BACKGROUND Physiotherapists and midwives in primary healthcare often encounter women with an increased separation between the two rectus abdominis muscle bellies after pregnancy, a so-called increased inter recti distance (IRD). There are few studies on the contribution of increased IRD to the explanation of post-partum health complaints, and very little guidance in the literature for health professionals on the management of increased IRD. The aim of this study was to describe how physiotherapists and midwives in primary healthcare perceive the phenomenon of increased IRD and its management in women after childbirth. METHODS A purposeful sampling approach was used to select physiotherapists and midwives working in primary healthcare in three large county council healthcare organisations in Sweden having experience of encountering women with increased IRD after pregnancy. Sixteen physiotherapists and midwives participated in focus group discussions. Four focus groups with four participants in each were undertaken. A semi-structured topic guide was used to explore responses to the research questions and the discussions were analysed using qualitative content analysis. RESULTS We identified an overarching theme: Ambivalence towards the phenomenon increased IRD and frustration over insufficient professional knowledge. The theme included three categories: Uncertainty concerning the significance of increased IRD as a causal factor for functional problems; perceived insufficient professional knowledge base for the management of increased IRD; and lack of inter-professional collaboration and teamwork in the management of patients with increased IRD. Due to sparse and somewhat contradictory research findings and absence of clinical guidelines, the health professionals lacked basic preconditions for applying an evidence-based practice concerning increased IRD. They obtained their information about increased IRD from the media and fitness coaches, and hence were somewhat unsure about what to believe regarding the phenomenon. CONCLUSIONS There was no consensus among the health professionals on how to best approach increased IRD in the clinical setting. Our findings stress the importance of more research to increase the professional knowledge base among physiotherapists and midwives. The findings highlight the urgent need for policies and clinical guidelines advising health professionals in the management of increased IRD and for facilitating inter-professional collaboration and teamwork.

中文翻译：

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物理治疗师和助产士的观点是，产后妇女的腹直距离增加及其管理。

背景技术在初级保健中的物理治疗师和助产士经常会遇到孕妇在怀孕后两个腹直肌腹之间分离增加的妇女，即所谓的直肠直距离（IRD）增加。很少有关于IRD增加对产后健康投诉解释的研究，而有关卫生专业人员IRD增加管理的文献报道也很少。这项研究的目的是描述初级保健中的物理治疗师和助产士如何感知分娩后妇女的IRD增加及其管理现象。方法采用有目的的抽样方法，选择瑞典三个大型县议会医疗机构中在初级医疗机构工作的物理治疗师和助产士，这些机构在怀孕后会遇到IRD增加的妇女。16位理疗师和助产士参加了焦点小组讨论。进行了四个焦点小组，每个小组有四个参与者。使用半结构化的主题指南来探索对研究问题的回答，并使用定性内容分析法对讨论进行分析。结果我们确定了一个总体主题：对现象的含糊不清增加了IRD并由于专业知识不足而感到沮丧。该主题包括三类：不确定性，IRD增加是功能性问题的成因；认为缺乏足够的专业知识来管理IRD；并且在IRD增加的患者管理中缺乏专业间的协作和团队合作。由于研究结果稀疏且有些矛盾，并且缺乏临床指南，因此卫生专业人员缺乏应用有关IRD增加的循证实践的基本前提。他们从媒体和健身教练那里获得了有关IRD增加的信息，因此不确定是否应该相信这种现象。结论在临床环境中，如何以最佳方式增加IRD的医务人员之间尚未达成共识。我们的发现强调了进行更多研究以增加物理治疗师和助产士专业知识基础的重要性。