was rounded back, slouching posture, rounded shoulders, and a protruding neck. Most (74.6%) preferred using a pillow to support their lower back and reclining backward, comfortable with flat feet supported on the ground while sitting on a chair (Diagram 2).

Furthermore, there wasn’t a significant association between age (P = 0.557), occupation (P = 0.012), and physically active (before and currently) (P = 0.506 and 0.54) and the severity of pain. In disparity, there was a significant association between BMI and level of education (P˂0.05) (Table 1). At the same time, a significant association was found between the obstetric variables, including gestational age, gravida, para, abortion, and cesarian section (CS) with pain intensity (P˂0.05). However, there was no significant association between normal vaginal delivery (NVD), anesthesia type, and pain severity (P˃0.05) (Table 2).

Table 1

Association between women’s socio-demographic data and pain intensity.
Variable	Pain intensity				Total	P-value
Variable		Moderate (4–6)	Severe (7–9)	Very severe (10)	Total	P-value
Age (Year; Binned)
≤ 24.0	Count	6.0	16	10	32	0.557
≤ 24.0	%	18.8	50.0	31.2	100
25.0–30.0	Count	7.0	25	15	47
25.0–30.0	%	14.90	53.2	31.9	100
31.0–36.0	Count	1.0	12	11	24
31.0–36.0	%	4.20	50.0	45.8	100
37.0+	Count	1.0	2.0	4.0	7.0
37.0+	%	14.30	28.6	57.1	100
Body mass index (kg/m²; Binned)
≤ 25.0	Count	7.0	12	9.0	28	0.026*
≤ 25.0	%	25.0	42.9	32.1	100
25.01–30.0	Count	8.0	27	14	49
25.01–30.0	%	16.3	55.1	28.6	100
30.01–35.0	Count	0.0	16	17	33
	%	0.0	48.5	51.5	100
	%	13.6	50.0	36.4	100
Education level
Primary and secondary	Count	1.0	21	17	39	0.039*
Primary and secondary	%	2.6	53.8	43.6	100
University	Count	14	34	23	71
University	%	19.7	47.9	32.4	100
Occupation
House Wife	Count	14	37	27	78	0.12
House Wife	%	17.9	47.4	34.6	100
Working	Count	1.0	18	13	32
Working	%	3.1	56.2	40.6	100
Physically active (before pregnancy)
Yes	Count	4.0	12	13	29	0.506
Yes	%	13.8	41.4	44.8	100
No	Count	11	43	27	81
No	%	13.6	53.1	33.3	100
Physically active (currently)
Yes	Count	0.0	3.0	1.0	4.0	0.54
Yes	%	0.0	75.0	25.0	100
No	Count	15	52	39	106
No	%	14.2	49.1	36.8	100
*: Significant difference

Table 2

Association between patient’s obstetric history characteristics and severity of pain.
Variable	Pain intensity					P-value
Variable		Moderate (4–6)	Severe (7–9)	Very severe (10)	Total	P-value
Gestational age (Week)
≤ 18	Count	5.0	6.0	10	21	0.004*
≤ 18	%	23.8	28.6	47.6	100
19–24	Count	9.0	17	16	42
19–24	%	21.4	40.5	38.1	100
25–30	Count	1.0	32	14	47
25–30	%	2.1	68.1	29.8	100
Gravida
Primigravida	Count	14	16	12	42	0.000*
Primigravida	%	33.3	38.1	28.6	100
Multi & Grand multi	Count	1.0	39	28	68
Multi & Grand multi	%	1.5	57.4	41.2	100
Para
Primipara	Count	14	24	16	54	0.001*
Primipara	%	25.9	44.4	29.6	100
Multipara	Count	1.0	31	24	56
Multipara	%	1.8	55.4	42.9	100
Abortion
No	Count	15	35	32	82	0.01*
No	%	18.3	42.7	39.0	100
Yes	Count	0.0	20	8.0	28
Yes	%	0.0	71.4	28.6	100
Normal Vaginal Delivery (NVD)
Non	Count	14	40	30	84	0.242
Non	%	16.7	47.6	35.7	100
NVD	Count	1.0	15	10	26
NVD	%	3.8	57.7	38.5	100
Cesarean section
Non	Count	15	37	23	75	0.01*
Non	%	20.0	49.3	30.7	100
≥ 1	Count	0.0	18	17	35
≥ 1	%	0.0	51.4	48.6	100
Type of anesthesia in cesarian section cases
Non	Count	15	36	23	74	0.21
Non	%	20.3	48.6	31.1	100
Spinal	Count	0.0	17	12	29
Spinal	%	0.0	58.6	41.4	100
General anesthesia	Count	0.0	2.0	5.0	7.0
General anesthesia	%	0.0	28.60	71.40	100
*: Significant difference

Moreover, there was a significant association between the severity of the pain and the history of the previous LBP with pregnancy and without pregnancy (P˂0.05). At the same time, there was no significant association between the severity of pain and consulting clinical professionals and family history with LBP (P˃0.05) (Table 3).

