The Assessment and Treatment of Postpartum Women with Diastasis Recti
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Diastasis recti abdominis (DrA), a separation of the paired rectus abdominis muscles, is associated with reduced abdominal muscle function, post-partum body image complaints, musculoskeletal pain, and possibly urogynecological complaints. The amount of separation present (inter-rectus distance, IRD) is currently considered the key indicator of DrA severity, yet prior to this thesis, facets of its reliability and validity had not been tested, and the relationship between IRD and symptoms was not well understood. Physiotherapists are often consulted by women with DrA, yet treatment efficacy remains unclear. The first three studies investigated the psychometric properties (intra- & inter-rater reliability, criterion-related validity) of ultrasound imaging to measure IRD and demonstrated that consistent IRD measurements from one day to another can be achieved if the rater is kept constant, but reliability is reduced when the rater is variable. When IRD is too large to measure using conventional ultrasound, extended field-of-view techniques may be useful. The fourth study investigated the relationship between IRD and symptom severity in women with DrA and found that IRD was significantly negatively correlated with body image and positively correlated with abdominal pain, but not with lumbopelvic pain, dysfunction nor with urogynecological complaints. The final study, a pilot randomized controlled trial (RCT), served to inform the feasibility and planning of future RCTs to evaluate physiotherapeutic treatment efficacy in DrA management. The recruitment rate was three participants per month. The retention rate was 84%. Intervention adherence rates were ≥ 53%. Positive, clinically meaningful effects in response to physiotherapeutic interventions were observed for body image and trunk flexor strength but not for IRD, pain, or dysfunction. This thesis provides novel information regarding the use of ultrasound imaging in the assessment of DrA and improved understanding of the significance of IRD on symptom presence and severity. This work is the first to report on the feasibility of running an RCT to test physiotherapeutic treatment efficacy in women with post-partum DrA. Before going forward with such an RCT, further pilot work is recommended and includes exploring the potential role of conservative interventions in women with DrA who report higher levels of pain and dysfunction.
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