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

Humans Female Pregnancy Rectus Abdominis Abdominal Muscles Exercise Therapy
DRAM Diastasis Recti Exercise Interventions Postnatal

Journal

Physiotherapy
ISSN: 1873-1465
Titre abrégé: Physiotherapy
Pays: England
ID NLM: 0401223

Informations de publication

Date de publication:
06 2023
Historique:
received: 03 12 2021
revised: 23 11 2022
accepted: 23 02 2023
medline: 1 5 2023
pubmed: 20 3 2023
entrez: 19 3 2023
Statut: ppublish

Résumé

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. To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women. EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021. Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included. 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. 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. Three of the 16 trials had a low risk of bias. 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).

Sections du résumé

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).

Identifiants

DOI: 10.1016/j.physio.2023.02.002 PMID: 36934466
pubmed: 36934466
pii: S0031-9406(23)00013-5
doi: 10.1016/j.physio.2023.02.002
pii:
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

54-71

Informations de copyright

Copyright © 2023 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Auteurs

Deenika R Benjamin (DR)

Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: d.benjamin@latrobe.edu.au.

Helena C Frawley (HC)

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.

Nora Shields (N)

Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria 3086, Australia. Electronic address: n.shields@latrobe.edu.au.

Casey L Peiris (CL)

Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: C.Peiris@latrobe.edu.au.

Alexander T M van de Water (ATM)

Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: a.vandewater@latrobe.edu.au.

Andrea M Bruder (AM)

Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia. Electronic address: a.bruder@latrobe.edu.au.

Nicholas F Taylor (NF)

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.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Conservative interventions may have little...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Conservative interventions may have little...
questionsmedicales.fr › Appareil locomoteur › Muscles abdominaux › Muscle droit de l'abdomen › Conservative interventions may have little...
questionsmedicales.fr › Appareil locomoteur › Muscles abdominaux › Conservative interventions may have little...
questionsmedicales.fr › Thérapeutique › Techniques de physiothérapie › Traitement par les exercices physiques › Conservative interventions may have little...