ASSESSMENT METHODS OF DIASTASIS RECTI ABDOMINIS IN POSTNATAL REHABILITATION

E. Rigby1, C. Lim Yenn1, K. Chua Yuann Nyng1, E. Tan Teck Wee1, G. Teng Shin Cheong1, T. Abdelkader1
1Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore

Background: Diastasis Recti Abdominis Muscles (DRAM) is a widening of the linea alba (LA) during pregnancy that persists in some postnatal women. Interest in the health literacy of DRAM has grown in recent years. DRAM is assessed using the inter-recti distance (IRD). Callipers, finger-width and real-time ultrasound (RTUS) methods have been shown to be reliable however, there is no standardized assessment for inter-recti distance (IRD) measurement to determine DRAM.

Purpose: To determine and describe the IRD assessment of DRAM by postnatal rehabilitation professionals.

Methods: A convenience sample, recruited by email and social media, completed an online mixed methods survey, consisting of multiple choice and short answer questions. Medical, allied health and certified fitness professionals whose practice includes measuring IRD width and/or the management of DRAM conditions were included. Respondents were surveyed on their choice and rationale for IRD measurement when assessing DRAM.

Results:
  1. Survey demographics n=16 responses (5 countries), 12 Physiotherapists, 3 Fitness Professionals, 1 Continence Rehab Clinician. 6 partially completed.
  2. Consensus on the usefulness of IRD measurement 87.50% indicated DRAM screening is part of routine post-natal assessment. The top 3 uses of IRD measurement: identify presence of DRAM (93.75%), determine severity of DRAM (87.5%), monitor rehabilitation (87.5%).
  3. IRD values for measurement methods IRD values mostly recorded using finger-width (93.75%) and centimetres (cm) (62.5%). Respectively, 2 finger-widths and 2.5 cm were the top thresholds used to determine DRAM. 18.75% assess DRAM based on depth and tension at the site(s) along Linea Alba (LA).
  4. Factors affecting the choice of measurement method 70% of practitioners follow evidence-informed recommendations. 50% select methods based on convenience, good reliability and comfort for patients. 40% choose the most time-efficient option available. Validity and clinic protocol affects 30% of choice. A minority of professionals (<10%) relied on word of mouth, clinical experience, ease of conveying results to patients.
  5. Most widely & frequently used parameters
    1. Measurement tools (available in clinic, used by clinicians): Finger width (100%, 100%); RTUS (42%, 83%); Measuring tape (42%, 33%); Physical calipers (7%, 0%).
    2. Measuring sites: 50% examine throughout entire LA; 50% examine specific sites along LA (40% at umbilicus, 60% at 2 cm below, 70% at 2 cm above umbilicus).
    3. Patient positioning: crook lying (70%); curled-up abdomen (100%).
    4. Breathing instructions: Normal breathing (73%), Measured at the end of expiration (18%), Breathhold at maximal expiration (9%), Breathhold at minimal expiration (9%).

Conclusions: DRAM screening is a routine part of post-natal assessment. Variation exists on where, why and how clinicians assess the presence of DRAM in postnatal women. Some clinicians vary measurement sites based on depth, tension and tissue torsion of the LA while others rely on landmarks along the LA during the assessment. RTUS is the gold standard for IRD measurement, but clinicians still prefer convenience and time efficiency of finger-width measurement. Access to RTUS may be another reason.

Implications:
  • Assessment of DRAM varies widely both in method and rationale.
  • Further research may be warranted on control and tension of LA and possible relationship with varying IRDs in DRAM patients, and its significance in the choice of IRD measurement method.

Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial-or-not for profit sectors

Keywords:
Diastasis Recti Abdominis
Assessment
Postnatal rehabilitation

Topics:
Pelvic, sexual and reproductive health
Musculoskeletal
Professional practice: other

Did this work require ethics approval? Yes
Institution: Singapore Institute of Technology
Committee: Singapore Institute of Technology Institutional Review Board
Ethics number: 2020151

All authors, affiliations and abstracts have been published as submitted.

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