Establishing measurement properties in the assessment of inter-recti distance of the abdominal muscles in a postnatal women

Benjamin, Deenika R.; Frawley, Helena; Shields, Nora; Georgiou, Chris; Taylor, Nicholas F.

doi:10.1016/j.msksp.2020.102202

Cited by 12 publications

(30 citation statements)

References 33 publications

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“…The SEM in our present study was about 4–5 mm and the MDC was about 11–13 mm, which is higher than in the comparable study of Benjamin et al 18 However, just two participants showed an inter-recti distance greater than 22 mm in their study, in our study the mean diastasis recti abdominis width was 25.9 mm. Furthermore, Benjamin et al are not discussing how much experience and training the two investigating physiotherapists had in measuring diastasis recti abdominis width with a calliper.…”

Section: Discussioncontrasting

confidence: 76%

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Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

et al. 2021

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ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.Outcome measuresInter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).ResultsVaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.ConclusionsVaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.Trial registration numberNCT03703804.

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Section: Discussioncontrasting

confidence: 76%

“…Diastasis recti abdominis width assessment using a calliper is reported to be nearly as accurate as ultrasound assessment, 15 17 although the inter-rater reliability of this method has been tested in just one study. 18 …”

Section: Introductionmentioning

confidence: 99%

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

et al. 2021

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“…The recurrence rate was zero and was assessed at least 24 months postoperatively using the finger-width method. It has been reported that it is a validated method in recognizing clinical RD recurrences [ 10 , 11 ]. Moreover, it is a safe, patient-friendly, and inexpensive evaluation method contrary to other methods such as U/S, MRI, or CT.…”

Section: Discussionmentioning

confidence: 99%

“… The finger-width method [ 10 , 11 ] is used preoperatively and postoperatively. It primarily functions as a screening tool to detect the presence or absence of RD.…”

Section: Methodsmentioning

confidence: 99%

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

2022

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Background This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty. Materials and methods One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result. Results No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results. Conclusions In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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“…This tool is valid and reliable to measure the IRD (Benjamin et al 2020 ; Boxer & Jones 1997 ; Chiarello & McAuley 2013 ; Van de Water & Benjamin 2016 ). The intra-class correlation coefficient (95% confidence interval) for the IRD measurement above the umbilicus is 0.98 (0.95–0.99) in Chiarello and McAuley ( 2013 ).…”

Section: Methodsmentioning

confidence: 99%

Diastasis recti in the Beninese population: Cross-sectional study from normal values to diagnosis

Djivoh

Kpadonou

Puttemans

et al. 2022

South African Journal of Physiotherapy

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Background: Diastasis recti is diagnosed when the interrecti distance (IRD) is larger than a threshold value. Published thresholds were measured at rest with ultrasound while in Benin physiotherapists use calipers during abdominal contraction.Objectives: The aim was to define IRD threshold values measured with calipers in Beninese participants in order to diagnose diastasis recti in a clinical environment and identify women needing abdominal rehabilitation.Method: Interrecti distance was measured using ultrasound and calipers. Linea alba stiffness was assessed by palpation, abdominal strength and endurance by manual testing. In men and nulliparous women, IRD threshold values were defined as IRD P90. In postpartum women, IRD P80 and a threshold defined with a receiver operating characteristics (ROC) curve based on linea alba stiffness were used. In these women, abdominal strength and endurance were compared depending on IRD threshold and linea alba stiffness with a Mann Whitney test.Results: In 391 Beninese participants, the IRD threshold measured with calipers was 17 mm in men, 15 mm in nulliparous and 18 mm (15 mm with ROC curve) in postpartum women. Postpartum women with an IRD above 18 mm had significantly lower abdominal strength. Those with a slack linea alba had significantly lower abdominal strength and endurance.Conclusion: The defined IRD threshold values can be used in a Beninese clinical environment. Future studies should confirm whether they can be applied to other African populations.Clinical implications: Abdominal rehabilitation should be recommended to postpartum women whose IRD is above the threshold values but also in cases of slack linea alba and poor abdominal function.

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Establishing measurement properties in the assessment of inter-recti distance of the abdominal muscles in a postnatal women

Cited by 12 publications

References 33 publications

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

Diastasis recti in the Beninese population: Cross-sectional study from normal values to diagnosis

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