Skip to main content
Top

29-01-2025 | Acupuncture | Systematic Review

Comparative Efficacy and Acceptability of Non-surgical Treatments with or without Exercise for Diastasis Recti Abdominis in Postpartum Women: A Network Meta-Analysis of Randomized Controlled Trials

Authors: Wen-Chieh Wu, Wen-Hong Wu, Ming-Fen Lee, Pei-Yu Wu, Yu-Kang Tu, Hsuan Lin, Chien-Yi Chan, Chun-Yin Huang

Published in: Sports Medicine

Login to get access

Abstract

Background

Diastasis recti abdominis (DRA), commonly occurring in postpartum women, is not only an aesthetic issue but is also highly associated with functional impairments. Various conservative treatment modalities have been employed in clinical practice to alleviate DRA. However, the comparative efficacy of these non-surgical treatments for improving the inter-recti distance (IRD) remains to be determined.

Aim

This current network meta-analysis (NMA) aims to compare the efficacy and acceptability of different non-surgical treatments with or without exercise for improving DRA in postpartum women.

Methods

This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ClinicalKey, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trial (RCT) studies up to April 2024. The analysis included studies that met the following criteria: (1) postpartum women diagnosed with DRA defined as an IRD greater than 2 cm; (2) intervention: any non-surgical treatments for at least 2 weeks; (3) comparator: no-treatment control; and (4) outcome: changes in IRD and acceptability. The relative efficacy between the non-surgical treatments tested and the probability of treatments were evaluated.

Results

Twenty-one RCTs comprising 1195 participants aged from 18 to 45 years old were included. The forest plot revealed that exercise coupling with neuromuscular electrical stimulation systems (NMES) [mean difference (MD) − 1.12 cm, 95% confidence interval (CI) − 1.66 to − 0.58], acupuncture (MD − 0.81 cm, 95% CI − 1.54 to − 0.08), corset (MD − 0.65 cm, 95% CI − 1.24 to − 0.06), and exercise alone (MD − 0.48 cm, 95% CI − 0.80 to − 0.16) led to significant reductions in IRD compared with control. Further, the treatment ranking indicated that the combination of NMES with exercise has the highest probability (91.0%) of being the best treatment for reducing IRD, followed by acupuncture with exercise (71.1%). Treatments combined with exercise demonstrated better rankings for reducing IRD than individual treatments without exercise. Acceptability did not significantly differ between the groups.

Limitations and Implications

This NMA encountered limitations due to participant variability, differing measurement methods, and sparse data, necessitating careful interpretation of findings regarding postpartum DRA interventions.

Conclusions

This NMA suggests NMES combined with exercise as the best treatment tested for DRA in postpartum women.

