Reliability and validity of clinical and imaging methods in the assessment of the diastasis recti: A systematic review

authors:

avatar Elham Soleimanzadeh , avatar Hakimeh Adigozali ORCID , * , avatar Fariba Ghaderi ORCID , avatar Tabassom Ghanavati ORCID , avatar Morteza Ghojazadeh , avatar Fatemeh Salehnia ORCID

Koomesh: Vol.24, issue 4; 434-450
published online: September 01, 2022
article type: issue_documents_importer
received: August 01, 2021
accepted: January 01, 2022

how to cite: Soleimanzadeh E, Adigozali H, Ghaderi F, Ghanavati T, Ghojazadeh M, et al. Reliability and validity of clinical and imaging methods in the assessment of the diastasis recti: A systematic review. koomesh. 2022;24(4):e152752. 

Abstract

Introduction: Diastasis recti is often caused by pregnancy in women and may cause complications such as low back pain, lumbopelvic pain, and pelvic floor disorders. Determining the most accurate method to measure diastasis recti is important to estimate the rate of recovery in response to treatment and the need for surgery. Thus, ths study aimed to review the evidence regarding methods of diastasis recti assessment. Materials and Methods: First, databases such as Web of Science, Pro-Quest, Em-base, PubMed, Google Scholar, AMED, and Scopus were searched using related keywords by June 2020. Then, articles were selected based on inclusion and exclusion criteria and the quality of the studies was assessed using the COSMIN checklist. Required information from each article was extracted and the table of characteristics and findings of the articles was recorded. Results: Amongst the 18 included articles, the reliability, and validity of the finger width method, caliper and ultrasonography were studied (one, one, and nine studies, respectively). Additionally, the comparison of the validity of ultrasonography and surgical compass, ultrasonography and the finger width, ultrasonography and caliper, CT scan and ruler, Magnetic Resonance Imaging and ruler, was performed in one, one, two, one, two, and one studies, respectively. Most of the evidence was in the field of ultrasonography and the ICC of this method and caliper was above 0.9. In addition, ICC for agreement between ultrasonography and caliper above umbilicus was more than 0.7 and below umbilicus was less than 0.5. The agreement between raters for the finger width method was moderate (62.5%). There is not enough evidence about other methods. Conclusion: Ultrasonography and caliper are lightly reliable and valid. In addition, these methods are safe and non-invasive. Due to real-time dynamic examination with ultrasonography and the limitation of using the caliper method, ultrasonography seems to be the best method for assessing diastasis recti. However, future studies seem to be necessary due to the heterogeneity of previous studies.

References

  • 1.

    Kisner C, Colby L A, Borstad J, Editors. Therapeutic Exercise Foundations and techniques. 2nd ed. United States of America: F.A Davis Company; 2018.

  • 2.

    Benjamin DR, Frawley HC, Shields N, Water ATMvd, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019; 105: 24-34.https://doi.org/10.1016/j.physio.2018.07.002PMid:30217494.

  • 3.

    Chiarello CM, McAuley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. J Orthop Sports Phys Ther 2013; 43: 495-503.https://doi.org/10.2519/jospt.2013.4449PMid:23633625.

  • 4.

    Izadi F, Khalkhali Zaviyeh M, Akbarzadeh Baghban A. Structural response of abdominal muscles to six weeks of strengthening training in women with diastasis recti. Iran J Obstet Gynecol Infert 2018; 21: 71-82.

  • 5.

    Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. Association of chartered physiotherapists in womens health 2005; 97: 49 [abstract].

  • 6.

    Emanuelsson P, Gunnarsson U, Dahlstrand U, Strigard K, Stark B. Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 2016; 160: 1367-1375.https://doi.org/10.1016/j.surg.2016.05.035PMid:27475817.

  • 7.

    Gillard S, Ryan CG, Stokes M, Warner M, Dixon J. Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women. Musculoskelet Sci Pract 2018; 34: 1-7.https://doi.org/10.1016/j.msksp.2017.11.010PMid:29195217.

  • 8.

    Liaw LJ, Hsu MJ, Liao Ch F, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: A 6-month follow-up study. J Orthop Sports Phys Ther 2011; 41: 435-443.https://doi.org/10.2519/jospt.2011.3507PMid:21289454.

  • 9.

    Dalal K, Kaur A, Mitra M. Correlation between diastasis rectus abdominis and lumbopelvic pain and dysfunction. Indian J Physiother Occup Ther 2014; 8: 210-214.https://doi.org/10.5958/j.0973-5674.8.1.040.

  • 10.

