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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 1

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 1 Pain intensity.
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Analysis 1.1

Comparison 1 Low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 1 Pain intensity.

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Comparison 1 Low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 2 Disability.
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Analysis 1.2

Comparison 1 Low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 2 Disability.

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Comparison 2 Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care, Outcome 1 Number of women taking sick leave because of back pain after 32 weeks' gestation.
Figuras y tablas -
Analysis 2.1

Comparison 2 Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care, Outcome 1 Number of women taking sick leave because of back pain after 32 weeks' gestation.

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Comparison 3 Low‐back pain: support belts, Outcome 1 Low‐back pain, measured with VAS; 0 to 10; 0 = no pain.
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Analysis 3.1

Comparison 3 Low‐back pain: support belts, Outcome 1 Low‐back pain, measured with VAS; 0 to 10; 0 = no pain.

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Comparison 4 Pelvic pain: deep versus superficial acupuncture, Outcome 1 Evening pain.
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Analysis 4.1

Comparison 4 Pelvic pain: deep versus superficial acupuncture, Outcome 1 Evening pain.

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Comparison 5 Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 1 Women who reported pain on Visual Analogue Scale.
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Analysis 5.1

Comparison 5 Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 1 Women who reported pain on Visual Analogue Scale.

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Comparison 5 Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 2 Women who reported LBP/PGP‐related sick leave.
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Analysis 5.2

Comparison 5 Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care, Outcome 2 Women who reported LBP/PGP‐related sick leave.

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Comparison 6 Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care, Outcome 1 Number of women who reported decreased pain.
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Analysis 6.1

Comparison 6 Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care, Outcome 1 Number of women who reported decreased pain.

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Comparison 7 Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care, Outcome 1 Numbers of women rating treatment as good or excellent.
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Analysis 7.1

Comparison 7 Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care, Outcome 1 Numbers of women rating treatment as good or excellent.

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Summary of findings for the main comparison. Low‐back pain: any exercises + usual prenatal care versus usual prenatal care for treating back pain in pregnancy

Low‐back pain: any exercises + usual prenatal care versus usual prenatal care for treating back pain in pregnancy

Patient or population: pregnant women with back pain
Intervention: Low‐back pain: any exercises + usual prenatal care versus usual prenatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Low‐back pain: any exercises + usual prenatal care versus usual prenatal care

Pain intensity measured by a number of different measurements; lower score = better

The mean pain intensity in the control groups was18.75

The mean pain intensity in the intervention groups was
0.80 standard deviations lower
(1.07 to 0.53 lower)

SMD ‐0.80 (‐1.07, ‐0.53)

543
(6 studies)

⊕⊕⊝⊝
low1,2

Disability measured by Roland Morris Disability Questionnaire and Oswestry Disability Index

The mean disability in the control groups was 26.6

The mean disability in the intervention groups was
0.56 standard deviations lower
(0.89 lower to 0.23 lower)

SMD ‐0.56 (‐0.89 to ‐0.23)

146
(2 studies)

⊕⊕⊝⊝
low1,3

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 poor or no description of randomisation process, allocation concealment, blinding of research personnel
2 two of the studies provided data that were more extreme than the other results, although all the results are positive. If these two are removed, the estimate of effect becomes much more modest, but still significant.
3 sparse data

Figuras y tablas -
Summary of findings for the main comparison. Low‐back pain: any exercises + usual prenatal care versus usual prenatal care for treating back pain in pregnancy
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Summary of findings 2. Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care for treating back pain in pregnancy

Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care for treating back pain in pregnancy

Patient or population: pregnant women with back pain
Intervention: Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (usual care)

water gymnastics

Number of women taking sick leave because of back pain after 32 weeks' gestation

Study population

RR 0.4
(0.17 to 0.92)

241
(1 study)

⊕⊕⊝⊝
low1,2

144 per 1000

58 per 1000
(24 to 132)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 unclear methods of randomisation; research personnel not blinded
2 sparse data

Figuras y tablas -
Summary of findings 2. Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care for treating back pain in pregnancy
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Summary of findings 3. Low‐back pain: support belts for treating back pain in pregnancy

Low‐back pain: support belts for preventing and treating pelvic and back pain in pregnancy

Patient or population: pregnant women with back pain
Intervention: Low‐back pain: support belts

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Low‐back pain: support belts

BellyBra versus Tubigrip ‐ Low‐back Pain

The mean Bellybra versus Tubigrip back pain in the control group was 4.7, measured on VAS 0 to 10

The mean Bellybra versus Tubigrip ‐ back pain in the intervention group was 0.2 lower (1.19 lower to 0.79 higher)

MD ‐0.20 (95% CI ‐1.19 to 0.79)

94
(1 study)

⊕⊕⊝⊝
low1,2

BellyBra versus Tubigrip ‐ ADL

The mean Bellybra versus Tubigrip ability to perform activities of daily living in the control group was 5.6, measured as a total of several activities

The mean Bellybra versus Tubigrip ability to perform activities of daily living in the intervention group was 0.9 lower
(1.81 lower to 0.01 higher)

MD ‐0.90 (95% CI ‐1.81 to 0.01)

94
(1 study)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; MD: mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 no blinding of research personnel described; no explanation provided for lost‐to‐follow‐up data; different co‐interventions and compliance between groups
2 sparse data

