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B22396184.Pdf THE HONG KONG POLYTECHNIC UNIVERSITY INSTITUE OF TEXTILES AND CLOTHING MATERNITY GARMENT TREATMENT FOR THE RELIEF OF LOW BACK PAIN SIMONE HO SIN MAN A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy May 2008 DEDICATION This thesis is dedicated to my family Background Low back pain (LBP) is the most common musculoskeletal problem during pregnancy. Pregnant women traditionally wear maternity support belts for back discomfort and have experienced pain relief. However, the designs of these maternity support garments lack scientific research and their clinical efficacy remains elusive. Limited evidence is available to substantiate its putative beneficial effects. Aims This study aims to investigate the garment needs of pregnant women in terms of physical and psychological comfort, based on which to establish design criteria, to develop a maternity support garment, and to evaluate the effect in the maternity garment treatment for the relief of LBP. Methods This study was conducted in three phases: a) an exploratory phase, b) a developmental phase, and c) an evaluative phase. In the exploratory phase, a longitudinal study of 29 pregnant women was undertaken to investigate which biomechanical measures should be used to specify the functional requirements of the maternity support garment. In-depth interviews and wear trials were completed to elicit responses of pregnant women (10 in personal interviews and 14 in wear trials) on 8 maternity support garments. Fabric objective measurements of the same 8 tested garments and 16 alternative samples were conducted before material selection for the first garment prototype. In the developmental phase, the functional garment design criteria were determined and several prototypes were made based on DeJonge’s design framework. In the evaluative phase, the garment prototype was assessed in a pilot clinical study on 9 patients with LBP between gestational weeks 29-36. Pain intensity, functional status, biomechanical measures, and pregnancy outcomes were also investigated. Results The interviews generated five main themes of garment needs including supportive function, comfort, ease to put on and take off, aesthetics and safety. The wear trials showed that the most preferred garment consisted of a thin cotton fabric with soft and smooth handfeel which was invisible in fitting, allowed easy movements and convenience for toileting. The material tests identified the characteristics of the most favorable sample. The longitudinal study found that the centre of pressure and sagittal lumbar curvature can be used to determine the biomechanical effect. Based on these findings, four garment prototypes were developed to i satisfy the design criteria developed under five main themes. The pilot clinical study suggested that the maternity support vest is feasible and comfortable to wear as an adjunct therapy to exercises and has promising effects on pregnancy-related low back pain. Conclusions The research deliverables not only improve the garment treatment for LBP in pregnant women, but also provide a new scientific basis for therapeutic garment design. The methodologies and the results in the interviews, wear trials, biomechanical study, prototyping and clinical trials contribute to future research on the effect of garment therapy. ii LIST OF PUBLICATIONS AND AWARDS Major parts of the material presented in this thesis have formed the basis for papers that have been presented and published as follows: Referred Journal Articles 1. Ho, S.S., Yu, W., Lao, T.T., Chow, D.H.K., Chung, J.W. & Li, Y. Comfort evaluation of maternity support garments in a wear trial. Ergonomics. 51(9): 1376-93. (2008). 2. Ho, S., Yu, W., Lao, T.T., Chow, D., Chung, J. & Li, Y. Effectiveness of maternity support belts in reducing low back pain during pregnancy: A review. Journal of Clinical Nursing. (2nd revision submitted in August 2008). 3. Ho, S., Yu, W., Lao, T.T., Chow, D., Chung, J. & Li, Y. Garment needs of pregnant women based on content analysis of in-depth interviews. Journal of Clinical Nursing. (1st revision submitted in July 2008). 4. Ho, S., Chow, D., Yu, W., Lao, T.T. & Chung, J. Relationship among biomechanical parameters during pregnancy. BMC Musculoskeletal Disorders. (1st revision in progress). 5. Ho, S., Yu, W., Lao, T.T., Chow, D., Chung, J. & Li, Y. Garment design for the relief of low back pain during pregnancy. Nursing Research (to be submitted in October 2008). 