CPP Among Somali Women in Norway: SCED

Single-case experimental design (SCED) with repeated measurements structured into a nonconcurrent randomized multiple baseline design is the method of this study. The study is divided into pre-intervention, baseline (Phase A), the intervention period (Phase B), post-intervention and follow-up. Pre-intervention is the time period before baseline (Phase A). During this timperiod the participants will fill out the first questionnaire package. Phase A is the baseline phase before initiation of the intervention. During this phase, pain-related outcomes and overall health (EQ VAS) will be measured repeatedly. There are three possible baseline lengths (4, 5, or 6 weeks) and the participants will be randomized to one of the baseline lenghts. Phase B is the multimodal physiotherapy intervention, which starts immediately after the baseline period (intervention starts in week 5, 6, or 7, depending on the baseline length) and lasts for six months (24 weeks). The intervention consists of two parts. During the first two months (Phase B1), participants receive weekly physiotherapy sessions that include pain education and general physical activity, consisting of exercises targeting strength, mobility, balance, and endurance. During the following four months (Phase B2), participants receive physiotherapy sessions every other week. They continue with pain education and general physical activity, while pelvic floor muscle training and education on pelvic anatomy are introduced during this phase. Participants receive a total of 16 physiotherapy sessions during Phase B. Throughout the intervention period (Phase B), participants will be encouraged to perform home-based exercises weekly as part of a self-management approach, supported by training diaries and individualized follow-up from women's health physiotherapists. Post-intervention is the time period six months after baseline (Phase A) and immediately after intervention (Phase B). During this timperiod the participants will fill out the second questionnaire package and participate in individual interviews. The physiotherapists delivering the intervention will also participate in individual interviews. Follow-up assessments will be conducted 12 months after baseline (Phase A). At this timperiod the participants will fill out the last questionnaire package and a second optional individual interview. Outcomes are measured repeatedly within the baseline and intervention phases, allowing each participant to serve as their own control and enabling evaluation of changes following intervention initiation. Pre-intervention, post-intervention, and follow-up questionnaire assessments will include outcomes related to health literacy, quality of life, function, self-efficacy, perceived change in condition, treatment satisfaction, and mental health symptoms.