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Background: Pregnancy-related pelvic girdle pain (PPGP) is a common musculoskeletal condition that affectsphysical functioning, emotional well-being, and everyday life for many women. While the physical symptoms of PPGPare increasingly recognised, there remains a lack of insight into the lived experiences of those affected, particularly inrelation to identity, coping, and family life.

Aim: This study aimed to explore pregnant Norwegian women’s experiences of PPGP, with a particular focus onsymptom burden, coping strategies, and the condition’s impact on quality of life and family dynamics.

Methods: Semi-structured in-depth individual interviews (n=18) were conducted with pregnant womenexperiencing PPGP. Data were analysed using thematic analysis.

Results: The overarching theme, This, too, shall pass, emerged from participants’ narratives, capturing a sharedperception of PPGP as a temporary, though challenging, aspect of the perinatal experience. While some participantsremained hopeful for immediate postpartum relief, others anticipated a longer recovery. The participants described aconstant need to adapt, striving to balance daily responsibilities and self-preservation despite persistent discomfort.PPGP significantly disrupted physical and emotional functioning, disrupted sleep, and hindering routine activities,including work participation. Partner support and social validation emerged as vital coping resources.

Interpretation: Our findings show that PPGP profoundly affects women’s physical, emotional well-being,occupational roles and sense of identity during pregnancy. These insights highlight the need for a holistic, personcentred approach to PPGP in clinical care. Improving professional awareness and the development of patientinformed interventions are essential to support coping strategies, safeguard maternal identity, and reduce the dailyburden of living with PPGP.

Background: Obstetric ultrasound is an important tool, aiding in screening, diagnosis, and surveillance throughout pregnancy.

Aims: To explore obstetric doctors', midwives', and sonographers' experiences and views of obstetric ultrasound in Victoria, Australia. To investigate the increasing role of obstetric ultrasound for clinical management, and the adequacy of resources and training for appropriate use of ultrasound in clinical management.

Materials and Methods: This cross-sectional study forms part of a multi-national CROss-Country Ultrasound Study (CROCUS) exploring the views of consumers and health professionals from high-, middle- and low-income countries. Qualitative studies conducted in several countries informed the construction of a quantitative survey. These quantitative surveys were distributed to 16 hospitals across regional and metropolitan Victoria, Australia. Descriptive statistics were analysed from the responses.

Results: There were 354 questionnaires returned from 106 doctors, 222 midwives, and 26 sonographers. Overall, 72% of respondents held concerns about the potential loss of focus on clinical skills with increasing ultrasound use. Midwives were more concerned about the contribution of ultrasound to medicalisation of pregnancy than were doctors (P < 0.001). Many respondents noted that geographical factors (71%), rather than income levels (53%) influenced access to obstetric ultrasound. Over 90% of doctors and midwives believed additional training for their respective professions in ultrasound would enhance its reach and effectiveness.

Conclusions: Our survey findings confirm that clinicians place high levels of trust in the diagnostic findings of obstetric ultrasound antenatal care in Australia. Access to routine ultrasound could be improved for women in rural and lower-income areas.

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care.

Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies.

Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements.

Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

Background: Obstetric ultrasound is considered important for determining gestational age, identifying single or multiple pregnancies, locating the placenta and fetal anomalies and monitoring fetal growth and pregnancy-related complications in order to improve patient management.

Objectives: To explore health professionals’ perspectives on different aspects of obstetric ultrasound in Tanzania regarding self-reported skills in performing ultrasound examinations and what could improve access to and utilization of obstetric ultrasound in the clinical setting.

Design: Cross-sectional study.

Material and Methods: Data was collected between November and December 2017 using a questionnaire based on previous qualitative research results from the CROss Country UltraSound Study (CROCUS Study). Seventeen healthcare facilities in 5 urban and semiurban municipalities in the Dar-es-Salaam region were included, with 636 health professionals participating (physicians, n = 307 and midwives/nurses, n = 329).

Results: Most health professionals (82% physicians, 81% midwives/nurses) believed that obstetric ultrasound was decisive in the clinical management of pregnancy. Results indicate proficiency gaps across disciplines: 51% of physicians and 48.8% of midwives/nurses reported no or low-level skills in assessing cervical length. Similarly, deficiencies were observed in evaluating the four-chamber view of the fetal heart (physicians: 51%, midwives/nurses: 61%), aorta, pulmonary artery (physicians: 60.5%, midwives/nurses: 65%) and Doppler assessments (umbilical artery: physicians 60.6%, midwives/nurses 56.1%). Compared to midwives/nurses, physicians were significantly more likely to agree or strongly agree that utilization would improve with more ultrasound machines (odds ratio (OR) 2.13; 95% confidence intervals (CI) 1.26–3.61), better quality of ultrasound machines (OR 2.27; 95% CI 1.10–4.69), more training for health professionals currently performing ultrasound (OR 2.11; 95% CI 1.08–4.17) and more physicians trained in ultrasound (OR 2.51; 95% CI 1.30–4.87).

