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Šćepanović D1, Osredkar N2, Rostohar M1, Verdenik I1, Žgur L1
1University Medical Centre Ljubljana, Department of Obstetrics and Gynaecology, Ljubljana, Slovenia, 2University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
Background: Diastasis recti abdominis is defined as an increased separation of the two rectus abdominis muscles along the linea alba. Ultrasonography is a reasonably priced, non-invasive, repeatable and safe method for measuring the excessive separation and for use during pregnancy. The values obtained with such measurements are in millimetres and in such, cannot be detected by palpation. Until now, there has been a lack of reliability research for measuring diastasis recti in pregnant women with the use of ultrasonography.
Purpose: To determine the intra-rater and the inter-rater reliability for measuring diastasis recti abdominis in pregnant women with the use of an ultrasound machine.
Methods: The research included 20 pregnant volunteers. Two qualified physiotherapists performed measurements 4.5 cm above the superior border of the umbilicus and 4.5 cm below the inferior border of the umbilicus, as well as in the position of a relaxed abdominal wall and while performing an abdominal crunch. Measurements were made using an ultrasound machine Samsung Medison UGEO H60 and a linear ultrasound probe. The reliability was assessed by the intra-class correlation coefficient (ICC).
Results: The ICC value in measurements above the umbilicus and in position of a relaxed abdominal wall was ICC=0.976 for the first rater and ICC=0.924 for the second rater. In measurements below the umbilicus and in position of a relaxed abdominal wall, the first rater reached the value of ICC=0.599, while the value for the second rater was negative, ICC= -5.170. In measurements above the umbilicus while performing an abdominal crunch, the ICC value for the first rater was ICC=0.918 and ICC=0.951 for the second rater. The ICC value in measurements below the umbilicus while performing an abdominal crunch was ICC=0.535 for the first rater and ICC=0.907 for the second one. The reliability among raters for measurements in position of a relaxed abdominal wall above the umbilicus was ICC=0.690, while the reliability for measurements in position of a relaxed abdominal wall below the umbilicus was ICC=0.620. In measurements while performing an abdominal crunch, the ICC for measurements above the umbilicus was ICC=0.754 while the ICC value for measurements below the umbilicus was ICC=0.753.
Conclusion(s): Based on the obtained results, it can be concluded that the intra-rater reliability above the umbilicus in both positions was very good. In measurements below the umbilicus, the reliability was average to very good. Reliability among raters in measurements above and below the umbilicus and in both positions was good. Narrow ultrasound probe and thus measurements made on smaller diastases, were considered as a limitation to our study. Further studies are necessary to evaluate the reliability of ultrasonography for measurements made on wider separations.
Implications: Ultrasonography is a reliable method to assess diastasis recti abdominis in pregnant women regardless if the measurements are taken by a single physiotherapist or by two different physiotherapists. Ultrasonography can be used to monitor changes of diastasis recti abdominis during pregnancy and postpartum. The key to achieving higher reliability is experience and continuous professional education.
Keywords: diastasis recti abdominis, pregnancy, ultrasound
Funding acknowledgements: The study was unfunded.
Purpose: To determine the intra-rater and the inter-rater reliability for measuring diastasis recti abdominis in pregnant women with the use of an ultrasound machine.
Methods: The research included 20 pregnant volunteers. Two qualified physiotherapists performed measurements 4.5 cm above the superior border of the umbilicus and 4.5 cm below the inferior border of the umbilicus, as well as in the position of a relaxed abdominal wall and while performing an abdominal crunch. Measurements were made using an ultrasound machine Samsung Medison UGEO H60 and a linear ultrasound probe. The reliability was assessed by the intra-class correlation coefficient (ICC).
Results: The ICC value in measurements above the umbilicus and in position of a relaxed abdominal wall was ICC=0.976 for the first rater and ICC=0.924 for the second rater. In measurements below the umbilicus and in position of a relaxed abdominal wall, the first rater reached the value of ICC=0.599, while the value for the second rater was negative, ICC= -5.170. In measurements above the umbilicus while performing an abdominal crunch, the ICC value for the first rater was ICC=0.918 and ICC=0.951 for the second rater. The ICC value in measurements below the umbilicus while performing an abdominal crunch was ICC=0.535 for the first rater and ICC=0.907 for the second one. The reliability among raters for measurements in position of a relaxed abdominal wall above the umbilicus was ICC=0.690, while the reliability for measurements in position of a relaxed abdominal wall below the umbilicus was ICC=0.620. In measurements while performing an abdominal crunch, the ICC for measurements above the umbilicus was ICC=0.754 while the ICC value for measurements below the umbilicus was ICC=0.753.
Conclusion(s): Based on the obtained results, it can be concluded that the intra-rater reliability above the umbilicus in both positions was very good. In measurements below the umbilicus, the reliability was average to very good. Reliability among raters in measurements above and below the umbilicus and in both positions was good. Narrow ultrasound probe and thus measurements made on smaller diastases, were considered as a limitation to our study. Further studies are necessary to evaluate the reliability of ultrasonography for measurements made on wider separations.
Implications: Ultrasonography is a reliable method to assess diastasis recti abdominis in pregnant women regardless if the measurements are taken by a single physiotherapist or by two different physiotherapists. Ultrasonography can be used to monitor changes of diastasis recti abdominis during pregnancy and postpartum. The key to achieving higher reliability is experience and continuous professional education.
Keywords: diastasis recti abdominis, pregnancy, ultrasound
Funding acknowledgements: The study was unfunded.
Topic: Women's & men's pelvic health; Women's & men's pelvic health
Ethics approval required: Yes
Institution: Ministry of Health of the Republic of Slovenia
Ethics committee: National Medical Ethics Committee
Ethics number: 0120-353/2017-3
All authors, affiliations and abstracts have been published as submitted.
