Telehealth: Diaphragmatic vs. Pelvic Exercise in Postpartum Pregnancy-related Pelvic Girdle Pain

Primary outcomes

1. Muscle function measures of lumbopelvic muscles

   Time frame: Change from baseline to 8 weeks

   Ultrasonography image for muscle thickness of trunk and back muscles during rest and during active straight leg raise.

   Ultrasonography image for bladder displacement for pelvic floor muscles during rest,maximum contraction and during active straight leg raise

2. Diaphragm thickness

   Time frame: Change from baseline to 8 weeks

   Ultrasonography image for diaphragm thickness during maximum inspiration and expiration (B mode)

3. Diaphragm mobility

   Time frame: Change from baseline to 8 weeks

   Ultrasonography image for mobility during maximum inspiration and expiration (M mode)

4. Diaphragm strength

   Time frame: Change from baseline to 8 weeks

   Ultrasonography image for diaphragm strength during maximal sniff and expiration (M mode). The slope achieved (mm/sec) during the diaphragmatic excursion is used to calculate the velocity of the diaphragmatic contraction

5. Mechanical Property of Thoracolumbar Fascia

   Time frame: Change from baseline to 8 weeks

   The biomechanical and viscoelastic properties of the muscles will be measured using a non-invasive myometer. It automatically calculate and provide the biomechanical and viscoelastic properties of stiffness, frequency, decrement, and stress relaxation time that offer the information of tone, elasticity, stiffness and stress relaxation time of the tested tissue.

6. Functional performance of ASLR fatigue task

   Time frame: Change from baseline to 8 weeks

   Participants lifted the heel of the test leg to 20 cm for as long as possible. Participants were required to maintain pressure in the cuff beneath their back as close to 40 mm Hg as possible. Visual feedback of cuff pressure was provided throughout the task, but no instruction was given on how to affect cuff pressure. Task failure was defi ned as an inability to maintain heel height 10 cm or more off the plinth and/or a change in cuff pressure of 20 mm Hg or more.

7. Functional performance of timed up and go test

   Time frame: Change from baseline to 8 weeks

   Test instructions were given in Norwegian. Translated into English, the instructions were as follows: 'After "ready, set, go" stand up, walk as fast as you can until you cross the white line, turn around, and walk back to the chair and sit down again'. The white line was positioned 3m from the patient's starting position.

   'After "ready, set, go" stand up, walk as fast as you can until you cross the white line, turn around, and walk back to the chair and sit down again'. The white line was positioned 3m from the patient's starting position.

8. Functional performance of 6m timed walk test

   Time frame: Change from baseline to 8 weeks

   Subjects commenced the test in standing with their toes up against the tape marker. Test instructions translated into English were as follows: 'After "ready, set, go", walk as fast as you can up to the last white line without stopping or speaking along the way'. Performances were timed (to the nearest 100th of a second) between the 2m and 8m markers and later converted into speed in metres per second.

9. pain intensity measure of Numeric Rating Scale (NRS)

   Time frame: Change from baseline to 8 weeks

   Numeric Rating Scale (NRS) is a self-reported instrument assessing average pain intensity in currently. Possible score range from 0 (no pain) to 10 (worst possible pain).

10. Disability Level: measure of pelvic girdle questionnaire(PGQ)

    Time frame: Change from baseline to 8 weeks

    pelvic girdle questionnaire(PGQ) is a self-reported instrument assessing pelvic girdle pain intensity in currently. Questionnaire consisting of 20 activity items and 5 symptom items on a 4-point response scale. Possible score range from 0 (no pain) to 100 (worst possible pain).

11. Health-related Quality of Life: Short Form-36 (SF36)

    Time frame: Change from baseline to 8 weeks

    SF-36 include 36 questions constructing into 8 domains (i.e., physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health). The scores of physical and mental components and total are ranged from 0 to 100, with higher scores representing better quality of life

12. Fear Avoidance Belief: Tampa Scale of Kinesiophobia

    Time frame: Change from baseline to 8 weeks

    Fear of movement, fear of physical activity, and fear avoidance will be assessed using the Tampa scale of kinesiophobia (TSK). The TSK is 17-items questionnaire, where patients rate their agreement using 4-points scale. It consists of two subscales including activity avoidance to reflect the activity that may result in an increase in pain or cause injury, and somatic focus to reflect the beliefs and underlying serious conditions

13. Self-Efficacy: Pain Self-efficacy Questionnaire

    Time frame: Change from baseline to 8 weeks

    The pain self-efficacy questionnaire (PSEQ) is a 10-item questionnaire, where patients rate their confidence from 0 points (not at all confident) to 6 points (completely confident). Total scores of the PSEQ is 60 points and a higher score indicates more self-efficacy

14. Parenting Stress Level: Parenting Stress Index-Short Form (PSI-SF)

    Time frame: Change from baseline to 8 weeks

    The PSI-SF is a self-reported questionnaire that consists of 36 items to assess stress related to three aspects including parent-child relationship, parental distress, and difficulties in the parent-child interaction. The subscales for parental distress, parent-child dysfunctional interaction and difficult child, as well as the total stress scale are rated from 1 (strongly disagree) to 5 (strongly agree). The higher the score indicates the greater the stress.

15. Self-perceived Change: Global Rating of Change Scale (GROC)

    Time frame: Change from baseline to 8 weeks

    The GROC rates perceived "overall change" on a 15-point Likert scale, with 7 (labeled "worse") on the left, +7 (labeled "better") on the right, and 0 in the middle (labeled "no change") compared to the baseline.