    Blyholder L, Chumanov E, Carr K, Heiderscheit B. Exercise behaviors and health conditions of runners after childbirth. Sports Health 2016; 9: 45-51.https://doi.org/10.1177/1941738116673605PMid:27742879 PMCid:PMC5315256.

  • 11.

    Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J 2007; 18: 321-328.https://doi.org/10.1007/s00192-006-0143-5PMid:16868659.

  • 12.

    Barbosa S, Sa Ramd, Velarde LG. Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination. Arch Gynecol Obstet 2013; 288: 299-303.https://doi.org/10.1007/s00404-013-2725-zPMid:23435798.

  • 13.

    Emanuelsson P, Dahlstrand U, Stromsten U, Gunnarsson U, Strigard K, Stark B. Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively. Hernia 2014; 18: 465-471.https://doi.org/10.1007/s10029-014-1221-0PMid:24488508.

  • 14.

    Elkhatib H, Buddhavarapu SR, Henna H, Kassem W. Abdominal musculoaponeuretic system: magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty. Plast Reconstr Surg 2011; 128: 733-740..https://doi.org/10.1097/PRS.0b013e318230c8a1PMid:22094774.

  • 15.

    Mendes Dde, Nahas FX, Veiga DF, Mende FV, Figueiras RG, Gomes HC, et al. Ultrasonography for measuring rectus abdominis muscles diastasis1. Acta Cir Bras 2007; 22: 182-186.https://doi.org/10.1590/S0102-86502007000300005PMid:17546290.

  • 16.

    Water ATMvd, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther 2016; 21: 41-53.https://doi.org/10.1016/j.math.2015.09.013PMid:26474542.

  • 17.

    Bursch SG. Interrater reliability of diastasis recti abdominis measurement. Phys Ther 1987; 67: 1077-1079.https://doi.org/10.1093/ptj/67.7.1077PMid:2955430.

  • 18.

    Mota P, Pascoal AG, Sancho F, Carita AI, B K. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther 2013; 18: 294-298.https://doi.org/10.1016/j.math.2012.10.013PMid:23298825.

  • 19.

    Boxer S, Jones S. Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. Aust J Physiother 1997; 43: 110-114.https://doi.org/10.1016/S0004-9514(14)60405-0.

  • 20.

    Nahas FX, Augusto SM, Ghelfond C. Nylon versus polydioxanone in the correction of rectus diastasis. Plast Reconstr Surg 2001; 107: 700-706.https://doi.org/10.1097/00006534-200103000-00008PMid:11304594.

  • 21.

    Liaw YF, Lie S, Hsiao S. The reliability of measuring of inter-recti distance using real-time ultrasonography. Formos J Phys Ther 2006. [Abstract].

  • 22.

    Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther 2011; 41: 435-443.https://doi.org/10.2519/jospt.2011.3507PMid:21289454.

  • 23.

    Mota P, Pascoal AG, Sancho F, Bo K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther 2012; 42: 940-946.https://doi.org/10.2519/jospt.2012.4115PMid:22810966.

  • 24.

    Iwan T, Garton B, Ellis R. The reliability of measuring the inter-recti distance using highresolution and low-resolution ultrasound imaging comparing a novice to an experienced sonographer. N Z J Physiother 2014; 42: 154-163.https://doi.org/10.15619/NZJP/42.3.07.

  • 25.

    Keshwani N, McLean L. Ultrasound imaging in postpartum women with diastasis recti: Intrarater between-session reliability. J Orthop Sports Phys Ther 2015; 45: 713-718.https://doi.org/10.2519/jospt.2015.5879PMid:26161625.

  • 26.

    Keshwani N, Mathur S, McLean L. Validity of inter-rectus distance measurement in postpartum women using extended field-of-view ultrasound imaging techniques. J Orthop Sports Phys Ther 2015; 45: 808-813.https://doi.org/10.2519/jospt.2015.6143PMid:26304645.

  • 27.

    Keshwani N, Hills N, McLean L. Inter-rectus distance measurement using ultrasound imaging: does the rater matter? Physiother Can 2016; 68: 223-229.https://doi.org/10.3138/ptc.2015-36PMid:27909371 PMCid:PMC5125459.

  • 28.

    Scepanovic D, Osredkar N, Rostohar M, Verdenik I. The reliability of measuring diastasis recti abdominis in pregnant women using ultrasound. Focus (Med Sci J) 2018; 4: 9-12.

  • 29.

    Tahan N, Mohseni-Bandpei AM, Mikaili S, Akbarzadeh-Baghban A. Sonography of the abdominal muscles thickness during rest and contraction before and after food consumption. Koomesh 2016; 18: 243-249. (Persian).