6. Ho, S., Yu, W., Lao, T.T., Chow, D., Chung, J. & Li, Y. Maternity support vest as an adjunct therapy for the relief of pregnancy-related low back pain: A pilot study. Journal of Clinical Nursing (to be submitted in October 2008). Book Chapter 7. Ho, S., Luo, Y., Yu, W., & Chung, J. Physical and Physiological Health Effects of Intimate Apparel. In Yu W., Fan J.T., Harlock S.C. & Ng S.P, Innovation and Technology of Women's Intimate Apparel. Cambridge: Woodhead Publishing Limited, p.132-150. (2006). iii Conference Presentations and Publications 8. Ho, S., Yu, W., Lao, T., Chow, D., Chung, J. & Li, Y. (2007). Maternity support garment for the relief of low back pain. Oral presentation and abstract in the Proceedings of The 4th International Conference and Exhibition on Healthcare and Medical Textiles, Bolton, UK, 16 -18 July 2007, p. 26. 9. Ho, S., Yu, W., Lao, T., Chow, D., Chung, J. & Li, Y. (2007). Physical and psychological comfort evaluation of maternity support garments. Oral presentation and abstract in the Proceedings of the 9th Asian Textile Conference, Taiwan, R.O.C., June 28-30, p. O-51. 10. Ho, S., Yu, W., Lao, T., Chow, D., Chung, J. & Li, Y. (2007). The centre of pressure changes during pregnancy: An objective measure to evaluate the action of maternity support garment? Oral presentation and abstract in the Proceedings of The Sigma Theta Tau International Conference on Evidence-Based Practice in Nursing: Paradigms & Dialogue, Hong Kong, April 19-21, p.35. 11. Ho, S., Yu, W., Lao, T., Chow, D., Chung, J. & Li, Y. (2006) Maternity support garments for low back pain: A review. Poster presented and abstract in the Proceedings of International Fiber Societies Conference, Seoul, 30 May – 2 June, p.609-610. Honours and Awards 1. Sir Edward Youde Memorial (SEYM) Fellowship, Sir Edward Youde Memorial Fund Council, 14 April 2007. 2. Mrs. Cheung Chan You Fong Grace Scholarship, The Hong Kong Polytechnic University, 31 March 2006. 3. Leung Chan Mo Ching Postgraduate Scholarship, Hong Kong Association of University Women (HKAUW), 10 December, 2005. iv ACKNOWLEDGMENTS I would like to acknowledge the special contributions of many individuals who gave of their time and wisdom to make this thesis a reality. First of all, I would like to sincerely thank my chief supervisor Dr. Winnie Yu, from the Institute of Textiles and Clothing, for her continuous guidance, advice and encouragement throughout the course of my PhD study. I have benefited deeply from her detailed and constructive feedback in guiding the article publication and thesis writing. I am especially grateful to my co-supervisors, Prof. Daniel Chow, from the Department of Health Technology and Informatics, for his expertise in the spine biomechanics, and his serious- mindedness and critical thinking in research has influenced the rigor of my research work; Prof. Joanne Chung, from the School of Nursing, for her expert advice on pain and the research design. My gratitude also extends to Prof. Terence Lao, from the Department of Obstetrics and Gynecology, the University of Hong Kong, for his valuable advice and criticisms on my research writing and career, and Prof. Li Yi, from the Institute of Textiles and Clothing, for his helpful comments. Special thanks for the pregnant subjects who participated in my research and the staff members of the Queen Mary Hospital for their friendliness and help, and in particular the arrangement of a private room, which facilitated the smooth flow of my data collection. I would like to thank the colleagues at the Hong Kong Polytechnic University, Mr. So, Joanne, Zerence, Sammy and Eddie for their technical support and assistance. A big thank you goes to Prof. Tao, Head of Textile Technology, the donors of the Postgraduate Scholarships, my parents and my sister Cynthia for their generosity and financial support. Most importantly, hearty thanks to my family (Kenneth and Polly, Cynthia and Michael, Kelvin and Karen, Jackie and Steffi, Louise, Isabel, William, Anna, Rachel, and Katie) for their love, support and understanding, and also to my friends especially to Ruby for her tireless support; Kitty, Justina and Ying for their supportive prayers. Above all, I cannot find meaning in all of this without my God, who has been a great source of strength and endurance all through this work, especially during many ‘sleepless nights’. v TABLE OF CONTENTS Page Abstract i List of Publications and Awards iii Acknowledgements v Table of Contents vii List of Figures xiv List of Tables xvii List of Appendices xix Abbreviations xx vi CONTENTS CHAPTER 1 INTRODUCTION Page 1.1 Background 1 1.1.1 Prevalence and significance of low back pain (LBP) 1 1.1.2 Maternity support belt for relieving LBP during 2 pregnancy 1.1.3 Existing maternity support garments 3 1.2 Statement of the problems 4 1.3 Objectives of this study 5 1.4 Research Methods 6 1.5 Significance of the study 7 1.6 Assumption 7 1.7 Delimitations 8 1.8 Organization of thesis 8 CHAPTER 2 LITERATURE REVIEW 2.1 Introduction 10 2.2 Terms and definitions of LBP 10 2.3 Definition of
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