PROSPERO Registration

CRD42024541345.
Appendix
Available only for authorised users
Literature
1.
2.
go back to reference Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990;43(10):5–8.PubMed Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990;43(10):5–8.PubMed
3.
go back to reference Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092–6.PubMedCrossRef Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092–6.PubMedCrossRef
4.
go back to reference van de Water AT, 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.PubMedCrossRef van de Water AT, 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.PubMedCrossRef
5.
go back to reference Mota P, Pascoal AG, Sancho F, Bø 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(11):940–6.PubMedCrossRef Mota P, Pascoal AG, Sancho F, Bø 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(11):940–6.PubMedCrossRef
6.
go back to reference Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA. The normal width of the linea alba in nulliparous women. Clin Anat. 2009;22(6):706–11.PubMedCrossRef Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA. The normal width of the linea alba in nulliparous women. Clin Anat. 2009;22(6):706–11.PubMedCrossRef
7.
go back to reference Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13(2):112–21.PubMedCrossRef Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13(2):112–21.PubMedCrossRef
8.
go back to reference Keshwani N, Mathur S, McLean L. Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period. Phys Ther. 2018;98(3):182–90.PubMedCrossRef Keshwani N, Mathur S, McLean L. Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period. Phys Ther. 2018;98(3):182–90.PubMedCrossRef
9.
go back to reference Veríssimo P, Nahas FX, Barbosa MV, de Carvalho Gomes HF, Ferreira LM. Is it possible to repair diastasis recti and shorten the aponeurosis at the same time? Aesthetic Plast Surg. 2014;38(2):379–86.PubMedCrossRef Veríssimo P, Nahas FX, Barbosa MV, de Carvalho Gomes HF, Ferreira LM. Is it possible to repair diastasis recti and shorten the aponeurosis at the same time? Aesthetic Plast Surg. 2014;38(2):379–86.PubMedCrossRef
10.
go back to reference Sokunbi G, Camino-Willhuber G, Paschal PK, Olufade O, Hussain FS, Shue J, et al. Is diastasis recti abdominis associated with low back pain? A systematic review. World Neurosurg. 2023;174:119–25.PubMedCrossRef Sokunbi G, Camino-Willhuber G, Paschal PK, Olufade O, Hussain FS, Shue J, et al. Is diastasis recti abdominis associated with low back pain? A systematic review. World Neurosurg. 2023;174:119–25.PubMedCrossRef
11.
go back to reference Benjamin DR, Frawley HC, Shields N, van de Water ATM, 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(1):24–34 (2019/03/01/).PubMedCrossRef Benjamin DR, Frawley HC, Shields N, van de Water ATM, 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(1):24–34 (2019/03/01/).PubMedCrossRef
12.
go back to reference Fuentes Aparicio L, Rejano-Campo M, Donnelly GM, Vicente-Campos V. Self-reported symptoms in women with diastasis rectus abdominis: a systematic review. J Gynecol Obstet Hum Reprod. 2021;50(7): 101995.PubMedCrossRef Fuentes Aparicio L, Rejano-Campo M, Donnelly GM, Vicente-Campos V. Self-reported symptoms in women with diastasis rectus abdominis: a systematic review. J Gynecol Obstet Hum Reprod. 2021;50(7): 101995.PubMedCrossRef
13.
go back to reference Mughal M, Ross D. Management of the post-pregnancy abdomen: the plastic surgical perspective. Hernia. 2021;25(4):929–38.PubMedCrossRef Mughal M, Ross D. Management of the post-pregnancy abdomen: the plastic surgical perspective. Hernia. 2021;25(4):929–38.PubMedCrossRef
14.
go back to reference Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? Aesthetic Plast Surg. 1997;21(4):285–9.PubMedCrossRef Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? Aesthetic Plast Surg. 1997;21(4):285–9.PubMedCrossRef
15.
16.
go back to reference Hu J, Gu J, Yu Z, Yang X, Fan J, You L, et al. Efficacy of standardized rehabilitation in the treatment of diastasis rectus abdominis in postpartum women. Int J Gen Med. 2021;14:10373–83.PubMedPubMedCentralCrossRef Hu J, Gu J, Yu Z, Yang X, Fan J, You L, et al. Efficacy of standardized rehabilitation in the treatment of diastasis rectus abdominis in postpartum women. Int J Gen Med. 2021;14:10373–83.PubMedPubMedCentralCrossRef
17.
go back to reference Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med. 2017;41(3):465–74.PubMedPubMedCentralCrossRef Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med. 2017;41(3):465–74.PubMedPubMedCentralCrossRef
