Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial.

One hospital and 54 women. The authors describe the size of the sample as a major constraint on generalising the results. The same physiotherapist taught the exercises and collected the pain scores, and the women knew whether they had received the training. The authors state that reporting bias cannot be completely excluded because the mothers who had more frequent and close contact with the physiotherapist tended to report more positive outcomes. Pain was self-rated on a visual analogue scale, so the scores are subjective. The intervention was delivered at what the authors call a centre of excellence in maternity care, and they say this may have produced a greater effect than would be seen elsewhere. Follow-up stopped at hospital discharge, so nothing is known about pain, function or recovery after going home. The training group was younger on average than the standard-care group (30.0 years against 32.6 years), so the two groups were not identical at the start. The paper describes itself as single blind but also states that no attempt was made to conceal group identity from the investigators.

The paper as supplied does not say who funded the work, and no competing interests declaration appears in the text provided.

Do not read the lower pain scores as the effect of the exercises alone. The same physiotherapist taught the exercises and collected the pain scores, the women knew which group they were in, and the authors themselves warn that mothers who saw more of the physiotherapist may have reported better outcomes. The study tested the whole package together, so it cannot tell you which part of it did the work.