Proposal for a systematic review of literature
of outcomes of Treatment of Postpartum depression or the Post-Natal Depression
in young mothers with the use of Manual Therapy.

 

Introduction, Back Ground

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Research subject there is a strong link
between depression and musculoskeletal issues.

 

In the last few decades the taboo of
Post Natal depression has been broken and we have witness an explosion on
literature about the subject.

 

Depression during pregnancy and following
childbirth has been historically regarded as a phenomenon that affects 15-20%
of women. The popular press as well as medical and mental health providers
emphasize the causative role of biochemical changes that the mother experiences
during pregnancy and following birth. Endocrine and biochemical theories of
childbirth-associated depression in women, despite their popularity, are
supported by a fragmented literature that inconsistently identifies hormonal
causes and insufficiently replicates hormone-depression correlations.

 

However Postpartum depression (PPD) is a devastating
illness that hugely negatively impact mother and their entourage. And the lack
of understanding and proper guidelines, make that only half of those women are
detected and treated adequately. The other fact is that most of the women
affected by PPD don’t seek help and treatment.

 

In other cultures, PPD is a (well known) subject
not fully understood but totally recognised and with guidelines. In the Maya
culture, it was believed that the PPD is the result of a spirit called HANTU
MEROYAN that was living in the placenta and the amniotic fluid. When the spirit
wasn’t happy it was triggering symptoms called “Sakit Meroyan” and they could
be stopped with the help of a shaman. Traditional Chinese Medicine believed that
woman could be helped if she participated in an exact post-natal ritual that
entitled that the new mother rested in bed for a month not being allowed to
wash and leave the house, while the mother and mother in law take care of the
domestic duties.

 

In the Western world, PPD wasn’t recognised and
mostly tabooed by society as it was often denied or misdiagnose as “Baby Blues”
to diminish its importance and its impact young mother. The lack of support and
recognition of the condition discouraged many women from seeking help leading
to deep trauma and stigma. It is only very recently that the western world
opened up to it and starting to recognise it. For example, in the United State
of America, the Patient Protection and Affordable Care Act include a whole
section related to researches project on postpartum Depression. Even so it
seems that it’s only a start as more and more people are calling for a proper
recognition.

 

The
diagnosis of PPD is often based on a simple questioner called the Edinburgh
Post Natal Depression Scale Test. This 10-question self-rating scale has been proven to be an efficient and
effective way of identifying patients at risk for PPD. While this test was
specifically designed for women who are pregnant or have just had a baby, it
has also been shown to be an effective measure for general depression in the
larger population.

The relationship between pain and
psychosocial factors, including depression, has been well researched in the
last few decades. Goldberg and Lox (1999), They review the role of the mind
body connection in low back pain, concluded that it was important to consider
and evaluate all the psychosocial aspects of pain in order to prevent
disability. Linton (2000) concluded with a systematic review of psychological
risk factors in back and neck pain, that depressed mood increases the risk of
concurrent problems associated with pain. This is a view reinforced by Rush,
Polatin and Gatchel (2000). They reported that while depression can precede
pain, in up to 50% of cases the severity of a person’s pain is related to the
degree of depression. In a review of the psychosocial aspects of the evaluation
and management of chronic low back pain, Cohen (1995) differentiated depression
from other factors. He concludes that depression require intervention to reduce
morbidity and comorbid issues such as musculoskeletal problems.

Manuel therapies (Osteopathy,
Chiropractic and Physiotherapy) are based on touch for the diagnostic and the
treatment. There is increasing amount of evidences that manual therapies are
effective in the treatment and the improvement of many different clinical
condition, variating from musculoskeletal issues to psychiatric.  indirect improvement of psychologic and
physiologic outcomes.

 

The proposed review is relevant to osteopathy
for a better understanding of the condition and its implication in the
treatment for better outcomes of women in postpartum period consulting at the Clinic
of University College of Osteopathy. Because the recognition,
understanding and treatment of postpartum depression is changing at the moment
in the medical world with a less pharmaceutical and reductionist approach, it
is a valid interrogation to want to know if manual therapy is effective in a
range of clinical condition and what role, how much osteopathy improve outcomes
in the treatment of Postpartum Depression.

