Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Issue 1 (March 2019)

• Record Type: Journal Article
• Authors: Benjamin, Deenika R.; Frawley, Helena C.; Shields, Nora; van de Water, Alexander T.M.; Taylor, Nicholas F.
• Is Part Of: Physiotherapy. Volume 105:Issue 1(2019)
• Page Start: 24
• Page End: 34
• Publication Date: 2019-03
• Subjects: Rectus abdominis -- Abdominal muscles -- Pelvic organ prolapse -- Pelvic pain -- Low back pain -- Urinary incontinence -- Diastasis; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2018.07.002
• Languages: English
• ISSNs: 0031-9406

Abstract

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.