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Pilot Abstract

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Rebound:  A Self-Management Intervention for Recovery from Antepartum Bedrest


Judith Maloni


Antepartum bed rest is prescribed for about one million US pregnant women each year despite evidence that it is ineffective and it causes significant muscle atrophy, decreased aerobic capacity, and depression from which women do not quickly recover. Because physicians are unaware of bed rest induced side effects, women are discharged in a physically and psychologically debilitated state without a plan for rehabilitation.  Using a physiologic framework, the specific aims are to determine across the first 3 months postpartum whether women who receive a tailored intervention for self-management of physical and emotional health after antepartum bed rest differ from a control group in: 1) Musculo-skeletal Health (MS) (lower body muscle strength), 2) Cardiovascular Health (CV) (aerobic endurance), 3) postpartum symptoms, 4) perceived health, 5) functional status, and 6) depressive symptoms, and whether 7) self-efficacy mediates outcomes. A three-month tailored intervention program will use an interventionist who has had bed rest experience  to provide a self-management program for exercise, symptom recognition and treatment, and stressors that contribute to postpartum depressive symptoms. A repeated measures experimental two-group design will be used.  The sample will consist of 80 postpartum women (40/grp) treated with  >21 days of hospital bed rest. Enrollment criteria include singleton pregnancy, healthy prior to pregnancy, no previous physical limitations, and diagnosed with either preterm labor, premature rupture of membranes, placenta previa, incompetent cervix, or placental abruption. Women with chronic medical diagnoses such as hypertension and depression or with fetal/infant death will be excluded. Repeated measures multivariate regression analysis will be used. This is the first self-management intervention developed to rehabilitate MS, CV, and psychological status of postpartum women treated with antepartum bed rest and will provide information for a larger trial.  The intervention is likely to increase maternal health by reducing postpartum morbidity that results in suboptimal health and functioning, and results in a downward spiral of a low level of activity and disability across the first postpartum year.

Lay description of study: After a pregnancy treated with bed rest, women have a difficult time recovering from loss of muscle strength, stamina, and depression.  This study will provide a program of education and exercise that will help women more quickly manage their recovery and decrease complications after birth.