 

Proposed Title / Research
Question

 

“A comparison of
the results of Manual Therapy treatment and Psychiatric intervention in women
diagnosed with Post Natal Depression.”

 

The
Title of the review is based and formulated following the PICO method (NICE, 2012; Higgins and Green,
2009; Huang et al., 2006).

The population (P) is the
ensemble of woman during post-partum period that have been diagnosed by
professional health care with depression. The intervention (I) is the use of
manual therapy that we define by Osteopathy, chiropractic and physiotherapy.
The (C) comparison is the use of traditional medicine and the psychiatric
approach. The primary outcome (O)is the conclusion in different studies
selected for the systematic review.

 

The hypothetical complications
encounter with the review result would be the heterogeneity in the measurement
of the different outcomes of the preferred studies used for the systematic
review, their design and the quality of their assessment. To reduce those
challenges a heterogeneity analysis will be included helping to decide if there
will be a need a meta-analysis. (Higgins and Green, 2009; CRD, 2009). The
quality of the studies will be assessed analysing different measure such
as concealment of random allocation, accurate reporting of withdrawals, degree
of reporting accuracy, appropriateness of statistical analysis, and blinding in
the assessment of outcomes. In theory, studies in which these measures are
poorly achieved are more likely to result in biased outcomes. (Russell R, Chung M,
Balk EM, et al., 2009).

The systematic
review’s objective is the evaluation of the literature relating to the
evaluation of outcomes in Postpartum Depression and to draw conclusion based on
the most objective and highest quality papers such as Radom Control Trial,
Control Clinical Trial, Cohorte studies and previous systematic reviews. So, we
can draw conclusion on the effectiveness of the postpartum depression
management with manual therapy.

 

Methodology

Search Strategy

Literature research:

Researched databases:

PubMed

Science Direct

MedLine

Semantic
Scholar

Cochrane
Databes

NCBI

AMED

BioMedCentral

ASSIA

SAGE

CINAHL

MEDNAR

EMBASE

 

 

The search strategy
will be based on the combination of different search technic.

The Keywords and
search terms use will be:

–       Perinatal depression

–       Postpartum depression

–       Manual therapy

–       Osteopathy

–       Chiropractic

–       Psychiatric

–       Outcomes

–       Help

–       Efficiency

–       Baby Blues

The key words will be
use in different manners. We have to understand that the use of keyword if
often giving very board results. They are useful to search Article title, names
and abstract. To refine the search, we are going to use Index/subjects terms we
will combine the use of Mesh term that will focus the search looking for items
with specific term applied by search engines.  The last technic used will be a string research
with the combination of keywords based on the Boolean operators (OR and AND).

The use of mesh will
be indicated if the keyword search using different technic reveal too much
result and if the result is not focused enough.

Inclusion and
exclusion

Due to the nature of
the subject and the amount of literature available the criteria summary will be
use as guide line and are susceptible to changes.

Summary of Inclusion
and Exclusion

Study
Characteristic

Inclusion

Exclusion

Type of Study

 

 

Population

Mother during
postpartum period
Diagnosed with
depression
 

Sample size
(less than 20)
Woman with
physical complication during labour or pregnancy

Intervention

Manual therapy
(Osteopathy, chiropractic, physiotherapy)
Psychiatric

Other
therapies

Settings

 

 

Publication

English
languages articles
Peer reviewed,
full-length publication of original data

Article in
other languages
Not reviewed
article.
 

 

 

 

 

The included studies, will restricted to RCT and
CCT and cohort studies. Previous systematic review and metadata analysis will
be disregarder for inclusion but the will be acknowledged as a potential source
of information and material relevant to the topic.

To help with the process of study selection, a form
will be used. The form is extracted and modified from the Cochrane Pregnancy
and Childbirth Group version. (cf. Form bellow).

