The American Journal of Obstetrics and Gynecology Accepts MOMS Manuscript
Logan Instructor and Graduate Served as First Author
Drs. James George, Clayton Skaggs and their research team have delivered consequential news to more than 45,000 doctors and specialists of obstetrics and gynecology: A multimodal approach to treating low-back and pelvic pain in mid-pregnancy benefits patients more than standard obstetric care.
The highly respected American Journal of Obstetrics & Gynecology has published a manuscript in which a chiropractic physician, Dr. George, serves as the first author. Referred to as “The Gray Journal,” the publication presents its readers with “leading-edge research,” which will now include the work of Drs. George and Clayton Skaggs and their research partners.*
The manuscript, “A randomized controlled trial comparing a multimodal intervention and standard obstetrical care for low-back and pelvic pain in pregnancy,” provides the critical physician audience with evidence of how a chiropractic-led intervention can help
the nearly 50 to 80 percent of pregnant women who suffer from low-back and/or pelvic pain.
“We conducted a randomized trial of 169 women who were between 24 and 28 weeks gestation and suffered low-back and/or pelvic pain,” explained Dr. George, Logan faculty member and April 2004 Logan graduate. “Our research objective was to determine if manual therapies, exercise and education could impact their health, reducing pain and disability.”
The answer they found was, objectively, yes.
The Gray Path
What’s currently available online and soon in the journal’s print publication represents years of work conducting research, compiling raw data, analyzing statistics and developing reports and presentations. Understanding the significance of the study and its publication in this prominent journal requires a re-examination of MOMS – the Musculoskeletal and Obstetric Management Study.
MOMS unfolded in 2006 at the hands of Dr. Clayton Skaggs, an April 1987 Logan graduate and then faculty member, and Michael Nelson, an obstetrician and researcher affiliated with Washington University’s Division of Maternal Fetal Medicine. Driven to remedy the needless suffering of women during pregnancy and eliminate unnecessary costs and pharmaceutical interventions, they assembled research teams and established clinics at Washington University’s Center for Advanced Medicine, Barnes-Jewish and Missouri Baptist hospitals. For five years, their teams would evaluate pregnant patients, 599 in all. The results were startling: 80 percent of pregnant patients reported they were offered no treatment for their pain during pregnancy.
With these foundational findings, Logan earned its first federal research grant of $234,000 to fund an official clinical trial, led by Drs. Skaggs and Nelson, to compare manual therapies to standard obstetric care alone in patients with lowback and pelvic pain. In total, the team earned $750,000 in grants to fund three years of patient study and data collection.
During the clinical trial, the research team randomly assigned its qualified pregnant participants to two groups for care:
- Group 1 patients received standard obstetric care and educational sessions on prenatal care.
- Group 2 followed the MOMS protocol.
The patients’ baseline musculoskeletal examination was divided into two parts:
- Self-reported tests, including both the pain-intensity numerical rating scale and personal pain history questionnaire; and
- Functional tests, which researchers used as secondary measures for comparing the two patient groups to determine the prevalence of musculoskeletal impairments during pregnancy and after treatment. To evaluate functional disability, the team referred to the Quebec Task Force Disability Scale Questionnaire.
Following the baseline examination and evaluation, patients in the MOMS group were seen by members of the health care team every one to two weeks depending on the severity of their symptoms. These patients’ multimodal treatment program included spinal manipulation; soft-tissue therapy; spinal stabilization exercises; and patient education, which emphasized the importance of proper exercise and chiropractic care for the health of the mother and baby.
Research in Practice
In 2010, the team completed its data compilation but faced another two years of work before they could publicize their results. Led by Drs. George and Skaggs, the team began drafting its manuscript and research papers for submission to the journal.
In November, their efforts were rewarded with the journal’s online posting of its results:
“The MOMS group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.
Conclusion: A multimodal approach to low back and pelvic pain in midpregnancy benefits patients more than standard obstetric care.”
“What we’ve learned from this experience is that obstetricians want to help their patients enjoy healthy pregnancies, but they don’t have the time or training to offer the manual therapies we employed during this clinical trial,” explained Dr. George. “These doctors want and need proper referral sources for patients experiencing low-back and pelvic pain during pregnancy. Now, chiropractors can refer obstetricians to this research, which is published in their journal, to validate our role as a trusted resource for proven manual therapies and effective patient care.”
With acceptance from “The Gray Journal,” subsequent print coverage anticipated by early 2013 and presentations to Washington University’s and Saint Louis University’s grand rounds, Dr. George and his research team vow to advance their work on behalf of MOMS.
According to Dr. George, dismissing or mistreating pain during pregnancy poses serious consequences for the expectant mother and her fetus. Persistent musculoskeletal pain can lead to prescribed and non-prescribed medications, which often only mask symptoms and can pose serious complications during pregnancy. Additionally, 30 to 50 percent of pregnant women who develop severe low-back pain face job loss, deterioration of social life and the development of mental and sexual problems.
“By studying a heterogeneous patient population, we found that pain during pregnancy does not discriminate,” offered Dr. George. “Whether the patient comes from an affluent or poor socioeconomic background, women can suffer from painful pregnancies. As chiropractic physicians who specialize in non-invasive, non-pharmaceutical remedies for musculoskeletal pain, we need to elevate our role in caring for pregnant patients to prevent unnecessary health risks to mothers and their unborn babies.”
Dr. George and his team are discussing a future study focusing on patients who are predisposed to low-back and pelvic pain — either symptomatic prior to pregnancy or patients who experienced symptoms with their previous pregnancies.
“Our objective is to prevent these patients from having a significant low-back or pelvic pain episode during pregnancy,” said Dr. George. “For this research, we would work with women at an earlier stage in their pregnancies so that, ultimately, we can prevent unnecessary pain and health risks to these women and their babies.”
With approximately six million pregnancies every year across the United States, according to the American Pregnancy Association, MOMS’ acceptance by “The Gray Journal” and obstetric community at large presents a level of chiropractic validation and exposure never before conceived. Now, factor in the U.S. Department of Labor report that 80 percent of women make health care decisions for their families. If MOMS helps foster greater levels of chiropractic care for pregnant women, the potential to impact the health of these women and their families remain immeasurable … even for experienced researchers like Dr. George.
*MOMS Manuscript Authors
James W. George, DC
Chiropractic Science Division, Logan College of Chiropractic/University Programs, Central Institute for Human Performance
Clayton D. Skaggs, DC
Central Institute for Human Performance, Washington University School of Medicine, St. Louis
Paul A. Thompson, PhD
Department of Pediatrics, Sanford Research, Sanford Health, University of South Dakota, Sioux Falls, SD
D. Michael Nelson, MD, PhD
Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School
of Medicine, St. Louis
Jeffrey A. Gavard, PhD
Division of Research, Department of Obstetrics, Gynecology, and Women’s Health, Saint Louis University School of Medicine
Gilad A. Gross, MD
Division of Maternal-Fetal Medicine, Saint Louis University School of Medicine