Author Names
Munoz-Gomez, Elena. et al
Reviewer Name
Kayla Contreras, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Program
Paper Abstract
A randomized controlled trial was carried out to assess the effectiveness of a manual therapy protocol in terms of the clinical characteristics, quality of life, and emotional condition of the women with endometriosis-related pelvic pain. Forty-one women (mean age of 36.10 (6.97) years) with pelvic pain due to endometriosis were randomly divided into (i) a manual therapy group (MTG) (n = 21) and (ii) a placebo group (PG) (n = 20). Both groups received an 8-week intervention. Pain, lumbar mobility, endometriosis health profile, quality of life, depression and anxiety levels, and the patient’s perception of change were assessed before (T0) and after (T1) the intervention, as well as at a one-month follow-up (T2) and a six-month follow-up (T3). The MTG significantly improved pain intensity, powerlessness, lumbar mobility, and physical quality of life at T1 (p < 0.05). The results were maintained for pain intensity at T2 and T3. In addition, both the MTG and PG improved emotional wellbeing at T1 (p < 0.05). Neither group improved in terms of social support, self-image, and depression and anxiety levels after the intervention (p > 0.05). In conclusion, manual therapy may be an excellent complement to the gynecological treatment of endometriosis-related pelvic pain by alleviating pain and improving women’s endometriosis health profile and physical quality of life.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Cannot Determine, Not Reported, or Not Applicable
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Pain often persists after the treatment of endometriosis as nociplastic pain so finding alternative treatments to relieve the patient of pain is a difficult challenge.
Key Finding #2
Changes in pelvic pain were maintained after both the one and six-month follow-ups
Key Finding #3
Emotional well-being also improved after the placebo intervention likely due to the “hands-on” effect or feeling of being treated.
Please provide your summary of the paper
The results of the study showed that manual therapy can be a helpful treatment to women with endometriosis by improving pelvic pain, the endometriosis health profile, and physical quality of life. Chronic fatigue and pain-catastrophizing thoughts have been related to functional limitations in this population leading to deconditioning and a lack of musculoskeletal flexibility. Therefore by applying manual therapy to the lumbar region the MTG showed significant improvements in lumbar mobility compared to the PG. A limitation to this study however, is that it used manual therapy techniques for multiple regions of the spine (cervical, thoracic, lumbar) therefore the positive results of the study as a whole cannot be narrowed down to a single manual therapy technique unless measuring that single region. The results of the MTG and PG showed that the use of manual therapy is a valuable tool to use when treating pelvic pain due to endometriosis, but does not show effects for the emotional status of the patients (anxiety and depression). In the future, combining the use of manual therapy as well as treatments to tackle the mental side effects of endometriosis (yoga, breathing strategies, cognitive therapy) would be a successful way to treat future patients.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
I think this study showed that even after the treatment of the a patient’s diagnosis, they may still experience pain. It is up to the clinician and their healthcare team to provide the patient with the resources and connections to treat their pain as much to our ability. The findings of this study can impact clinical practice by referring patients with endometriosis or other pelvic pathologies to physical therapy to see if manual therapy may benefit them. It also reminded me that we have to treat our patients holistically as well. If manual therapy is treating the patient’s physical symptoms but they are still showing mental health symptoms I could refer them to a cognitive therapist or discuss breathing treatments, yoga, or other calming exercises they could use. I will implement these results by keeping my mind open to all treatment approaches and by also trying manual therapy with patients if I feel that it could benefit them and increase their functional mobility.