18.
go back to reference Liang P, Liang M, Shi S, Liu Y, Xiong R. Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial. Physiotherapy. 2022;117:16–21.PubMedCrossRef Liang P, Liang M, Shi S, Liu Y, Xiong R. Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial. Physiotherapy. 2022;117:16–21.PubMedCrossRef
19.
go back to reference Situt G, Kanase S. Effectiveness of NMES and taping on diastasis recti in postnatal women. J Ecophysiol Occup Health. 2021;21(3):105–11.CrossRef Situt G, Kanase S. Effectiveness of NMES and taping on diastasis recti in postnatal women. J Ecophysiol Occup Health. 2021;21(3):105–11.CrossRef
20.
go back to reference Tadmare S, Bhatnagar G, Kamble R, Phad S, Landge K, Pawadshetty V. Comparison of abdominal exercises and neuromuscular electrical stimulation on diastasis recti abdominis muscle in postnatal females with caesarean section. Georgian Med News. 2024;346:63–7. Tadmare S, Bhatnagar G, Kamble R, Phad S, Landge K, Pawadshetty V. Comparison of abdominal exercises and neuromuscular electrical stimulation on diastasis recti abdominis muscle in postnatal females with caesarean section. Georgian Med News. 2024;346:63–7.
21.
go back to reference Wang H, Feng X, Liu Z, Liu Y, Xiong R. A rehabilitation programme focussing on pelvic floor muscle training for persistent lumbopelvic pain after childbirth: a randomized controlled trial. J Rehabil Med. 2021;53(4): jrm00180.PubMedCrossRef Wang H, Feng X, Liu Z, Liu Y, Xiong R. A rehabilitation programme focussing on pelvic floor muscle training for persistent lumbopelvic pain after childbirth: a randomized controlled trial. J Rehabil Med. 2021;53(4): jrm00180.PubMedCrossRef
22.
go back to reference Wei R, Yu F, Ju H, Jiang Q. Effect of electrical stimulation followed by exercises in postnatal diastasis recti abdominis via MMP2 gene expression. Cell Mol Biol (Noisy-le-grand). 2022;67(6):82–8.PubMedCrossRef Wei R, Yu F, Ju H, Jiang Q. Effect of electrical stimulation followed by exercises in postnatal diastasis recti abdominis via MMP2 gene expression. Cell Mol Biol (Noisy-le-grand). 2022;67(6):82–8.PubMedCrossRef
23.
go back to reference Liu Y, Zhu Y, Jiang L, Lu C, Xiao L, Wang T, et al. Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: a randomized controlled clinical trial. Front Public Health. 2022;10:1003361.PubMedPubMedCentralCrossRef Liu Y, Zhu Y, Jiang L, Lu C, Xiao L, Wang T, et al. Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: a randomized controlled clinical trial. Front Public Health. 2022;10:1003361.PubMedPubMedCentralCrossRef
24.
go back to reference Zhang C, Yang X, Zhao Y, Xie D, Wang L. Acupuncture for postpartum diastasis recti abdominis and its effects on abdominal circumference, separation distance of rectus abdominis. Zhongguo Zhen Jiu. 2024;44(2):139–43.PubMed Zhang C, Yang X, Zhao Y, Xie D, Wang L. Acupuncture for postpartum diastasis recti abdominis and its effects on abdominal circumference, separation distance of rectus abdominis. Zhongguo Zhen Jiu. 2024;44(2):139–43.PubMed
25.
go back to reference Awad E, Mobark A, Zidan AA, Hamada HA, Shousha TM. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: a randomized controlled trial. J Hum Sport Exerc. 2021;16(2):S395–S403. Awad E, Mobark A, Zidan AA, Hamada HA, Shousha TM. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: a randomized controlled trial. J Hum Sport Exerc. 2021;16(2):S395–S403.
26.
go back to reference Bobowik PŻ, Dąbek A. Physiotherapy in women with diastasis of the rectus abdominis muscles. Adv Rehabil. 2018;32(3):11–7.CrossRef Bobowik PŻ, Dąbek A. Physiotherapy in women with diastasis of the rectus abdominis muscles. Adv Rehabil. 2018;32(3):11–7.CrossRef
27.
go back to reference Dave H, AratiMahishale MPT. Effect of structured abdominal exercise programme on diastasis of rectus abdominis muscle in postpartum women-an experimental study. IOSR J Sports Phys Educ 2019;6(3):7–15. Dave H, AratiMahishale MPT. Effect of structured abdominal exercise programme on diastasis of rectus abdominis muscle in postpartum women-an experimental study. IOSR J Sports Phys Educ 2019;6(3):7–15.
28.
go back to reference El-Mekawy HS, Eldeeb AME, Lythy MAE, Elbegawy AF. Effect of abdominal exercises versus abdominal supporting belt on post-partum abdominal efficiency and rectus separation. Int J Med Health Sci. 2013;7:75–9. El-Mekawy HS, Eldeeb AME, Lythy MAE, Elbegawy AF. Effect of abdominal exercises versus abdominal supporting belt on post-partum abdominal efficiency and rectus separation. Int J Med Health Sci. 2013;7:75–9.
