O16 THE TOR-CONCEPT (TRAINING-OPERATION-REHABILITATION) APPLIED TO A COHORT OF POST-PARTUM WOMEN WITH SYMPTOMATIC DRA (DIASTASIS RECTI ABDOMINIS). EVALUATION OF PHYSICAL FUNCTION AND QUALITY OF LIFE ONE YEAR AFTER SURGERY

Aim Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program. Material and Methods A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery. Results Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population. Conclusions In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.

P075 IS INTER-RECTI DISTANCE (IRD) A RELIABLE PROXY FOR EVALUATION OF FUNCTIONAL IMPAIRMENTS ASSOCIATED WITH DIASTASIS RECTI ABDOMINIS (DRA)?

Aim Diastasis recti abdominis (DRA) following pregnancy is associated with functional impairment such as back pain, abdominal core instability, urinary incontinence, and abdominal bulging. Several studies have reported functional improvements after surgical repair of the DRA. The aim of this study was to investigate the association between the inter-recti distance (IRD) and self-reported functional disabilities measured with the Disability Rating Index questionnaire (DRI), with the hypothesis that inter-recti distance could serve as a proxy for core instability symptoms. Material and Methods A retrospective study based on a consecutive cohort of patients with core instability symptoms combined with DRA. The IRD was measured with ultrasonography among women with symptomatic post-partum DRA and functional impairments were registered with the self-report DRI questionnaire that covers twelve unspecific daily activities. IRD results were analysed against the DRI score with uni- and multivariable regression analyses. Results A total of 222 women were included in this study. Univariable regression analyses showed a significant positive correlation between the heavier activities running, heavy work, lifting heavy objects and exercise/sports and IRD, which failed to reach significance in the multivariable regression analysis with adjustments for length, weight, and BMI. Conclusions This study could not show any significant correlation between self-reported functional impairments and DRA isolated in the multivariable analysis, even though there is a tendency towards an association between DRA and heavy activities. The post-partum core instability situation is complex and probably origins from more components than solely the inter-recti distance.

Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study

Aim The prevalence and definition of diastasis recti abdominis (DRA) is under debate. This retrospective cross-sectional study evaluated the interrectal distance and the prevalence of DRA in computed tomography (CT) in an asymptomatic population. Materials and methods Patients undergoing CT scans for suspected appendicitis or kidney stones from 01/2016 to 12/2018 were screened retrospectively to participate. A study population with equal distribution according to gender and age (18–90 years) was generated (n = 329 patients) and the interrectal distance was measured at six reference points. Results DRA (defined as > 2 cm at 3 cm above the umbilicus) was present in 57% of the population. The 80th percentile of the interrectal distance was 10 mm at the xiphoid (median 3 mm, 95% confidence interval (CI) 0–19 mm), 27 mm halfway from xiphoid to umbilicus (median 17 mm, 95% CI 0–39 mm), 34 mm at 3 cm above the umbilicus (median 22 mm, 95% CI 0–50 mm), 32 mm at the umbilicus (median 25 mm, 95% CI 0–45 mm), 25 mm at 2 cm below the umbilicus (median 14 mm, 95% CI 0–39 mm), and 4 mm halfway from umbilicus to pubic symphysis (median 0 mm, 95% CI 0–19 mm). In the multivariate analysis, higher age (p = 0.001), increased body mass index (p < 0.001), and parity (p < 0.037) were independent risk factors for DRA, while split xiphoid, tobacco abuse, and umbilical hernia were not. Conclusion The prevalence of DRA is much higher than commonly estimated (57%). The IRD 3 cm above the umbilicus may be considered normal up to 34 mm. To avoid over-treatment, the definition of DRA should be revised.

Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation

Purpose Diastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but with no fascia defect. To data there is no consensus about risk factors for DRA. The aim of this article is to critically review the literature about prevalence and risk factor of DRA. Method A total of 13 papers were identified. Results The real prevalence of DRA is unknown because the prevalence rate varies with measurement method, measurement site and judgment criteria, but it is certainly an extremely frequent condition. Numbers of parity, BMI, diabetes are the most plausible risk factors. We identified a new anatomical variation in cadaveric dissection and in abdominal CT image evaluation: along the semilunar line the internal oblique aponeurosis could join the rectus sheath with only a posterior layer, so without a double layer (anterior and posterior) as usually described. We conducted a retrospective review of abdominal CT images and the presence of the posterior insertion only could be considered as a risk factor for DRA. Conclusion Further studies with large sample size, including nulliparous, primiparous, pluriparous and men too, are necessary for identify the real prevalence