Conclusions: Improving the provision of obstetric ultrasound examinations in Tanzania requires more and better-quality ultrasound machines, enhanced training for health professionals and an increased number of physicians trained in ultrasound use. To further increase the accessibility and utilization of obstetric ultrasound in maternity care in Tanzania, it is essential to provide training for midwives in basic obstetric ultrasound techniques.

Background: Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM.

Methods: The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not.

Results: The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change. Conclusion: We found few studies on this topic. However, there are two promising areas for future study: facet joint space and spinal stiffness. A research strategy should be developed with funding for high quality research centres.

The world’s elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services’ ability to meet this demand. While chiropractic care is gaining recognition for its benefits in treating older adults with musculoskeletal disorders, there is limited scientific literature on chiropractors’ role and experiences in this area. To bridge this gap, we interviewed 21 chiropractors in Great Britain, the Netherlands, Norway, and Sweden. Inductive qualitative content analysis was used to analyse the interviews, and despite differences in integration and regulation between the countries, several common facilitators and barriers in caring for and managing older patients with musculoskeletal complaints emerged. While participants expressed optimism about future collaborations with other healthcare professionals and the integration of chiropractic into national healthcare systems, they also highlighted significant concerns regarding the existing healthcare infrastructure. The participants also felt that chiropractors, with their non-surgical and holistic approach, were well-positioned to be the primary point of contact for older patients. However, there were some common barriers, such as the affordability of care, limited integration of chiropractic, and the need to prioritise musculoskeletal complaints within public healthcare. Our findings suggest that chiropractors experience their clinical competencies as an underutilised resource in the available healthcare systems and that they could contribute to and potentially reduce the escalating burden of musculoskeletal complaints and associated costs among older patients. Additionally, our findings highlight the desire among the participants to foster collaboration among healthcare professionals and integrate chiropractic into the national public healthcare system. Integrating chiropractors as allied health professionals was also perceived to improve coordinated, patient-centred healthcare for older adults.

Obstetric ultrasound is an important tool in managing pregnancies and its use is increasing globally. However, the status of the pregnant woman and the fetus may vary in terms of clinical management, views in the community and legislation. To investigate the views and experiences of Vietnamese health professionals on maternal and fetal health interests, priority setting and potential conflicts, we conducted a cross-sectional study using a structured questionnaire. Obstetricians/gynecologists, midwives and sonographers who manage pregnant women in maternity wards were invited to participate. We purposively chose public health facilities in the Hanoi region of Vietnam to obtain a representative sample. The final sample included 882 health professionals, of which 32.7% (n = 289) were obstetricians/ gynecologists, 60.7% (n = 535) midwives and 6.6% (n = 58) sonographers. The majority of participants (60.3%) agreed that “The fetus is a person from the time of conception” and that maternal health interests should always be prioritised over fetal health interests in care provided (54.4%). 19.7% agreed that the fetus is never a patient, only the pregnant woman can be the patient, while 60.5% disagreed. Participants who performed ultrasounds were more likely to agree that fetal health interests are being given more weight in decision-making the further the gestation advances compared to those who did not perform ultrasounds (cOR 2.47, CI 1.27–4.79: n = 811). A significant proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. While the fetus is often considered a patient with its own health interests, a majority of participants did give priority to maternal health interests. Health professionals appear to favour increased legal protection of the fetus. Strengthening the legal status of the fetus might have adverse implications for maternal autonomy. Measures to restrict maternal autonomy might require close observation to ensure that maternal reproductive rights are protected.

Purpose: The scope of this study is women’s descriptions of symptoms experienced through persistent pregnancy-related lumbopelvic pain (PPLP) as well as their strategies to cope with the condition.

Methods: This is a mixed-method study based on questionnaire responses and inductive interviews with 12 Swedish women with self-reported PLP during pregnancy 2002 partaking in a 12-year postpartum follow-up questionnaire cohort. Test of statistical differences between the interview cohort and the total cohort was performed and the interviews were analysed through inductive qualitative content analysis.

Results: The questionnaire data showed that the interview sample reported significantly more pain than the questionnaire respondents but resembled the questionnaire respondents on most other characteristics. The theme “Balancing avoidance and activity” and its sub-themes illustrate the strategies the participants used to manage their situation on a daily basis. The pain was a constant reminder that led to evaluation of pros and cons for physical, social, and mental activities as well as the search for therapies and treatments.

Conclusions: For the women who participated in the interviews, living with persistent pregnancy-related lumbopelvic pain caused limitations and negatively affected various and major parts of life to a far greater extent than previously known.

Implications for rehabilitation:

• Persisting pregnancy-related lumbopelvic pain affects various and major parts of life, including working, physical and social activities, and psychological well-being.
• Rehabilitation should focus on individualized physical activities and effective coping strategies.
• Effort should be put into helping the patient find fulfilling explanatory reasons for the persisting pregnancy-related lumbopelvic pain.

Background: This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.

Methods: A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS).

Results: Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy.

Conclusions: Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.