Table 1, Summary of findings. - Treatment of women with diastasis recti

Outcome	Number of studies and participants	Results MD/RR (95% CI)	Certainty of evidence
BAS = Body Appreciation Scale; CI = confidence interval; HRQoL = Health-related quality of life; MD = mean difference; n.s. = non-significant result; PFDI-20 = Pelvic Floor Distress Inventory, 20-items; RCT = Randomised Controlled Trial; RDQ = Roland-Morris Disability Questionnaire; reps. = repetitions; RR = relative risk; SD = standard deviation; SF-36 = Medical Outcomes Study 36-item Short-Form Health Survey; VHPQ = Ventral Hernia Pain Questionnaire. ^A RR over 1 indicates a higher proportion of resolution in DRAM in the intervention group compared to the control group. ^B BAS. A positive value indicates a better outcome for the combination treatment. Range 1–5, higher score indicates greater body appreciation. ^C A positive value indicate a better outcome for the combination treatment compared to physical exercise alone. ^D Results from 1 RCT with 36 participants. ^E A positive value indicates a worse outcome for the intervention, range 0 (least distress) to 300 (greatest distress). ^F A negative value indicates a better outcome for the intervention group compared to the control group, range 0 (no disability) to 24 (severe disability). ^G RR over 1 indicate a higher proportion of recurrence in the mesh group compared to the suture groups. ¹ Risk of Bias –2. Few studies with relatively few participants. Concerns about the RoB for one study. One study with per protocol analysis. ² Directness –1. Both studies are from a specific context and have included a narrowly defined population. ³ Only one study with relatively few participants, insufficient evidence to support any conclusions.
Physical exercise compared with no treatment, end of treatment
Width of DRAM	1 RCT n=17	MD (SD): –1.09 cm (0.63) vs. –0.13 cm (0.31) (p≤0.05)	Very low³ ⊕◯◯◯
Resolution of DRAM (<2 fingerwidths)	1 RCT n=96	RR: 1.11 (0.5 to 2.49) ^A (n.s., p>0.05)	Very low³ ⊕◯◯◯
Physical function – Pelvic floor (PFDI-20)	1 RCT n=13	MD: 2.80 (–10.01 to 15.61)^E (n.s., p>0.05)	Very low³ ⊕◯◯◯
Disability – Pain related disability (RDQ)	1 RCT n=13	MD: –0.30 (–5.63 to 5.03)^F (n.s., p>0.05)	Very low³ ⊕◯◯◯
Physical exercise in combination with taping compared with no treatment, end of treatment
Reduction in width of DRAM	1 RCT n=12	MD (SD): –1.07 cm (0.66) vs. –0.13 cm (0.31) (p≤0.05)	Very low³ ⊕◯◯◯
Physical function – Pelvic floor (PFDI-20)	1 RCT n=10	MD: 14.80 (–11.65 to 41.25)^E(n.s., p>0.05)	Very low³ ⊕◯◯◯
Disability – Pain related disability (RDQ)	1 RCT n=10	MD: –1.00 (–6.26 to 4.26)^F(n.s., p>0.05)	Very low³ ⊕◯◯◯
Taping compared with no treatment, end of treatment
Width of DRAM	1 RCT n=15	MD (SD): –0.29 cm (0.28) vs. –0.13 cm (0.31) (n.s., p>0.05)	Very low³ ⊕◯◯◯
Physical function – Pelvic floor (PFDI-20)	1 RCT n=9	MD: 10.40 (–3.67 to 24.47)^E(n.s., p>0.05)	Very low³ ⊕◯◯◯
Disability – Pain related disability (RDQ)	1 RCT n=9	MD: –0.30 (–6.99 to 6.39)^F(n.s., p>0.05)	Very low³ ⊕◯◯◯
Physical exercise in combination with NMES compared with physical exercise, end of treatment
Width of DRAM	1 RCT & 1 quasi-RCT n=93	MD: –0.36 cm (–0.46 to –0.26)	Very low^1,2 ⊕◯◯◯
Symptoms – body image (BAS)	1 RCT n=36	MD: 0.71 (0.52 to 0.90)^B (p≤0.05)	Very low³ ⊕◯◯◯
Physical function – abdominal muscle strength (dynamometer)	1 RCT & 1 quasi-RCT n=93	Peak torque (Nm): MD: 5.14 (3.29 to 6.99)^C Average power (W): MD: 3.85 (2.64 to 5.07)^C Total work (J): MD: 6.05 v(4.14 to 7.95)^C Endurance (reps.)^D: MD: 8.33 (6.38 to 10.28)^C	Very low^1,2 ⊕◯◯◯
Physical exercise compared with surgical treatment with mesh implant, 3 months after treatment
Physical function – effect of pain on function (VHPQ)	1 RCT n=57	No significant difference between the groups for 8/9 items on the VHPQ	Very low³ ⊕◯◯◯
Physical exercise compared with surgical treatment with suture alone, 3 months after treatment
Physical function – disability (VHPQ)	1 RCT n=58	No significant difference between the groups for any of the items on the VHPQ	Very low³ ⊕◯◯◯
Surgical treatment with mesh implant compared with suture alone, 1 year after treatment
Recurrence of DRAM (≥3 cm)	1 RCT n=57	RR: 3.10 (0.13 to 73.12), (n.s., p>0.05)^G	Very low³ ⊕◯◯◯
Physical function – abdominal muscle strength (dynamometer)	1 RCT n=56	Difference between groups reported to be n.s. (p>0.05)	Very low³ ⊕◯◯◯
Physical function – abdominal muscle strength (self-reported)	1 RCT n=56	Median (SD): 7 (2.62) vs. 8 (2.08) (n.s., p>0.05)	Very low³ ⊕◯◯◯
Physical function – effect of pain on function (VHPQ)	1 RCT n=56	No statistically significant difference between the groups for 6/9 items on the VHPQ	Very low³ ⊕◯◯◯
HRQoL (SF-36, reported for 8 subscales)	1 RCT n=57	3/8 subscales (GH, VT & MH) indicate benefit for mesh implant (p≤0.05).	Very low³ ⊕◯◯◯

