Variation of Q’angle in Multiparous Pregnant Females: An Observational Cross-Sectional Study

Abstract

Introduction: There are hormonal, biomechanical and postural adjustments that occur during pregnancy that can affect the alignment of the lower limb and musculoskeletal function. Multiparous pregnant females are at higher risk of musculoskeletal problems because of multiple biomechanical stresses and ligamentous laxity. Alteration of the Q angle is regarded as an important sign of patellofemoral dysfunction and knee malalignment. There is limited literature on the relationship between variation in the Q-angle and physical activity levels in multiparous pregnant females, and the effect of physical activity during pregnancy on musculoskeletal health and postural stability are likely to be different.

Objective: To investigate the changes in Q-angle and the relationship between physical activity and Q-angle in multiparous pregnant females.

Methodology: The study was a cross-sectional observational study conducted in the gynecology department of DHQ Hospital Mandi Baha-ud-Din, Aziz Bhatti Hospital and Rehmat hospital Gujrat for six months period from August 2020 to February 2021. The number of pregnant females recruited for the study were 317 (multiparous women) using non-probability purposive sampling technique. The angle of Q was bilaterally measured with a standard universal goniometer in standing position. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to measure physical activity level. Demographic data such as age, BMI, parity, weight and height were also documented. The data was analysed using SPSS version 21. A chi-square test was used and the correlation was done by the Spearman method with statistical significance set at p≤0.05.

Results: Among the total of 317 participants, 26.5% had normal Q-angle value and 73.5% showed bilaterally increased Q-angle values (>20°). The BMI (p<0.001), age group (p<0.001) and physical activity level, assessed by PPAQ (p<0.001) were found to be significant associations with abnormal Q-angle values. The prevalence of abnormal Q-angle values was greater in the overweight/obese individuals. Females who were not very active had a significantly larger change in the Q-angle than the moderately active females.

Conclusion: Bilateral increased Q-angle values are commonly found in multiparous pregnant females, especially those with greater BMI, older maternal age and lower physical activity. Lower limb biomechanics changes and the risk of musculoskeletal complications during pregnancy can be attributed to lower level of exercise.