Reliability analyzes of rectus abdominis diastasis assessment methods: a systematic review

Introduction

DRA is a common clinical condition, which can lead to secondary musculoskeletal dysfunction and requires specific management. Nowadays, ≥ 2cm of
distance between the rectus abdominis indicates, for common agreement, the presence of this condition, but both the evaluation tools and procedures to follow to identify and monitor it over time are controversial.

Methods

The search was led by two independent, blinded reviewers, on Medline, Cinahl, Web of Science and Scopus databases between March and October 2022. A
third reviewer was involved in conflict resolution in all review’s step. Informations about population, method and protocol of assessment, results were extracted from each study. The risk of bias was assessed using the QUADAS-2.

Results

17 studies were included. They analyzed intra-rater, inter-raters and test-retest reliability of DRAM assessment using ultrasound, CT, caliper, fingers width method and tape measure. Ultrasound was the most investigated tool. The methodological quality of the studies varied widely: each of them contains a risk of bias. For all methods analyzed, intra-rater reliability was very good to excellent. The inter-rater reliability of ultrasound measurement was good to excellent if the rater was trained and if it is performed above the umbilicus; it was from moderate to excellent using caliper depending on the procedure; the inter-rater reliability for finger-width method was moderate to very goodand for tape measure was very good. Test-retest reliability of all methods was very good to excellent. Choosing ultrasound as reference
standard, there is very good correlation with caliper, but moderate agreement, and moderate to very good correlation with finger-width and tape measure.

Discussion and Conclusion

Conclusions: the available evidence for DRA assessment are weak and heterogeneous. They support the use of ultrasound imaging and if it is not available, calipers is adequate too. Other methods could be used to screen the presence of DRA, but we need further studies to confirm their properties.

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