Figuras y tablas -
Summary of findings 3. Low‐back pain: support belts for treating back pain in pregnancy
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Summary of findings 4. Pelvic pain: deep versus superficial acupuncture for treating pelvic pain in pregnancy

Pelvic pain: deep versus superficial acupuncture for preventing and treating pelvic and back pain in pregnancy

Patient or population: pregnant women with pelvic pain
Intervention: Pelvic pain: deep versus superficial acupuncture

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (superficial)

Intervention (deep)

evening pain, reported as better, based on women's report on Visual Analogue Scale

Study population

RR 1.06
(0.73 to 1.54)

47
(1 study)

⊕⊕⊝⊝
low1,2

682 per 1000

723 per 1000
(498 to 1000)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 randomisation process and attrition rate/explanations not described
2 sparse data

Figuras y tablas -
Summary of findings 4. Pelvic pain: deep versus superficial acupuncture for treating pelvic pain in pregnancy
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Summary of findings 5. Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Patient or population: pregnant women with, or at risk of developing, pelvic and back pain
Intervention: Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (usual prenatal care)

Any exercises + usual prenatal care

Number of women who reported pain on Visual Analogue Scale

Study population

RR 0.85
(0.73 to 1)

1344
(4 studies)

⊕⊕⊕⊝
moderate1

747 per 1000

635 per 1000
(546 to 747)

Number of women who reported LBP/PGP‐related sick leave

Study population

RR 0.76
(0.62 to 0.94)

1062

(2 studies)

⊕⊕⊕⊝
moderate2

288 per 1000

219 per 1000
(178 to 270)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 there was a mix of potential biases among the four studies: no allocation concealment (1); no blinding of research personnel (all); poor/no description of drop‐outs, co‐interventions and baseline inequality (mixed)
2 no blinding of research personnel; poor description of attrition; some differences in co‐interventions

Figuras y tablas -
Summary of findings 5. Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy
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Summary of findings 6. Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Patient or population: pregnant women with, or at risk of developing, pelvic and back pain
Intervention: Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care

Number of women who reported decreased pain

Study population

RR 4.16
(1.77 to 9.78)

72
(1 study)

⊕⊕⊝⊝
low1,2

143 per 1000

594 per 1000
(253 to 1000)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 no blinding of research personnel, over 20% attrition, different co‐interventions
2 sparse data

Figuras y tablas -
Summary of findings 6. Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care for preventing and treating pelvic and back pain in pregnancy
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Summary of findings 7. Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care for preventing and treating pelvic and back pain in pregnancy

Patient or population: pregnant women with, or at risk of developing, pelvic and back pain
Intervention: Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (individualised physio + usual prenatal care)

acupuncture + usual prenatal care

Numbers of women rating treatment as good or excellent

Study population

RR 1.24
(0.96 to 1.6)

46
(1 study)

⊕⊕⊝⊝
low1,2

778 per 1000

964 per 1000
(747 to 1000)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 no description of randomisation process, no blinding of research personnel described, uneven attrition (12 dropped out of physio group, while none dropped out of the acupuncture group) and co‐interventions between groups
2 sparse data

Figuras y tablas -
Summary of findings 7. Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care for preventing and treating pelvic and back pain in pregnancy
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Comparison 1. Low‐back pain: any exercises + usual prenatal care versus usual prenatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain intensity Show forest plot

6

543

Std. Mean Difference (IV, Random, 95% CI)

‐0.80 [‐1.07, ‐0.53]

2 Disability Show forest plot

2

146

Std. Mean Difference (IV, Random, 95% CI)

‐0.56 [‐0.89, ‐0.23]
Figuras y tablas -
Comparison 1. Low‐back pain: any exercises + usual prenatal care versus usual prenatal care
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Comparison 2. Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women taking sick leave because of back pain after 32 weeks' gestation Show forest plot

1

241

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.17, 0.92]
Figuras y tablas -
Comparison 2. Low‐back pain: water gymnastics + usual prenatal care versus usual prenatal care
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Comparison 3. Low‐back pain: support belts

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Low‐back pain, measured with VAS; 0 to 10; 0 = no pain Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Low‐back Pain

1

94

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐1.19, 0.79]

1.2 ADL

1

94

Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐1.81, 0.01]
Figuras y tablas -
Comparison 3. Low‐back pain: support belts
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Comparison 4. Pelvic pain: deep versus superficial acupuncture

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Evening pain Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.73, 1.54]
Figuras y tablas -
Comparison 4. Pelvic pain: deep versus superficial acupuncture
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Comparison 5. Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Women who reported pain on Visual Analogue Scale Show forest plot

4

1344

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.73, 1.00]

2 Women who reported LBP/PGP‐related sick leave Show forest plot

2

1062

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.62, 0.94]
Figuras y tablas -
Comparison 5. Pelvic + low‐back pain: any exercises + usual prenatal care versus usual prenatal care
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Comparison 6. Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women who reported decreased pain Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

4.16 [1.77, 9.78]
Figuras y tablas -
Comparison 6. Pelvic + low‐back pain: acupuncture + usual prenatal care versus usual prenatal care
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Comparison 7. Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Numbers of women rating treatment as good or excellent Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.96, 1.60]
Figuras y tablas -
Comparison 7. Pelvic + low‐back pain: acupuncture + usual prenatal care versus individualised physio + usual prenatal care
Ir a la tabla de la revisión