Table 3

Association between patient’s lower back pain history characteristics and severity of pain.
Class		Pain Intensity			Total	P-value
Class		Moderate (4–6)	Severe (7–9)	Very severe (10)	Total	P-value
Complain of lower back pain in her previous pregnancy
No	Count	15	27	22	64	0.002*
No	%	23.40	42.2	34.4	100
Yes	Count	0.0	28	18	46
Yes	%	0.0	60.9	39.1	100
Complain of lower back pain before being pregnant
No	Count	13	30	20	63	0.042*
No	%	20.6	47.6	31.7	100
Yes	Count	2.0	25	20	47
Yes	%	4.3	53.2	42.6	100
Consult any health professionals for her current lower back pain
No	Count	14	37	28	79	0.132
No	%	17.7	46.8	35.4	100
Yes	Count	1.0	18	12	31
Yes	%	0.32	58.1	38.7	100
Other family members are complaining of lower back pain
No	Count	4.0	18	10	32	0.698
No	%	12.5	56.3	31.3	100
Yes	Count	11	37	30	78
Yes	%	14.1	47.4	38.5	100
*: Significant difference

Additionally, there was a significant association between BM practice and pain intensity (P˂0.05). This result was clarified by the lower scores (0–21 = Not done) that show the incorrect performance of BM significantly associated with the severity of pain in sequence (42.6%: very severe, 50.8%: severe, and 6.6%: moderate pain) that reported in 61% participants. Conversely, the higher scores (21–44 = Done) express the rate of adherence with correct BM among 49% of pregnant women in association with pain intensity (28.6%: very severe, 49%: severe, and 22.4%: moderate pain). BM knowledge showed a significant association (p˂0.05) with pain intensity. The result demonstrates that higher scores (21–44 = good knowledge) were identified as having a higher level of knowledge of BM and less pain severity (25.4%: very severe, 55.9%: severe, and 18.8%: moderate pain) that was found in 59% of the participants. In comparison, a lower score (0–21 = poor knowledge) indicated a lower level of knowledge and higher pain intensity (49%: very severe, 43%: severe, and 8%: moderate pain) in 51% of the subjects (Table 4).

Table 4

Association between patient’s body mechanics (practice & knowledge) and intensity of pain.
Variable		Pain intensity			Total	P-value
Variable		Moderate (4–6)	Severe (7–9)	Very severe (10)	Total	P-value
Body mechanics – Practice (BM-P)
0–21 Score¹	Count	4.0	31	26	61	0.038*
0–21 Score¹	%	6.6	50.8	42.6	100
21–44 Score²	Count	11	24	14	49
21–44 Score²	%	22.4	49.0	28.6	100
Body mechanics – Knowledge (BM-K)
0–21 Score³	Count	4.0	22	25	51	0.024*
0–21 Score³	%	7.8	43.1	49.0	100
21–44 Score⁴	Count	11	33	15	59
21–44 Score⁴	%	18.6	55.9	25.4	100
Total	Count	15	55	40	110
Total	%	13.6	50.0	36.4	100
*Significant difference, 1 = Practice BM incorrectly; 2 = Practice BM correctly; 4 = Poor knowledge, and4 = Good knowledge

On the other hand, we found that those who practiced BM poorly had a higher potential (OR = 3.552) to obtain severe LBP than those who practiced BM correctly. In contrast, potentiality could be increased to 5.107 (OR) in those with very severe pain and poorly practiced BMs compared to those who practiced BMs appropriately. Regarding BM knowledge, those who had a lower level of knowledge about correct BMs had a higher potential (OR = 1.833) time to develop severe BP than those who were aware of the correct BM. In contrast, those with very severe pain and limited knowledge of BM had a higher potential (OR = 4.583) than those who could identify the correct BM (Table 5).

