Do Non-surgical interventions (exercise, education, brace/corset) reduce the effects of Diastasis Recti Abdominis?
Which non-surgical intervention is the most effective in improving Diastasis Recti Abdominis?
Searches
Databases: MEDLINE, EMBASE, CINAHL,PEDRO, PUBMED, AMED. These electronic databases were searched from earlist date available to July 2012. Manual searching of reference listsof included studies and citation tracking were conducted to ensure all of relevant studies found.
No restriction to Language.
No restriction to publication period.
Types of study to be included
All study designs except for sytematic reviews, editorial/opinions.
Condition or domain being studied
Diastasis Recti Abdominis Muscle (DRAM) is a separation of the 2 bellies of the rectus abdominis at the linea alba.It is a widening of the inter-recti distance due to stretching and thinning of the linea alba associated with hormonal and mechanical stresses placed upon the structures of the abdominal wall in pregnancy.These alterations in abdominal muscle attachment and angle of insertion may alter the line of action of the muscle and its ability to produce torque. This leads to altered trunk mechanics, faulty pelvic stability,changed posture and decreased support of the abdominal viscera. DRAM manifests as weakened core stability, back and abdominal discomfort and leaves the lumbar spine and pelvis vulnerable to injury. Finding non-surgical interventions to reduce the presence, size and speed up the recovery of DRAM and associated effects (abdominal strength, activity level, quality of life) will assist the pregnant population and those planning pregnancy.
Participants/ population
Inclusion: pregnant and post-natal females-women
Exclusion: pregnant women with: pre-existing neurological disorders/ musculoskletetal disorders/ medically unstable/ prev. abdo surgery unrealted to pregnancy. No animals.
Intervention(s), exposure(s)
INCLUSION: non surgical Rx, education, exercise and external support(tubigrip, corset, tape)
EXCLUSION: Surgical interventions
Comparator(s)/ control
Inclusion:Non exposed group - no intervention, Routine care
Exclusion: Surgical interventions
Outcome(s)
Primary outcomes
Absence/presnece of DRAM
Size of DRAM
Abdominal strength/endurance
Quality of Life
Activity Levels
-post-natal and or antenatal measurements
-preferably pre and post intervention measurements
Secondary outcomes
Impairments
Back pain
post-natal and or antenatal measurements
preferably pre and post intervention measurements
Data extraction, (selection and coding)
Two reviewers independently applied the inclusion and exclusion criteria to the titles and abstracts of all studies retrieved and any that did not meet the criteria were eliminated. Any disagreements were resolved by discussion between the two reviewers, and if consensus could not be reached a third reviewer was to be consulted. Where it is not clear whether the study met the inclusion criteria the full text papers of the studies were obtained for review.
A data extraction form was developed a priori based on the Cochrane Consumers and Communication Review Group data extraction template, which was revised to suit our review. The form will be pilot tested on a selection of trials and subsequently refined. One reviewer will independently extract data, and the second reviewer will check the accuracy of the data extracted. Where there may be discrepancies the reviewers will refer back to the orignal study report. Where there is missing data attempts will be made to contact the authors of the trial for clarification.
Data will be extracted from each study on participant characteristics, intervention (type, duration, frequency, delivery, setting, providers for experimental and control groups), outcomes (primary and secondary ), and results.
Risk of bias (quality) assessment
All studies will be critically appraised for methodological quality using the 'Downs and Black checklist for randomised and non-randomised studies of health care interventions' by the two authors independently. Any disagreements will be resolved by discussion between the two reviewers, and if consensus cannot be reached a third reviewer will be consulted. Trials will not be excluded on the basis of quality, but quality of the study will be taken into account when analysing the results.
Strategy for data synthesis
Standardised mean differences(effect sizes) will be calucluated for the outcomes based on post intervention means and pooled estimate of post intervention SDs. Study data will only be pooled if they fit into common outcome categories. Meta-analysis will be performed with a random-effects model for outcomes using an inverse variance methods (RevMan, Version 5) for studies of higher quality. Statistical heterogenity will be assessed using I-squared statistic.
A descriptive synthesis is planned for studies of lesser quality.
Analysis of subgroups or subsets
None planned -may look at subgroups -types of exercise, effects of exercise prior to, during and post pregnancy.
Dissemination plans
via jounal submission, conference presentations, local inservices
Contact details for further information
Deenika Benjamin
Angliss Hospital
Albert Street,
Upper Ferntree Gully, Victoria
3156
Australia
Deenika.Benjamin@easternhealth.org.au
Organisational affiliation of the review
Easternhealth - Angliss Hospital
www.easternhealth.org.au
Review team
Ms Deenika Benjamin, Easternhealth Mrs Casey Peris, Easternhealth
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis
Prospective meta-analysis
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.
