Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study

Abstract

Purpose: Pregnancy-related diastasis rectus abdominis (DRA) is a prevalent condition. Consequences of a widened linea alba ultimately remain unknown. Current evidence on conservative management is conflicting, creating debate among practitioners. This study aims at developing a set of expert consensus-based recommendations for the assessment and conservative management of DRA. Methods: Selected Canadian women's health physiotherapists were invited to participate in a 3-phase Delphi consensus study. Phase I comprised 82 items divided into 6 domains, and to determine agreement, each item was rated on a 5-point Likert scale. Consensus was defined as agreement greater than 80%. In phase II, items receiving consensus were ranked and collapsed and summary descriptions were proposed. In phase III, final consensus was determined. Results: A total of 21 of the 28 (75%) invited experts participated. Phase I generated 38 consensus statements. Phase II translated into 30 consensus statements as well as modifications to proposed summary statements for each data category. Remaining items did not reach consensus. Consensus for 28 expert-based recommendations was achieved in phase III. Conclusions: This study generated 28 expert-based recommendations achieved through a 3-phase consensus process for the assessment and conservative management of DRA. Nationally recognized Canadian expert physiotherapists in women's health agree that the impairments and dysfunctions related to DRA are multidimensional and emphasize the need for a global and tailored care approach. Clinical Relevance: This is the first study to establish consensus across key stakeholders to assist in bridging the current evidence-practice gap regarding pregnancy-related DRA. Our findings point to matters that require further study. Level of Evidence: 5 (expert opinion).