Table 5

Odd ratio and confidence interval of body mechanics (Knowledge & Practice).
Pain intensity	Variable classes	Reference	OR	CI	P-value
Body mechanics - Practice
Severe	Practice BM Incorrectly	Practice BM Correctly	3.552	(1.005–12.552)	0.036*
Very severe	Practice BM Incorrectly	Practice BM Correctly	5.107	(1.37-19.041)	0.036*
Body mechanics – Knowledge
Severe	Poor knowledge	Good Knowledge	1.833	(0.517–6.497)	0.023*
Very severe	Poor knowledge	Good Knowledge	4.583	(1.235–17.008)	0.023*
Multinomial logistic regression model, *: Significant difference, Reference category = moderate

Diagram 3 shows the risk of experiencing severe pain (2.48/3, defined as a score of 8 or higher) increased by 30% among pregnant women who were poorly knowledgeable and inaccurately practiced BMs compared to those who knew how to perform their daily activities correctly. Diagram 4 displays the effects of demographic and obstetric variables on pain intensity as pain severity (2.8/3: over nine scores) increased by 9.1% among multigravida women with a BMI of 30 kg/m² and were in the 2nd trimester. This effectiveness was significant among gravid, para, abortion, no cesarean section, gestational age, education level, and BMI with pain severity. Pregnant women who were primipara, with gestational age between 19th and 24th weeks, and held a university degree faced a 20% increase in pain score (1.59/3 = five scores).

Sociodemographic data, obstetric and LBP history

In this study, BMs were not the only risk factor for pregnancy-related LPP. Previous studies identified several variables as risk factors for LPP during pregnancy. Younger mothers (˂35 years) and those with a BMI ≥ 25 kg/m² were associated with LBP, multiparity (Bjelland et al., 2013), family history of LBP (Toktaş et al., 2015), lack of exercise (Tariq et al., 2020), history of LBP, or previous pregnancy-related LBP. Abortion increases the risk of LBP during pregnancy (Sencan et al., 2018), gestational age (Katonis et al., 2011), higher levels of maternal education (Manyozo, 2019), and previous cesarean sections (Chia et al., 2016). Additionally, cultural and environmental factors may influence the discomfort experienced by pregnant women.

Body Mechanics As Knowledge And Practice

Pregnancy is a risk factor for LPP (Carlson et al., 2003). Although pregnancy progresses, it changes the BMs and posture (Morino et al., 2017) to compensate for this physiological and anatomical transformation. We revealed that most participants habituated their daily activities inappropriately, despite having moderate BM information. However, a significant association between the knowledge of BMs and the severity of pain (P = 0.024) was found, indicating that a higher level of knowledge among participants about preventing LBP during pregnancy can help reduce pain intensity. In addition, the level of practice was significantly associated with pain severity (p = 0.038). This indicated that the higher the habituating daily mobilities according to BMs' principles, the less pain can be experienced during pregnancy. We confirmed that improper BMs (knowledge and practice) were more effective than other risk factors (2 and 3).

Many researchers have investigated BMs and posture as practical skills and knowledge in terms of risk factors, preventive techniques (El-sol et al., 2018), and treatment for LBP among nurses (Ibrahim et al., 2015; Belay et al., 2016; Moustafa et al., 2022), community (Wanless, 2017). However, conservative treatment combined with exercise has been used to manage pregnancy-related LPP (Awad et al.; Ozdemir et al., 2015; Mirmolaei et al., 2018).

Similar to our findings, a cross-sectional study on 24 pregnant women in their third trimester of pregnancy found that those who performed their daily activities according to the principles of BMs had fewer complaints of LBP, and those who did not practice BMs had higher pain scores than those who did (Dewi et al., 2017). A quasi-experimental study investigated the effect of an educational program on the BM performance of 76 nurses. Before the intervention, most nurses had BP, limited knowledge, and poorly experienced BMs. There was a significant difference in nurses' knowledge, practice, pain intensity, and disability between the pre-and post-program phases (Hemed et al., 2017). (Ramadhania et al., 2020) experimented with a group of pregnant women in their third trimester (n = 31) who experienced LBP. The study outcomes showed decreased pain after reforming BM, body posture, and balance training. Pregnant women should know how to get into and out of bed and live down in bed to decrease muscle stiffness, increase blood flow, and keep the spine in a good position and body alignment (APA, 2018). In contrast to this study result, another cross-sectional study on 100 nurses to assess the knowledge and practice of BMs showed that nurses' knowledge (42%) was lower than that of the practice (71%) (Jayakrishnan, 2016).