Outcome

Number of studies and participants

Results MD/RR (95% CI)

Certainty of evidence

BAS = Body Appreciation Scale; CI = confidence interval; HRQoL = Health-related quality of life; MD = mean difference; n.s. = non-significant result; PFDI-20 = Pelvic Floor Distress Inventory, 20-items; RCT = Randomised Controlled Trial; RDQ = Roland-Morris Disability Questionnaire; reps. = repetitions; RR = relative risk; SD = standard deviation; SF-36 = Medical Outcomes Study 36-item Short-Form Health Survey; VHPQ = Ventral Hernia Pain Questionnaire. ^A RR over 1 indicates a higher proportion of resolution in DRAM in the intervention group compared to the control group. ^B BAS. A positive value indicates a better outcome for the combination treatment. Range 1–5, higher score indicates greater body appreciation. ^C A positive value indicate a better outcome for the combination treatment compared to physical exercise alone. ^D Results from 1 RCT with 36 participants. ^E A positive value indicates a worse outcome for the intervention, range 0 (least distress) to 300 (greatest distress). ^F A negative value indicates a better outcome for the intervention group compared to the control group, range 0 (no disability) to 24 (severe disability). ^G RR over 1 indicate a higher proportion of recurrence in the mesh group compared to the suture groups. ¹ Risk of Bias –2. Few studies with relatively few participants. Concerns about the RoB for one study. One study with per protocol analysis. ² Directness –1. Both studies are from a specific context and have included a narrowly defined population. ³ Only one study with relatively few participants, insufficient evidence to support any conclusions.