29.
go back to reference Gluppe SB, Ellström Engh M, Bø K. Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. J Physiother. 2023;69(3):160–7.PubMedCrossRef Gluppe SB, Ellström Engh M, Bø K. Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. J Physiother. 2023;69(3):160–7.PubMedCrossRef
30.
go back to reference Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bo K. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther. 2018;98(4):260–8.PubMedPubMedCentralCrossRef Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bo K. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther. 2018;98(4):260–8.PubMedPubMedCentralCrossRef
31.
go back to reference Izadi F, Khalkhali Zaviyeh M, Akbarzadeh BA. Structural response of abdominal muscles to six weeks of strengthening training in women with diastasis recti. Iran J Obst Gynecol Infertility. 2018;21(9):71–82. Izadi F, Khalkhali Zaviyeh M, Akbarzadeh BA. Structural response of abdominal muscles to six weeks of strengthening training in women with diastasis recti. Iran J Obst Gynecol Infertility. 2018;21(9):71–82.
32.
go back to reference Kaya AK, Menek MY. Comparison of the efficiency of core stabilization exercises and abdominal corset in the treatment of postpartum diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol. 2023;285:24–30.PubMedCrossRef Kaya AK, Menek MY. Comparison of the efficiency of core stabilization exercises and abdominal corset in the treatment of postpartum diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol. 2023;285:24–30.PubMedCrossRef
33.
go back to reference Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract. 2021;37(9):1018–33.PubMedCrossRef Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract. 2021;37(9):1018–33.PubMedCrossRef
34.
go back to reference Laframboise FC, Schlaff RA, Baruth M. Postpartum exercise intervention targeting diastasis recti abdominis. Int J Exerc Sci. 2021;14(3):400.PubMedPubMedCentral Laframboise FC, Schlaff RA, Baruth M. Postpartum exercise intervention targeting diastasis recti abdominis. Int J Exerc Sci. 2021;14(3):400.PubMedPubMedCentral
35.
go back to reference Lee N, Bae YH, Fong SSM, Lee WH. Effects of Pilates on inter-recti distance, thickness of rectus abdominis, waist circumference and abdominal muscle endurance in primiparous women. BMC Womens Health. 2023;23(1):626.PubMedPubMedCentralCrossRef Lee N, Bae YH, Fong SSM, Lee WH. Effects of Pilates on inter-recti distance, thickness of rectus abdominis, waist circumference and abdominal muscle endurance in primiparous women. BMC Womens Health. 2023;23(1):626.PubMedPubMedCentralCrossRef
36.
go back to reference Mesquita LA, Machado AV, Andrade AV. Physiotherapy for reduction of diastasis of the recti abdominis muscles in the postpartum period. Rev Bras Ginecol Obstet. 1999;21:267–72.CrossRef Mesquita LA, Machado AV, Andrade AV. Physiotherapy for reduction of diastasis of the recti abdominis muscles in the postpartum period. Rev Bras Ginecol Obstet. 1999;21:267–72.CrossRef
38.
go back to reference Saleem Z, Khan AA, Farooqui SI, Yasmeen R, Rizvi J. Effect of exercise on inter-recti distance and associated low back pain among post-partum females: a randomized controlled trial. J Family Reprod Health. 2021;15(3):202.PubMedPubMedCentral Saleem Z, Khan AA, Farooqui SI, Yasmeen R, Rizvi J. Effect of exercise on inter-recti distance and associated low back pain among post-partum females: a randomized controlled trial. J Family Reprod Health. 2021;15(3):202.PubMedPubMedCentral
39.
go back to reference Shohaimi S, Husain NRN, Zaki FM, Atan IK. Split tummy exercise program for reducing diastasis recti in postpartum primigravidae: a randomized controlled trial. Korean J Fam Med. 2023;44(2):102–8.PubMedPubMedCentralCrossRef Shohaimi S, Husain NRN, Zaki FM, Atan IK. Split tummy exercise program for reducing diastasis recti in postpartum primigravidae: a randomized controlled trial. Korean J Fam Med. 2023;44(2):102–8.PubMedPubMedCentralCrossRef
40.
go back to reference Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019;19(1):62–8.PubMedPubMedCentral Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019;19(1):62–8.PubMedPubMedCentral
41.
go back to reference Tuttle LJ, Fasching J, Keller A, Patel M, Saville C, Schlaff R, et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Women’s Health Phys Ther. 2018;42(2):65–75.CrossRef Tuttle LJ, Fasching J, Keller A, Patel M, Saville C, Schlaff R, et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Women’s Health Phys Ther. 2018;42(2):65–75.CrossRef