 

 

Proposal for a systematic review of literature
of outcomes of Treatment of Postpartum depression or the Post-Natal Depression
in young mothers with the use of Manual Therapy.

 

Introduction, Back Ground

 

Research subject there is a strong link
between depression and musculoskeletal issues.

 

In the last few decades the taboo of
Post Natal depression has been broken and we have witness an explosion on
literature about the subject.

 

Depression during pregnancy and following
childbirth has been historically regarded as a phenomenon that affects 15-20%
of women. The popular press as well as medical and mental health providers
emphasize the causative role of biochemical changes that the mother experiences
during pregnancy and following birth. Endocrine and biochemical theories of
childbirth-associated depression in women, despite their popularity, are
supported by a fragmented literature that inconsistently identifies hormonal
causes and insufficiently replicates hormone-depression correlations.

 

However Postpartum depression (PPD) is a devastating
illness that hugely negatively impact mother and their entourage. And the lack
of understanding and proper guidelines, make that only half of those women are
detected and treated adequately. The other fact is that most of the women
affected by PPD don’t seek help and treatment.

 

In other cultures, PPD is a (well known) subject
not fully understood but totally recognised and with guidelines. In the Maya
culture, it was believed that the PPD is the result of a spirit called HANTU
MEROYAN that was living in the placenta and the amniotic fluid. When the spirit
wasn’t happy it was triggering symptoms called “Sakit Meroyan” and they could
be stopped with the help of a shaman. Traditional Chinese Medicine believed that
woman could be helped if she participated in an exact post-natal ritual that
entitled that the new mother rested in bed for a month not being allowed to
wash and leave the house, while the mother and mother in law take care of the
domestic duties.

 

In the Western world, PPD wasn’t recognised and
mostly tabooed by society as it was often denied or misdiagnose as “Baby Blues”
to diminish its importance and its impact young mother. The lack of support and
recognition of the condition discouraged many women from seeking help leading
to deep trauma and stigma. It is only very recently that the western world
opened up to it and starting to recognise it. For example, in the United State
of America, the Patient Protection and Affordable Care Act include a whole
section related to researches project on postpartum Depression. Even so it
seems that it’s only a start as more and more people are calling for a proper
recognition.

 

The
diagnosis of PPD is often based on a simple questioner called the Edinburgh
Post Natal Depression Scale Test. This 10-question self-rating scale has been proven to be an efficient and
effective way of identifying patients at risk for PPD. While this test was
specifically designed for women who are pregnant or have just had a baby, it
has also been shown to be an effective measure for general depression in the
larger population.

The relationship between pain and
psychosocial factors, including depression, has been well researched in the
last few decades. Goldberg and Lox (1999), They review the role of the mind
body connection in low back pain, concluded that it was important to consider
and evaluate all the psychosocial aspects of pain in order to prevent
disability. Linton (2000) concluded with a systematic review of psychological
risk factors in back and neck pain, that depressed mood increases the risk of
concurrent problems associated with pain. This is a view reinforced by Rush,
Polatin and Gatchel (2000). They reported that while depression can precede
pain, in up to 50% of cases the severity of a person’s pain is related to the
degree of depression. In a review of the psychosocial aspects of the evaluation
and management of chronic low back pain, Cohen (1995) differentiated depression
from other factors. He concludes that depression require intervention to reduce
morbidity and comorbid issues such as musculoskeletal problems.

Manuel therapies (Osteopathy,
Chiropractic and Physiotherapy) are based on touch for the diagnostic and the
treatment. There is increasing amount of evidences that manual therapies are
effective in the treatment and the improvement of many different clinical
condition, variating from musculoskeletal issues to psychiatric.  indirect improvement of psychologic and
physiologic outcomes.

 

The proposed review is relevant to osteopathy
for a better understanding of the condition and its implication in the
treatment for better outcomes of women in postpartum period consulting at the Clinic
of University College of Osteopathy. Because the recognition,
understanding and treatment of postpartum depression is changing at the moment
in the medical world with a less pharmaceutical and reductionist approach, it
is a valid interrogation to want to know if manual therapy is effective in a
range of clinical condition and what role, how much osteopathy improve outcomes
in the treatment of Postpartum Depression.

