Self-administered Tests for Pelvic Girdle Pain in Pregnancy

Results

The 123 women who performed the self-administered tests before the visit to the clinic were on average 30.7 (SD 4.5) years of age, in gestational week 22 (SD 4.7) and pregnant with their second child (min 0- max 4). The women were well distributed as concerns educational level and sedentary vs. active lifestyle.

Results of the self-administered tests and the tests performed at the clinic are given in Table 1 . There were significantly higher numbers of positive P4 and bridging tests during the visit compared to positive self-administered tests (P = 0.036 and 0.001 respectively). There were significantly lower numbers of positive modified Trendelenburg tests (anterior p < 0.001, posterior p < 0.016) ASLR and SLR (both p < 0.001) during the visit compared to positive self-administered tests.

The percentage of agreement, sensitivity and PPV between the self-administered tests and the tests done by the examiner during the visit was calculated. Results are given in Table 2 . Of the evaluated tests for posterior PGP the P4 and bridging tests had the highest percentage of agreement (77.2 and 74.8%), sensitivity (80.6 and 75.5) and PPV (91.2 and 92.8%). Of the two tests for anterior pelvic pain the MAT test had the highest percentage of agreement (76.4%) and PPV (69.5%) but the modified Trendelenburg test had the highest sensitivity (93.0%).

The percentage of agreement between P4 performed by an examiner and the self-administered bridging test was 78% and the sensitivity 77%. The percentage of agreement and sensitivity between the palpation of the symphysis and the self-administered MAT test were found to be 65% and 67%.

Of the 123 women with a positive pain drawing and pain history according to the questionnaire, 109 also had positive self-administered tests. One hundred and eleven women were classified with PGP by the examiner. There was no significant difference between the proportion of women who were classified with PGP by the self-administered tests and questionnaire and during the visit (p = 0.845). Of the 118 women classified with PGP either based on results from self-administered tests and response to questionnaire or based on classification of the examiner, nine were classified only by self-administered tests combined with response to questionnaire, seven only during the visit. The agreement between both classifications of the examiner and what was reported in the self-administered tests combined with questionnaires was 87% (n = 102) ( Table 2 ).

Table 1. Number of positive self-administered tests performed at home and positive tests performed by an examiner on women with suspected PGP and classification made by an examiner and based on results of the self-administered tests plus questionnaire.
Test	Positive test during the visit, n = 123	Positive self-administered test, n = 123	P-value between the groups
Posterior pain
Positive P4, n	103	91	0.036
Positive Patrick Faber test, n	73	83	0.174
Positive, modified Trendelenburg test, n	54	71	0.016
Positive bridging test, n	102	83	0.001
Anterior pain
Positive palpation of the symphysis, n	60	n.a
Positive modified Trendelenburg test, n	43	97	<0.001
Positive MAT test, n	52	59	0.265
Additional tests
ASLR, 0–10	2 (0–10)	4 (1–10)	<0.001
Positive ASLR (≥1), n	83	105	<0.001
SLR, n	0	23	<0.001
Diagnosis
Fulfilling the criteria for classification of posterior pain, n*	103	99	0.481
Fulfilling the criteria for classification of anterior pain, n*	52	50	0.845

N or median (min-max).
n.a. not applicable.
*Classification during the clinical visit: pain experienced between the posterior iliac crest and the gluteal fold or in the symphysis, weight-bearing related pain, diminished capacity to stand, walk and sit, positive clinical diagnostic tests and no nerve root syndrome [3]. Classification based on the results of the self-administered tests and questionnaires: pain drawing with well defined markings of pain over the gluteal area or the symphyseal joint, a history of weight-bearing related pain in the pelvic girdle, positive self-administered tests and no nerve root syndrome.

Table 2. The proportion of positive and negative tests, percentage of agreement (POA), sensitivity and PPV
Test	Both +	Both -	Visit + home -	Visit - home +	POA	Sensitivity	PPV
Posterior pain
P4	67%	10%	16%	7%	77.2	80.6	91.2
Patrick Faber test	46%	19%	14%	22%	64.2	76.7	67.5
Modified Trendelenburg test	33%	31%	11%	25%	51.3	56.3	74.1
Bridging test	63%	12%	20%	5%	74.8	75.5	92.8
Anterior pain
Modified Trendelenburg test	33%	18%	2%	47%	50.4	93.0	40.8
MAT test	33%	43%	9%	15%	76.4	78.8	69.5
Additional tests
ASLR, 0–10					38.2	78.9
Positive ASLR (≥1), n	66%	13%	2%	20%	78.9	97.6	77.1
SLR	0%	81%	0%	19%	81.3	0	0
Diagnosis
Fulfilling the criteria for diagnosis	83%	4%	7%	6%	87.0	91.9	93.6