Background

Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period.

Objective

To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum.

Methods

Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI).

Results

Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I² = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA.

Conclusion

There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.

中文翻译：

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腹部和盆底肌肉训练治疗产后腹直肌舒张症的证据是什么？荟萃分析的系统评价

背景

腹直肌舒张症 (DRA) 影响大量产后妇女。

客观的

系统评价腹部和盆底肌肉 (PFM) 锻炼计划是否对治疗产后 DRA 有效。

方法

从开始到 2020 年 3 月进行了电子搜索。包括在至少一个试验组中比较腹部训练、PFM 训练或两者组合的随机对照试验 (RCT) 或试点 RCT。主要结果是存在 DRA（数量/百分比）或直肌间距离 (IRD) 变化。GRADE 用于评估证据的整体质量。合并效应量表示为具有 95% 置信区间 (CI) 的平均差 (MD)。

结果

共纳入 7 项 RCT，共 381 名女性。两项比较腹横肌 (TrA) 训练与最小干预的研究提供了纳入荟萃分析的数据。结果提供了非常低质量的证据，表明 TrA 训练减少了 IRD（MD = -0.63 cm，95% 置信区间：-1.25，-0.01，I ²  = 0%）。两项研究将卷腹练习作为其干预的一部分。基于高偏倚风险的单一试验的证据水平显示，非常低的证据表明蜷缩训练比最小干预治疗 DRA 更有效。同样，基于单一试验的分析提供了低到极低质量的证据，表明 PFM 培训并不比治疗 DRA 的最小干预更有效。

结论

目前有非常低质量的科学证据来推荐特定的锻炼计划来治疗 DRA 产后。