None listed
Conditions
Brief summary
Diastasis of the rectus abdominis muscle (DRAM or DRA) is a common condition postpartum where the abdominal muscles seperate along the linea alba. Current physiotherapy management is overwhelmingly reported to include transversus abdominis (TrA) training (Keeler et al., 2012), however, ultrasound imaging evidence is growing to support rectus abdominis (RA) training in the early postpartum period instead (Mota, 2014; Mota et al., 2015; Sancho et al., 2015). While ultrasound imaging has previously shown contraction of the TrA muscle increases the inter-recti distance and RA reduces it, no current evidence exists comparing the two when precribed as a treatment. References Keeler, J., Albrecht, M., Eberhardt, L., Horn, L., Donnelly, C., & Lowe, D. (2012). Diastasis recti abdominis: a survey of women's health specialists for current physical therapy clinical practice for postpartum women. Journal of women’s health physical therapy, 36(3), 131-142. Mota, P., Pascoal, A. G., Carita, A. I., & Bø, K. (2015). The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. journal of orthopaedic & sports physical therapy, 45(10), 781-788. Mota, P., Pascoal, A. G., Carita, A. I., & Bø, K. (2018). Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskeletal Science and Practice, 35, 34-37. Sancho, M. F., Pascoal, A. G., Mota, P., & Bø, K. (2015). Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy, 101(3), 286-291.
Interventions
Participants will be randomised into one of two treatment groups within 72 hours of giving birth.
Those in the experimental intervention group will be asked to complete the following protocol:
Between 1-10 x 1 second crunch (head lift) with dosage prescribed once again depending on patient’s technique. Exercise will be completed and assessed in crook lie and exercise prescription based on number able to complete with good technique and prior to the onset of doming of linea alba as assessed by a
Participants will be randomised into one of two treatment groups within 72 hours of giving birth. Those in the experimental intervention group will be asked to complete the following protocol: Between 1-10 x 1 second crunch (head lift) with dosage prescribed once again depending on patient’s technique. Exercise will be completed and assessed in crook lie and exercise prescription based on number able to complete with good technique and prior to the onset of doming of linea alba as assessed by a senior physiotherapist. Dosage will be 1-2 x a day, at least 5 days of the week with a tick-box exercise diary provided for data on compliance. Verbal and written education will be provided at the time of exercise prescription about some exercise being better than none, and to continue even if not meeting prescribed dosages. Participants will also be taught about being able to make the exercises “Mother-baby friendly” to better fit them into their routine by encouraging baby to be completing tummy time on her chest during completion. The participants will be provided with a written home exercise program with the same information. They will then be asked to come in for re-assessment and progression (if appropriate) at 6 and 12 weeks postpartum. Progression will include re-assessment of exercise technique and prescription of a new dosage between 1-20 repetitions of the prescribed exercise as appropriate at the week 6 review. Re-assessment will involve the standardised assessment position from baseline measures (flat supine lie with extended legs) using ultrasound to measure 2cm above/below and at the level of the umbilicus. This is the measurement technique which will also be used at baseline on the ward. Progression will not occur at the 12 week appointment as this will be the conclusion of the participant's program. Follow up appointments will have the option of being held at the hospital or as a home-based appointment and are expected to run for 15 minutes each. All participants will receive a modified version of the hospital's standard physiotherapy postpartum education material which will be edited to remove the current advice regarding DRAM to avoid confusion. A seperate education sheet created for the study including details of the prescribed exercise will be provided. All education and prescription will be completed face to face by a senior physiotherapist. Participants will be encouraged to return their exercise diary at each follow up appointment to monitor compliance.
Sponsors
Eloise Simpson
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DRAM of >30mm at one or more of the measurement points of 2cm above/below/at the level of the umbilicus. Delivered vaginally after 37 weeks gestation Delivered within past 72 hours Age > 18 years
Exclusion criteria
Caesarean section delivery, Delivered >72 hours prior to assessment, < 18 years of age, Presence of serious disease/pathology or impaired cognition contraindicating involvement in an exercise program.
Outcome results
None listed