The Effect of Connective Tissue Manipulation on General Health and Emotional Status in Women With Primary Dysmenorrhea
Condition: Primary Dysmenorrhea
MeSH terms: Dysmenorrhea
Study type: Interventional

Summary: 
      The purpose of this study was to reveal the effects of connective tissue manipulation (CTM)
      on pain severity, fatigue, sleep quality, general health status, systemic symptoms, anxiety
      and depression in women with primary dysmenorrhoea and to determine the effect of treatment
      time on recovery in a longterm period. Our primary outcome was intensity of menstrual pain.
      Secondary outcomes were intensity of sleep disturbance, fatigue, depression and anxiety
      status, general health and premenstrual symptoms.
    

Detailed description: 
      The purpose of this study was to reveal the effects of CTM on pain severity, fatigue, sleep
      quality, general health status, systemic symptoms, anxiety and depression in women with
      primary dysmenorrhoea and to determine the effect of treatment time on recovery in a longterm
      period. Our primary outcome was intensity of menstrual pain. Secondary outcomes were
      intensity of sleep disturbance, fatigue, depression and anxiety status, general health and
      premenstrual symptoms. The participants included to this study were randomised into two
      groups with simple randomisation method. CTM was performed to participants in both groups
      included the basic region (Sacral and lumbar), lower thoracic (between T12-T7) and anterior
      pelvic regions. In Group 1, starting at the end of the menstrual cycle, CTM was applied for 5
      days a week and for 1 cycle (approximately 3 weeks) until the beginning of the next period.
      Participants in the Group 2 CTM was started with the completion of menstrual cycle, 5 days a
      week and until the other menstrual cycles. At the end of the menstrual cycle, it was
      restarted and a total of 2 cycles were applied until the second menstrual cycle started
      (approximately 6 weeks). Both short and long strokes were used during manipulation. Each
      stroke was repeated for three times first on the right and then on the left side of all
      manipulated regions. All sessions were ended with bilateral long strokes to the iliac crest
      and subcostal regions. The treatment was started from the basic region and proceeded to other
      regions according to the vascular reaction of the connective tissue. Each session lasted 5 to
      20 minutes, depending on the size of the treated region. During manipulation, the pad of the
      middle finger was in contact with the patient's skin. The finger was placed on the skin at
      45° angle with distal interphalangeal joint in flexion and moved to cause traction. During
      back treatment, the participant was asked to sit erect, with hips, knees, and ankles at 90°
      flexion and thighs and feet are fully supported. During the treatment of anterior pelvic
      region, the patient was in a supine position with pillows placed under the head and knees.
      Treatment was performed by a trained physiotherapist. The participants' intensity of pain,
      fatigue and sleep quality were assessed with Visual Analogue Scale. Depressive symptoms and
      anxiety status, general health and premenstrual symptoms were assessed with Beck Depression
      Inventory, Beck Anxiety Inventory, General Health Questionnaire and Premenstrual Syndrome
      Scale, respectively. All measurements were repeated 5 times; baseline, after the first
      menstruation following the intervention period, 3th, 6th and 12th months after treatment.
    

Intervention name(s): Connective Tissue Manipulation
Intervention type(s): Other
Intervention description(s): The position of the patients during treatment sessions was sitting with the hips and knees at 90° flexion and feet supported, arms relaxed on the thighs, back naked and straight, allowing optimal tension of the connective tissue. The CTM procedure consisted of treating 3 sections in the back. These sections were basic (sacral and lumbar regions), lower thoracic (L1 through T7) and anterior pelvic. All sessions were ended with bilateral long strokes to the iliac crest and subcostal regions. The physiotherapist applied strokes bilaterally by her middle finger of the right or left hand to the defined zones of the mentioned sections in the back. The treatment started from the basic section, and progress to other regions was decided according to the vascular reaction of the connective tissue. Each session lasted for 5 to 20 minutes, depending on the extent of the treated area.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: primary dysmenorrhea; pain; women; connective tissue manipulation; longterm follow up