Deenika R Benjamin1, Helena C Frawley2, Nora Shields3, Alexander T M van de Water4, Nicholas F Taylor5. 1. Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia. Electronic address: d.benjamin@latrobe.edu.au. 2. School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Centre of Allied Health Research & Education, Cabrini Hospital, Victoria Australia. Electronic address: helena.frawley@monash.edu. 3. Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia. Electronic address: N.Shields@latrobe.edu.au. 4. Department of Physiotherapy and Lectorate of Health and Movement, Academy of Health Sciences, Saxion University of Applied Sciences, Netherlands. Electronic address: a.vandewater@latrobe.edu.au. 5. Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia; School of Allied Health, Allied Health Clinical Research Office, Eastern Health, Victoria, Australia. Electronic address: N.Taylor@latrobe.edu.au.
Abstract
BACKGROUND: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy. OBJECTIVES: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes. DATA SOURCES: Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). STUDY SELECTION: Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. STUDY APPRAISAL & SYNTHESIS METHODS: Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions. RESULTS: Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain. LIMITATIONS: Quality of studies was weak. There was variability in the methods used to assess DRAM. CONCLUSION: There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.
BACKGROUND: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy. OBJECTIVES: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes. DATA SOURCES: Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). STUDY SELECTION: Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. STUDY APPRAISAL & SYNTHESIS METHODS: Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions. RESULTS: Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain. LIMITATIONS: Quality of studies was weak. There was variability in the methods used to assess DRAM. CONCLUSION: There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.
Authors: Vanesa Abuín-Porras; Mónica de la Cueva-Reguera; Pedro Benavides-Morales; Rocío Ávila-Pérez; Blanca de la Cruz-Torres; Helios Pareja-Galeano; María Blanco-Morales; Carlos Romero-Morales Journal: Medicina (Kaunas) Date: 2019-12-25 Impact factor: 2.430