Objective: Determine current trends in physical therapy interventions for high-risk pregnancy and to arrive at a consensus on diagnosis-specific interventions.
Study Design: Qualitative.
Background: Currently, limited anecdotal information exists in the literature regarding appropriate physical therapy interventions for women experiencing activity restrictions secondary to a high-risk pregnancy. Because of this lack of evidence, physicians may be reluctant to prescribe physical therapy for their high-risk patients due to fear of placing the expectant mother and fetus at greater risk for an adverse outcome.
Methods and Measures: The Delphi technique was used in an online format. An expert panel was recruited by announcements sent to members of the Acute Care, Home Health, and Women's Health sections. Panel members were sent an initial set of open-ended questions and 2 rounds of follow-up close-ended questions. Consensus was defined a priori as 70% or greater agreement of the panel members.
Results: Consensus was reached on medical diagnoses defining high-risk pregnancy, definitions of levels of bed rest, examination of the high-risk patient, red flags and necessary modifications or precautions with examination and intervention, development of a problem list and goals, development of a plan of care and utilization of current procedural terminology codes, identifying potential members of a multidisciplinary approach, patient education programming specific to high-risk pregnancy, and resources for the high-risk patient and her family.
Conclusion: This consensus-building process can serve as a basis for development of physical therapy protocols, clinical pathways, indications, contraindications, or recommendations concerning physical therapy intervention for high-risk pregnancy conditions. Interventions recommended in this study can be used as a basis for follow-up clinical studies to determine the impact of physical therapy intervention during bed rest or restricted activity on the physiological and psychological effects of bed rest and on postpartum outcomes.
Department of Physical Therapy, University of South Alabama, Mobile
This research was presented at the Combined Sections Meeting, San Diego, California, on February 18, 2010.
Project funded by SOWH research grant.
The authors declare no conflicts of interest.