 

Proposed Title / Research
Question

 

“A comparison of
the results of Manual Therapy treatment and Psychiatric intervention in women
diagnosed with Post Natal Depression.”

 

The
Title of the review is based and formulated following the PICO method (NICE, 2012; Higgins and Green,
2009; Huang et al., 2006).

The population (P) is the
ensemble of woman during post-partum period that have been diagnosed by
professional health care with depression. The intervention (I) is the use of
manual therapy that we define by Osteopathy, chiropractic and physiotherapy.
The (C) comparison is the use of traditional medicine and the psychiatric
approach. The primary outcome (O)is the conclusion in different studies
selected for the systematic review.

 

The hypothetical complications
encounter with the review result would be the heterogeneity in the measurement
of the different outcomes of the preferred studies used for the systematic
review, their design and the quality of their assessment. To reduce those
challenges a heterogeneity analysis will be included helping to decide if there
will be a need a meta-analysis. (Higgins and Green, 2009; CRD, 2009). The
quality of the studies will be assessed analysing different measure such
as concealment of random allocation, accurate reporting of withdrawals, degree
of reporting accuracy, appropriateness of statistical analysis, and blinding in
the assessment of outcomes. In theory, studies in which these measures are
poorly achieved are more likely to result in biased outcomes. (Russell R, Chung M,
Balk EM, et al., 2009).

The systematic
review’s objective is the evaluation of the literature relating to the
evaluation of outcomes in Postpartum Depression and to draw conclusion based on
the most objective and highest quality papers such as Radom Control Trial,
Control Clinical Trial, Cohorte studies and previous systematic reviews. So, we
can draw conclusion on the effectiveness of the postpartum depression
management with manual therapy.

 

Methodology

Search Strategy

Literature research:

Researched databases:

PubMed

Science Direct

MedLine

Semantic
Scholar

Cochrane
Databes

NCBI

AMED

BioMedCentral

ASSIA

SAGE

CINAHL

MEDNAR

EMBASE

 

 

The search strategy
will be based on the combination of different search technic.

The Keywords and
search terms use will be:

–       Perinatal depression

–       Postpartum depression

–       Manual therapy

–       Osteopathy

–       Chiropractic

–       Psychiatric

–       Outcomes

–       Help

–       Efficiency

–       Baby Blues

The key words will be
use in different manners. We have to understand that the use of keyword if
often giving very board results. They are useful to search Article title, names
and abstract. To refine the search, we are going to use Index/subjects terms we
will combine the use of Mesh term that will focus the search looking for items
with specific term applied by search engines.  The last technic used will be a string research
with the combination of keywords based on the Boolean operators (OR and AND).

The use of mesh will
be indicated if the keyword search using different technic reveal too much
result and if the result is not focused enough.

Inclusion and
exclusion

Due to the nature of
the subject and the amount of literature available the criteria summary will be
use as guide line and are susceptible to changes.

Summary of Inclusion
and Exclusion

Study
Characteristic

Inclusion

Exclusion

Type of Study

 

 

Population

Mother during
postpartum period
Diagnosed with
depression
 

Sample size
(less than 20)
Woman with
physical complication during labour or pregnancy

Intervention

Manual therapy
(Osteopathy, chiropractic, physiotherapy)
Psychiatric

Other
therapies

Settings

 

 

Publication

English
languages articles
Peer reviewed,
full-length publication of original data

Article in
other languages
Not reviewed
article.
 

 

 

 

 

The included studies, will restricted to RCT and
CCT and cohort studies. Previous systematic review and metadata analysis will
be disregarder for inclusion but the will be acknowledged as a potential source
of information and material relevant to the topic.

To help with the process of study selection, a form
will be used. The form is extracted and modified from the Cochrane Pregnancy
and Childbirth Group version. (cf. Form bellow) 

 

 

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