Physical exercise compared with no treatment, end of treatment

Width of DRAM

1 RCT n=17

MD (SD): –1.09 cm (0.63) vs. –0.13 cm (0.31) (p≤0.05)

Very low³ ⊕◯◯◯

Resolution of DRAM (<2 fingerwidths)

1 RCT n=96

RR: 1.11 (0.5 to 2.49) ^A (n.s., p>0.05)

Very low³ ⊕◯◯◯

Physical function – Pelvic floor (PFDI-20)

1 RCT n=13

MD: 2.80 (–10.01 to 15.61)^E (n.s., p>0.05)

Very low³ ⊕◯◯◯

Disability – Pain related disability (RDQ)

1 RCT n=13

MD: –0.30 (–5.63 to 5.03)^F (n.s., p>0.05)

Very low³ ⊕◯◯◯

Physical exercise in combination with taping compared with no treatment, end of treatment

Reduction in width of DRAM

1 RCT n=12

MD (SD): –1.07 cm (0.66) vs. –0.13 cm (0.31) (p≤0.05)

Very low³ ⊕◯◯◯

Physical function – Pelvic floor (PFDI-20)

1 RCT n=10

MD: 14.80 (–11.65 to 41.25)^E(n.s., p>0.05)

Very low³ ⊕◯◯◯

Disability – Pain related disability (RDQ)

1 RCT n=10

MD: –1.00 (–6.26 to 4.26)^F(n.s., p>0.05)

Very low³ ⊕◯◯◯

Taping compared with no treatment, end of treatment

Width of DRAM

1 RCT n=15

MD (SD): –0.29 cm (0.28) vs. –0.13 cm (0.31) (n.s., p>0.05)

Very low³ ⊕◯◯◯

Physical function – Pelvic floor (PFDI-20)

1 RCT n=9

MD: 10.40 (–3.67 to 24.47)^E(n.s., p>0.05)

Very low³ ⊕◯◯◯

Disability – Pain related disability (RDQ)

1 RCT n=9

MD: –0.30 (–6.99 to 6.39)^F(n.s., p>0.05)

Very low³ ⊕◯◯◯

Physical exercise in combination with NMES compared with physical exercise, end of treatment

Width of DRAM

1 RCT & 1 quasi-RCT n=93

MD: –0.36 cm (–0.46 to –0.26)

Very low^1,2 ⊕◯◯◯

Symptoms – body image (BAS)

1 RCT n=36

MD: 0.71 (0.52 to 0.90)^B (p≤0.05)

Very low³ ⊕◯◯◯

Physical function – abdominal muscle strength (dynamometer)

1 RCT & 1 quasi-RCT n=93

Peak torque (Nm): MD: 5.14 (3.29 to 6.99)^C Average power (W): MD: 3.85 (2.64 to 5.07)^C Total work (J): MD: 6.05 v(4.14 to 7.95)^C Endurance (reps.)^D: MD: 8.33 (6.38 to 10.28)^C

Very low^1,2 ⊕◯◯◯

Physical exercise compared with surgical treatment with mesh implant, 3 months after treatment

Physical function – effect of pain on function (VHPQ)

1 RCT n=57

No significant difference between the groups for 8/9 items on the VHPQ

Very low³ ⊕◯◯◯

Physical exercise compared with surgical treatment with suture alone, 3 months after treatment

Physical function – disability (VHPQ)

1 RCT n=58

No significant difference between the groups for any of the items on the VHPQ

Very low³ ⊕◯◯◯

Surgical treatment with mesh implant compared with suture alone, 1 year after treatment

Recurrence of DRAM (≥3 cm)

1 RCT n=57

RR: 3.10 (0.13 to 73.12), (n.s., p>0.05)^G

Very low³ ⊕◯◯◯

Physical function – abdominal muscle strength (dynamometer)

1 RCT n=56

Difference between groups reported to be n.s. (p>0.05)

Very low³ ⊕◯◯◯

Physical function – abdominal muscle strength (self-reported)

1 RCT n=56

Median (SD): 7 (2.62) vs. 8 (2.08) (n.s., p>0.05)

Very low³ ⊕◯◯◯

Physical function – effect of pain on function (VHPQ)

1 RCT n=56

No statistically significant difference between the groups for 6/9 items on the VHPQ

Very low³ ⊕◯◯◯

HRQoL (SF-36, reported for 8 subscales)

1 RCT n=57

3/8 subscales (GH, VT & MH) indicate benefit for mesh implant (p≤0.05).

Very low³ ⊕◯◯◯

From: Treatment of women with diastasis recti

Cover of Treatment of women with diastasis recti

Treatment of women with diastasis recti: HTA Report [Internet].

SBU Assessment, No. 346.

Stockholm: Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); 2022 Mar 15.

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Table 1Summary of findings.