PROMOTE study protocol

Question 1

effect of OMT on low back pain and functional status in pregnant women

Answer 1

OMT lessens or halts the deterioration in back-specific functioning that often characterizes the 3rd trimester of prenancy and thereby provides an important clinical benefit.

Question 2

hypothesis of PROMOTE

Answer 2

OMT protocol would improve low back pain and functional status in the 3rd trimester of pregnancy and reduce the inciddence of certain complications of pregnancy, labor and delivery.

Question 3

rationale for treating OA joing

Answer 3

attachment site for many cervical muscles
become hypertonic because of alteration of posture during pregnancy
vagus nerve course

Question 4

rationale for treating cervical vertebrae

Answer 4

phrenic nerve and thoracoabdominal diaphragm

Question 5

rationale for treating clavicles and sibson fascia

Answer 5

lymph system

strain pattern in sibson fascia may decrease caliber of lymphatic vessels and their ability to return lymph

Question 6

rationale for treating thoracoabdominal diaphragm and lower 6 ribs

Answer 6

uterus expansion restricts diaphragm motion –> affect ventilation, rib and spine movement, venous and lymphatic fluid flow, and digestion

Question 7

rationale for treating thoracolumbar junction

Answer 7

attachment site for crura of diaphragm
position and motion of the thoracolumbar vertebrae affect function of diaphragm

also, sympathetic nervous supplly to the uterus and pelvic organs is from T12-L2. Improve autonomic tone of uterus

Question 8

rationale for treating pelvic diaphragm

Answer 8

improve mobility and supportive ability of pelvic diaphragm, decrease neural impingement.

prone to lymphatic congestion; improve flow to –> decrease constipation, hemorrhoids, perineal lacerations

Question 9

rationale for treating innominates

Answer 9

thought to directly decrease low back pain and improve funcitonal status

help restore mobility of bony pelvis

Question 10

rationale for treating sacrum

Answer 10

improve mobility and alignment so fetus has uncompromised path of descent

affect parasympathetic neural tone, preventing poor cervical dilation

Question 11

rationale for treating hips

Answer 11

affect alignment of innominates and sacrum –> gait.

improve position and mobility of these structures and associated myofascial components

Question 12

rationale for treating cranium

Answer 12

normalize function of cerebrospinal fluid

Question 13

outcomes

Answer 13

OMT effective for mitigating pain and functional deterioration compared UCO (usual care only) treat but not significantly different from PUT (placebo ultrasound)

no higher likelihood of conversion to high risk status

OMT- safe, effective adjunctive modality to improve pain and functioning during 3rd trimester