Effect of Conventional Abdominal Binder on Diastasis Recti Abdominis in Post-Partum Women

BACKGROUND Pregnancy creates a radical change in a woman’s life. The physical, hormonal, and psychosocial changes during pregnancy affect the quality of life in post pregnancy phase. Diastasis recti abdominis (DRA) is one of the most common problems seen in post-partum period. DRA is a separation between two bellies of the rectus abdominis muscle connected by the linea alba. A significant DRA, if left untreated at the right time can lead to delirious complications. Prior researches have shown that diastasis recti abdominis is a very common condition seen in the post-partum period. Previous studies have shown that DRA can be reduced with help of an abdominal binder but have very less recorded data. Fewer studies have been conducted showing the combined effect of use of abdominal binder with core strengthening exercises in reduction of DRA. The purpose of this study was to find out the effect of a conventional abdominal binder on diastasis recti abdominis in post-partum women and determine the effect of a conventional abdominal binder on diastasis recti abdominis in post-partum women. METHODS This experimental study included 9 post-partum women with significant DRA. Their age ranged from 25 - 30 years, body mass index (BMI) less than 40 kg/m2. The outcome measures included DRA, lumbar lordosis measurement, low back pain and disability in post-partum period. The subjects were instructed to use an abdominal binder and were taught core strengthening exercises up to 3 months post-partum. RESULTS The obtained results show that there is statistically significant reduction in DRA after use of conventional abdominal binder and exercises. The before treatment values for mean and standard deviation at, above and below umbilicus were 59.39 ± 14.24, 51.87 ± 12.37, 38.15 ± 12.13 respectively which reduced to 41.19 ± 12.21, 37.76 ± 12.98, 30.76 ± 8.94 respectively after using conventional binder with exercises for 3 months. The P value at all three levels of measurements namely - at, above and below umbilicus was < 0.0001 which is statistically considered to be extremely significant. The study duration was of 3 months. CONCLUSIONS The findings conclude that the mean value of DRA decreases with the help of abdominal binder and core strengthening exercise regime. Hence, the abdominal binder and core strengthening exercises were effective in reducing the DRA. KEY WORDS Abdominal Binder, Diastasis Recti Abdominis, Rectus Abdominis, Core Strengthening, Post-Partum

Assessment of Diastasis Recti Abdominis using Dial Caliper in Overweight and Obese Adults (18 years and above) and Its Relationship with Lumbopelvic Pain: A Pilot Study

Background: Diastasis recti abdominis is present in both gender and is associated with increasing age, activities including regular lifting of heavy weights or sit-ups, a history of midline abdominal surgery, significant hormonal changes due to replacement therapy, menopause, congenital, chronic obstructive pulmonary disease and obesity. Studies have proven physiotherapy is beneficial in managing DRA but not many studies are done to show presence of DRA. Hence our study is a small attempt at diagnosing DRA in most vulnerable population i.e. overweight and obese population. Objective: To assess presence of diastasis recti abdominis in overweight and obese adults (18 years and above) using dial caliper. To correlate diastasis recti abdominis with lumbopelvic pain, gender and parity. Methods: 90 subjects were allocated in this study (30 overweight, 30 obese 1 and 30 obese 2). Presence of DRA was assessed using dial caliper in them and correlated with BMI. Subjects who had DRA present, their values were correlated further with Lumbopelvic pain, gender and parity. Results: Out of 90 subjects, 67 (74%) had DRA present [21 (23.3%) in overweight, 22 (24.4%) in obese 1, 24 (26.6%) in obese 2].There is no correlation of Presence of DRA with BMI. DRA has no correlation with lumbopelvic pain and gender. DRA has moderate positive correlation with parity. Conclusion: There is Presence of Diastasis Recti Abdominis in overweight, obese 1 and obese 2 adults; however, they are at equal risk of having DRA. Subjects with DRA are not more likely to have lumbopelvic pain than subjects without DRA. DRA can occur in males as well as females and multiparous females are at increased risk of developing DRA than nulliparous and primiparous. KEY WORDS: Diastasis recti abdominis, overweight, obesity, physiotherapy, lumbopelvic pain.

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls. Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.