2. International Academy on Women's Health and Gender Equity Studies, Illinois, USA.
Purpose/Hypothesis: The purpose of this randomized controlled study was to determine if there was a significant difference between a six week traditional treatment program compared to an experimental treatment program consisting of core stabilization plank exercise routine in the closure of diastasis recti abdominis (DRA) and to determine the relationship between DRA measurements, pain, Oswestry Disability Index (ODI), and Pelvic Floor Disability Index scores (PFDI).
Study design: Subjects were recruited in the local community utilizing a purposive sampling technique that considered women (postpartum 3 months to 3 years) between the ages of 18-45. Nine subjects volunteered to be in the study, signed an informed consent, and were randomly selected to be in either in a traditional or experimental group. Each participant completed both pre and post test diagnostic ultrasound and caliper measurements for DRA, health questionnaire, PFDI, and ODI scores.
Materials and methods: A pilot study (n=5) was performed prior to the full study and indicated significant and strong inter-rater and intra-rater reliability for the diagnostic ultrasound DRA measurement at (r=0.945-0.989, p<0.0005). All participants were measured prior to being randomly placed into either the traditional or experimental group. Co-researchers who were in charge of DRA measurement were blinded from the group designation. The traditionalgroup received a supine strengthening program and the experimental group received a dynamic core stabilization program including the addition of plank exercise to approximate the DRA.
Results: Overall, in both groups there was a measured, significant decline in the DRA measurement at the umbilicus (F=7.28, p=0.036), but the traditional group showed a slightly greater decline from pre to posttest (M (pre)=10.97+/-1.96; M(post)=6.63+/-1.65) compared to the experimental group (M(pre)=8.75+/-0.87 )(M(post)=7.58+/-2.01). Disability scores also revealed a significant decline with respect to the ODI for both the traditional group (Z=-1.95, p=0.50) (M(pre)=5.50+/-5.51) (M(post)=3.50+/-3.00) and the experimental group (M(pre)=14.40+/-15.39) (M(post)=4.40+/-3.58). A significant difference was not found within groups, from pre to post-test, for the overall PFDI scores and its components (UDI and POPDI). However, a significant difference was found, within group, with respect to CRADI scores (Z=-2.032, p=0.042). In addition, a significant difference was not found between women who reported participation in pre-natal exercises compared with those who did not participate in pre-natal exercises with respect to baseline DRA measurements (above umbilicus: Z=-0.980, p=0.327), (at umbilicus: Z=-0.735, p=0.462), and (below umbilicus: Z=-0.980, p=0.327). Finally, a negative but non-significant correlation was found between PFDI scores and DRA closure measurements (r=0.605, r2=0.366, p=0.084).
Conclusions: Both the traditional and experimental group showed significant reduction in DRA measurement from pre to posttest, with the traditional program exhibiting a slightly greater decline from pre to post DRA measurement than the experimental group. These findings suggest that either strengthening program, traditional or experimental, could be effective at reducing DRA measurement in postpartum women. However, this study was limited by a small sample size and would benefit from future research focused on specific exercise prescription progression.
Keywords: Diastasis rectus abdominis, diagnostic ultrasound, pelvic rehabilitation