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Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis

A Delphi Consensus Study

Dufour, Sinéad PT, PhD1; Bernard, Stéphanie PT, MSc2; Murray-Davis, Beth PhD, RM3; Graham, Nadine PT, MSc1

Journal of Women’s Health Physical Therapy: April/June 2019 - Volume 43 - Issue 2 - p 73–81
doi: 10.1097/JWH.0000000000000130
Research Reports

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).

This article has a Video Abstract available at

1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

2Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.

3Department of Obstetrics and Gynecology, School of Medicine, McMaster University, Hamilton, Ontario, Canada.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2019 by the Section on Women's Health, American Physical Therapy Association.
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