42.
go back to reference Walton LM, Costa A, LaVanture D, McIlrath S, Stebbins B. The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index scores (PFDI). Phys Ther Rehabil. 2016;3(1):3.CrossRef Walton LM, Costa A, LaVanture D, McIlrath S, Stebbins B. The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index scores (PFDI). Phys Ther Rehabil. 2016;3(1):3.CrossRef
43.
go back to reference Ptaszkowska L, Gorecka J, Paprocka-Borowicz M, Walewicz K, Jarzab S, Majewska-Pulsakowska M, et al. Immediate effects of kinesio taping on rectus abdominis diastasis in postpartum women-preliminary report. J Clin Med. 2021;10(21):5043.PubMedPubMedCentralCrossRef Ptaszkowska L, Gorecka J, Paprocka-Borowicz M, Walewicz K, Jarzab S, Majewska-Pulsakowska M, et al. Immediate effects of kinesio taping on rectus abdominis diastasis in postpartum women-preliminary report. J Clin Med. 2021;10(21):5043.PubMedPubMedCentralCrossRef
44.
go back to reference Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy. 2023;119:54–71. Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy. 2023;119:54–71.
45.
go back to reference Di Mascio D, Caruso G, Prata G, Saccone G, Terrin G, Giancotti A, et al. The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2021;262:73–9.PubMedCrossRef Di Mascio D, Caruso G, Prata G, Saccone G, Terrin G, Giancotti A, et al. The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2021;262:73–9.PubMedCrossRef
46.
go back to reference Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664–75.PubMedPubMedCentralCrossRef Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664–75.PubMedPubMedCentralCrossRef
47.
go back to reference Higgins JP, Welton NJ. Network meta-analysis: a norm for comparative effectiveness? Lancet. 2015;386(9994):628–30.PubMedCrossRef Higgins JP, Welton NJ. Network meta-analysis: a norm for comparative effectiveness? Lancet. 2015;386(9994):628–30.PubMedCrossRef
48.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7): e1000097.CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7): e1000097.CrossRef
50.
go back to reference Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;28(366): l4898.CrossRef Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;28(366): l4898.CrossRef
51.
go back to reference Nikolakopoulou A, Higgins JPT, Papakonstantinou T, Chaimani A, Del Giovane C, Egger M, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020;17(4): e1003082.PubMedPubMedCentralCrossRef Nikolakopoulou A, Higgins JPT, Papakonstantinou T, Chaimani A, Del Giovane C, Egger M, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020;17(4): e1003082.PubMedPubMedCentralCrossRef
52.
go back to reference Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357–66.PubMedPubMedCentralCrossRef Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357–66.PubMedPubMedCentralCrossRef
53.
go back to reference White IR. Network meta-analysis. Stand Genomic Sci. 2015;15(4):951–85. White IR. Network meta-analysis. Stand Genomic Sci. 2015;15(4):951–85.
55.
go back to reference Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, et al. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods. 2016;7(1):55–79.PubMedCrossRef Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, et al. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods. 2016;7(1):55–79.PubMedCrossRef
56.
go back to reference Langan D, Higgins JPT, Jackson D, Bowden J, Veroniki AA, Kontopantelis E, et al. A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res Synth Methods. 2019;10(1):83–98.PubMedCrossRef Langan D, Higgins JPT, Jackson D, Bowden J, Veroniki AA, Kontopantelis E, et al. A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res Synth Methods. 2019;10(1):83–98.PubMedCrossRef
57.
go back to reference Axon E, Dwan K, Richardson R. Multiarm studies and how to handle them in a meta-analysis: a tutorial. Cochrane Evidence Synth Methods. 2023;1(10): e12033.CrossRef Axon E, Dwan K, Richardson R. Multiarm studies and how to handle them in a meta-analysis: a tutorial. Cochrane Evidence Synth Methods. 2023;1(10): e12033.CrossRef
58.
59.
go back to reference Deeks JJ, Higgins JP, Altman DG, Group obotCSM. Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions; 2019. p. 241–84. Deeks JJ, Higgins JP, Altman DG, Group obotCSM. Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions; 2019. p. 241–84.
60.
61.
