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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

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Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review

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Review published: .

CRD summary

The authors concluded that because of the poor quality of the current literature, the evidence suggested that non-specific exercise may or may not help to prevent or reduce diastasis of the rectus abdominis muscle during antenatal and postnatal periods. The authors acknowledged the limitations in their review and their cautious conclusion seems reliable.

Authors' objectives

To determine if non-surgical interventions (such as exercise) prevent or reduce diastasis of the rectus abdominis muscle.

Searching

Five databases including PubMed and EMBASE were searched up to July 2012 with no language restrictions. Search terms were reported. Reference lists of included studies were also searched and citations tracked.

Study selection

Studies of all designs that included any non-surgical interventions to manage diastasis of the rectus abdominis muscle during the antenatal and postnatal periods were eligible for inclusion in the review. The primary outcomes of interest were the presence/absence and width (cms) of diastasis of the rectus abdominis muscle. Secondary outcomes were back pain, abdominal strength, ability to complete activities of daily living and quality of life.

Included studies examined antenatal interventions to reduce the risk of developing diastasis of the rectus abdominis muscle, and the postnatal interventions to reduce the width of diastasis and aid recovery. Participants were aged from 18 to 40 years, of mixed parity and had various modes of delivery. All interventions included some form of exercise, which was carried out in isolation as the only intervention or in conjunction with corset/tubigrip application and/or education. The exercise settings, delivery, frequency, duration and methods of measuring diastasis varied between the studies.

Two reviewers independently selected studies for inclusion; any disagreements were resolved by discussion or involvement of a third reviewer.

Assessment of study quality

Study quality was assessed using a modified Downs and Black checklist (total scores ranged from 0 to 28 points). Studies were rated as excellent if they scored 26 to 28, good if they scored 20 to 25, fair if they scored 15 to 19, and poor if the total score was 14 or less.

Two reviewers independently assessed the quality of the studies; any disagreement were resolved by discussion or involvement of a third reviewer.

Data extraction

Data were extracted to calculate relative risk and 95% confidence intervals. Study authors were contacted for additional information if necessary.

One reviewer extracted the data, and a second reviewer checked the accuracy of the data extracted;any disagreements were resolved by referring back to the original study.

Methods of synthesis

Pooled relative risk and 95% confidence intervals were calculated for studies with similar interventions that reported on the same outcomes using a fixed-effect model where there was no evidence of heterogeneity. Heterogeneity was assessed using the Ι² statistic; values larger than 50% represented substantial levels of heterogeneity. Analysis was performed separately for interventions to prevent diastasis of the rectus abdominis muscle during the antenatal period and for interventions to treat diastasis during the postnatal period.

If it was not possible to pool data, a narrative summary was reported.

Results of the review

Eight studies (four case studies, one quasi-experimental post-test studies, two retrospective observational studies and one randomised controlled trial) were included in the review (336 participants). Seven out of eight studies were rated as fair to poor in quality (scores ranged from 12 to 23 out of 28 points); overall quality was judged to be fair. There was a lack of blinding in all of the trials.

Antenatal exercise: Three studies reported that antenatal exercise reduced the presence of diastasis of the rectus abdominis muscle by 35% (RR 0.65, 95% CI 0.46 to 0.92; Ι²=39%; NNT=3) compared with non-exercising control groups. Two studies (one reported both antenatal and postnatal) showed that antenatal exercise reduced the width of diastasis during the antenatal and postnatal periods (no pooled analysis). No significant difference was found for the time to recovery of diastasis of the rectus abdominis muscle (one study).

Postnatal exercise: One RCT reported a reduction in diastasis of the rectus abdominis muscle width with postnatal abdominal exercise. Two studies reported a reduction in diastasis width with combined abdominal exercise and a tubigrip/corset and or posture/back care education (no pooled analysis).

One study reported the effects of diastasis of the rectus abdominis muscle on quality of life; aerobic exercise and neuromuscular education improved physical and social SF36 scores.

No adverse events were reported in any of the included studies.

Authors' conclusions

Due to the poor quality of the available literature, the evidence suggested that non-specific exercise may or may not help to prevent or reduce diastasis of the rectus abdominis muscle during antenatal and postnatal periods.

CRD commentary

The review question and inclusion criteria were clear. The search was adequate and not restricted by language or other factors. Attempts were made to minimise reviewer errors and bias during the review process. Study quality was assessed using appropriate criteria; most studies were rated as poor quality. Heterogeneity was assessed and appropriate methods were used to pool the results. The authors acknowledged the limitation in their review due to poor quality studies, small number of participants and clinical heterogeneity between studies.

The authors' cautious conclusion reflected the evidence presented and seems reliable.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that adequate powered, high-quality randomised controlled trials were needed to target specific non-surgical strategies with a single exercise intervention rather than a varied regime of different exercises and strategies. Also further research was required to evaluate the external support garments (such as tubigrip or corsets) and at the same time evaluate the transverse abdominal muscle activation exercise to prevent or reduce diastasis of the rectus abdominis muscle.

Funding

Not reported.

Bibliographic details

Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 2014; 100(1): 1-8. [PubMed: 24268942]

Indexing Status

Subject indexing assigned by CRD

MeSH

Rectus Abdominis; Humans; Female; Pregnancy; Exercise Therapy; Postnatal Care; Prenatal Care

AccessionNumber

12013069654

Database entry date

08/05/2014

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Copyright © 2014 University of York.
Bookshelf ID: NBK179548

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