Pregnancy-related LBP may be strongly associated with body posture and movement, and its management is clinically significant. Another study investigated activities related to LBP during pregnancy (n = 275) over 12 weeks. The pain was evaluated at 12, 24, 30, and 36 weeks, and free-form descriptive answers were used to investigate the movements that produce LBP. Sixteen movements induced LBP, especially sitting up, standing up from a chair, and tossing and turning, all of which are daily activities rather than particular movements that require extra tasks or effort. These results suggest that recommendations for pregnant women regarding basic physical movements, such as ways of standing up to reduce body load, might help manage LBP (Morino et al., 2017). Good posture during pregnancy involves training one's body to stand, walk, sit, and lie in positions with the least strain on the back (Souza et al., 2019). A cross-sectional descriptive study in Pakistan, similar to this study, aimed to assess the knowledge and practice of BM techniques among 216 nurses and 65% had adequate knowledge of BM, while 35% had poor knowledge. As for BM-Practices, 60% practiced BM, while 40% did not. Most nurses knew about BM techniques, but only a few practiced them as the more participants knew about BM, the more they practiced it (Akhtar et al., 2017).

Our results are similar to the outcomes of a study conducted to determine the relationship between body posture and BP among primiparous mothers during the three trimesters in selected ANC. Most antenatal mothers (44%) reported moderate BP, 27% with mild pain, 20% without pain, and 9% reported severe back pain. The highest percentage (78%) of antenatal mothers maintained a poor body posture, whereas 22% maintained a good body posture. A positive correlation (r = 78.92) was found between BP and body posture (Souza & Sandhya, 2019). The importance of a BM does not refer to one group of people or work; every individual must act in any environment. Good BMs should always be used at all times (Kaur et al., 2018).

Education on proper BM and positioning inside and outside of the home are other essential requirements for pregnant women. This education is important for providing safety and increasing tolerance for working longer (Ibrahim & Elsaay, 2015).

The limitation of this study was the style of assessing BM practice, as some participants could not understand the images without assistance. Some participants required more time to complete the questionnaire due to pain. Therefore, future studies assessing BM in locally pregnant women should be conducted. Selecting illustrations does not provide reality as knowledge and practice because they know to bend their knees to lift objects on the ground. Nevertheless, they did not realize the alignment of their spine, legs, and feet and how they should be positioned. Therefore, pregnant women need to have scientific references to consult about their daily mobility and to receive practical information on BM and posture.

Many risk factors enhance the occurrence of LPP in pregnant women, including the history of LBP, weight gain, gestational age, and maternal age. This study showed that maladaptation of body mobility while performing daily activities and inadequate information on BMs were significantly associated with pain intensity in pregnancy-related LPP in the second trimester. Thus, we recommend adding BM as an important subject for training and education in antenatal education programs and repeating the same research among bigger sample sizes locally.

Ethical approval and consent to participate

The study protocol was reviewed and approved ethically and scientifically by the boards of the Nursing College and the University of Raparin (No. 7/29/3634 on November 8^th, 2020). Permission to access ANC units was obtained from Sulaimaniyah DoH and the Director of each PHC. On the other hand, a written informed consent was obtained using the local language (Kurdish) after providing oral information on the aim of the study with a hand sheet. This code was used in the questionnaire instead of participants' names to ensure privacy and confidentiality. Participants were free to withdraw from the study without any problems or declarations. All methods were performed in accordance with the relevant guidelines and regulations of Declaration of Helsinki.

Consent for publication

Not applicable

Data availability statement

Data presented in this study are available upon request from the corresponding author.

Author contributions

BOM, HMA, and SKM: Conceptualization, design, data analysis and interpretation, and critical review. HMA and SKM: Supervision and consulting. BOM: Resources, funding, materials, data collection and processing, and manuscript writing.

Funding

This study did not receive external funding.

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

The authors acknowledge the Nursing College at the University of Raprin, Director of Health in Sulaimaniyah city, all the participants, all the antenatal staff, the statistical team (Sigma-Square), and the nurse; Mrs. Chawan Abobaker for admitting the study’s data.

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Diagrams 1 to 4 is available in the Supplementary Files section.

No competing interests reported.

d1.png
Diagram 1. A Flow chart of the study samples.
d2.png
Diagram 2. illustrates the most popular frequency of performance in the seven dimensions of daily activities among participants.
d3.png
Diagram 3. shows the risk of experiencing severe pain. Pain intensity level = y, BM-practice = x1, and BM-knowledge = x2
d4.png
Diagram 4. Displays the effects of demographic and obstetric variables on pain intensity. #Pain intensity level= y, Education level = x1, Gravida = x2, Para = x3, Abortion = x4, No. Cesarean section = x5, BMI= x6, and Gestational age = x7

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Body mechanics among pregnant women with lumbopelvic pain: A cross- sectional study

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Abstract

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Introduction

Methodology

Patients and study setting

Inclusion Criteria

Exclusion Criteria

Questionnaire

Study Protocol

Statistical analysis

Results

Discussion

Sociodemographic data, obstetric and LBP history

Body Mechanics As Knowledge And Practice

Conclusions

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References

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Additional Declarations

Supplementary Files

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