Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis

Deenika R Benjamin; Helena C Frawley; Nora Shields; Casey L Peiris; Alexander T M van de Water; Andrea M Bruder; Nicholas F Taylor

doi:10.1016/j.physio.2023.02.002

Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis

Physiotherapy. 2023 Jun:119:54-71. doi: 10.1016/j.physio.2023.02.002. Epub 2023 Mar 5.

Authors

Deenika R Benjamin¹, Helena C Frawley², Nora Shields³, Casey L Peiris⁴, Alexander T M van de Water⁵, Andrea M Bruder⁶, Nicholas F Taylor⁷

Affiliations

¹ Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: d.benjamin@latrobe.edu.au.
² Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia; Allied Health Research, Royal Women's Hospital, Australia; Allied Health Research, Mercy Hospital for Women, Australia. Electronic address: h.frawley@unimelb.edu.au.
³ Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria 3086, Australia. Electronic address: n.shields@latrobe.edu.au.
⁴ Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: C.Peiris@latrobe.edu.au.
⁵ Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: a.vandewater@latrobe.edu.au.
⁶ Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: a.bruder@latrobe.edu.au.
⁷ Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia; Allied Health Clinical Research Office, Eastern Health 5 Arnold Street, Box Hill 3128, Australia. Electronic address: n.taylor@latrobe.edu.au.

PMID: 36934466
DOI: 10.1016/j.physio.2023.02.002

Abstract

Background: Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown.

Objectives: To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women.

Data sources: EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021.

Study selection/eligibility: Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included.

Study appraisal and synthesis methods: Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis.

Results: Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care.

Limitations: Three of the 16 trials had a low risk of bias.

Conclusion and implications: Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).

Keywords: DRAM; Diastasis Recti; Exercise; Interventions; Postnatal.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Abdominal Muscles*
Exercise Therapy
Female
Humans
Pregnancy
Rectus Abdominis*