go back to reference Noma H, Hamura Y, Sugasawa S, Furukawa TA. Improved methods to construct prediction intervals for network meta-analysis. Research Synthesis Methods. 2023;14(6):794–806.PubMedCrossRef Noma H, Hamura Y, Sugasawa S, Furukawa TA. Improved methods to construct prediction intervals for network meta-analysis. Research Synthesis Methods. 2023;14(6):794–806.PubMedCrossRef
62.
go back to reference Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45(7):769–73.PubMedCrossRef Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45(7):769–73.PubMedCrossRef
63.
go back to reference Wu P-Y, Huang K-S, Chen K-M, Chou C-P, Tu Y-K. Exercise, nutrition, and combined exercise and nutrition in older adults with sarcopenia: a systematic review and network meta-analysis. Maturitas. 2021;145:38–48.PubMedCrossRef Wu P-Y, Huang K-S, Chen K-M, Chou C-P, Tu Y-K. Exercise, nutrition, and combined exercise and nutrition in older adults with sarcopenia: a systematic review and network meta-analysis. Maturitas. 2021;145:38–48.PubMedCrossRef
64.
go back to reference Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JP. Evaluating the quality of evidence from a network meta-analysis. PLoS One. 2014;9(7): e99682.PubMedPubMedCentralCrossRef Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JP. Evaluating the quality of evidence from a network meta-analysis. PLoS One. 2014;9(7): e99682.PubMedPubMedCentralCrossRef
65.
go back to reference Salanti G, Ades A, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.PubMedCrossRef Salanti G, Ades A, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.PubMedCrossRef
66.
go back to reference Lai C-C, Tu Y-K, Wang T-G, Huang Y-T, Chien K-L. Effects of resistance training, endurance training and whole-body vibration on lean body mass, muscle strength and physical performance in older people: a systematic review and network meta-analysis. Age Ageing. 2018;47(3):367–73.PubMedCrossRef Lai C-C, Tu Y-K, Wang T-G, Huang Y-T, Chien K-L. Effects of resistance training, endurance training and whole-body vibration on lean body mass, muscle strength and physical performance in older people: a systematic review and network meta-analysis. Age Ageing. 2018;47(3):367–73.PubMedCrossRef
67.
go back to reference Higgins J, Del Giovane C, Chaimani A, Caldwell D, Salanti G. Evaluating the quality of evidence from a network meta-analysis. Value Health. 2014;17(7):A324.PubMedCrossRef Higgins J, Del Giovane C, Chaimani A, Caldwell D, Salanti G. Evaluating the quality of evidence from a network meta-analysis. Value Health. 2014;17(7):A324.PubMedCrossRef
68.
go back to reference Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother. 2024;70(2):142–8.PubMedCrossRef Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother. 2024;70(2):142–8.PubMedCrossRef
69.
go back to reference Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012;92(2):210–26.PubMedCrossRef Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012;92(2):210–26.PubMedCrossRef
70.
go back to reference Guan Y, Wacnik PW, Yang F, Carteret AF, Chung CY, Meyer RA, et al. Spinal cord stimulation-induced analgesia: electrical stimulation of dorsal column and dorsal roots attenuates dorsal horn neuronal excitability in neuropathic rats. Anesthesiology. 2010;113(6):1392–405.PubMedCrossRef Guan Y, Wacnik PW, Yang F, Carteret AF, Chung CY, Meyer RA, et al. Spinal cord stimulation-induced analgesia: electrical stimulation of dorsal column and dorsal roots attenuates dorsal horn neuronal excitability in neuropathic rats. Anesthesiology. 2010;113(6):1392–405.PubMedCrossRef
71.
go back to reference Yun GJ, Chun MH, Park JY, Kim BR. The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med. 2011;35(3):316–21.PubMedPubMedCentralCrossRef Yun GJ, Chun MH, Park JY, Kim BR. The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med. 2011;35(3):316–21.PubMedPubMedCentralCrossRef
72.
go back to reference Alon G, McCombe SA, Koutsantonis S, Stumphauzer LJ, Burgwin KC, Parent MM, et al. Comparison of the effects of electrical stimulation and exercise on abdominal musculature. J Orthop Sports Phys Ther. 1987;8(12):567–73.PubMedCrossRef Alon G, McCombe SA, Koutsantonis S, Stumphauzer LJ, Burgwin KC, Parent MM, et al. Comparison of the effects of electrical stimulation and exercise on abdominal musculature. J Orthop Sports Phys Ther. 1987;8(12):567–73.PubMedCrossRef
73.
go back to reference Gregory CM, Bickel CS. Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther. 2005;85(4):358–64.PubMedCrossRef Gregory CM, Bickel CS. Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther. 2005;85(4):358–64.PubMedCrossRef
74.
go back to reference Dudley GA, Castro MJ, Rogers S, Apple DF Jr. A simple means of increasing muscle size after spinal cord injury: a pilot study. Eur J Appl Physiol Occup Physiol. 1999;80(4):394–6.PubMedCrossRef Dudley GA, Castro MJ, Rogers S, Apple DF Jr. A simple means of increasing muscle size after spinal cord injury: a pilot study. Eur J Appl Physiol Occup Physiol. 1999;80(4):394–6.PubMedCrossRef
75.
go back to reference Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair. 2007;21(6):475–85.PubMedPubMedCentralCrossRef Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair. 2007;21(6):475–85.PubMedPubMedCentralCrossRef
76.
go back to reference Tinazzi M, Zarattini S, Valeriani M, Romito S, Farina S, Moretto G, et al. Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res. 2005;161(4):457–64.PubMedCrossRef Tinazzi M, Zarattini S, Valeriani M, Romito S, Farina S, Moretto G, et al. Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res. 2005;161(4):457–64.PubMedCrossRef
77.
go back to reference Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey LL, Lojovich JM, Carey JR. Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res. 2004;154:450–60.PubMedCrossRef Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey LL, Lojovich JM, Carey JR. Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res. 2004;154:450–60.PubMedCrossRef
78.
go back to reference Hsu CH, Hwang KC, Chao CL, Lin JG, Kao ST, Chou P. Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obes (Lond). 2005;29(11):1379–84.PubMedCrossRef Hsu CH, Hwang KC, Chao CL, Lin JG, Kao ST, Chou P. Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obes (Lond). 2005;29(11):1379–84.PubMedCrossRef
79.
go back to reference Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev. 2018;3(3): Cd004046.PubMed Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev. 2018;3(3): Cd004046.PubMed
80.
go back to reference Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women—a systematic review and meta-analysis. Physiotherapy. 2023;119:54–71 (2023/06/01/). Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women—a systematic review and meta-analysis. Physiotherapy. 2023;119:54–71 (2023/06/01/).
81.
go back to reference Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Women’s & Pelvic Health Phys Therapy. 2012;36(3):131–42.CrossRef Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Women’s & Pelvic Health Phys Therapy. 2012;36(3):131–42.CrossRef
82.
go back to reference Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, et al. Diastasis recti abdominis rehabilitation in the postpartum period: a scoping review of current clinical practice. Int Urogynecol J. 2024;35(3):491–520.PubMedPubMedCentralCrossRef Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, et al. Diastasis recti abdominis rehabilitation in the postpartum period: a scoping review of current clinical practice. Int Urogynecol J. 2024;35(3):491–520.PubMedPubMedCentralCrossRef
83.
go back to reference Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case–control study. Physiotherapy. 2014;100(4):344–8.PubMedCrossRef Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case–control study. Physiotherapy. 2014;100(4):344–8.PubMedCrossRef
84.
go back to reference Mota P, Pascoal AG, Carita AI, Bø K. The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthopaedic Sports Phys Therapy. 2015;45(10):781–8.CrossRef Mota P, Pascoal AG, Carita AI, Bø K. The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthopaedic Sports Phys Therapy. 2015;45(10):781–8.CrossRef
85.
go back to reference Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther. 2016;46(7):580–9.PubMedCrossRef Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther. 2016;46(7):580–9.PubMedCrossRef
86.
go back to reference Gluppe S, Ellström Engh M, Kari B. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. 2021;111:57–65 (2021/06/01/).PubMedCrossRef Gluppe S, Ellström Engh M, Kari B. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. 2021;111:57–65 (2021/06/01/).PubMedCrossRef
Metadata
Title
Comparative Efficacy and Acceptability of Non-surgical Treatments with or without Exercise for Diastasis Recti Abdominis in Postpartum Women: A Network Meta-Analysis of Randomized Controlled Trials
Authors
Wen-Chieh Wu
Wen-Hong Wu
Ming-Fen Lee
Pei-Yu Wu
Yu-Kang Tu
Hsuan Lin
Chien-Yi Chan
Chun-Yin Huang
Publication date
29-01-2025
Publisher
Springer International Publishing
Published in
Sports Medicine
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-025-02179-5